Standard virologic methods were used to characterize the relative contribution of each of the enterovirus classes to the etiology of aseptic meningitis during a prospective study of this disease among children < 24 months old. Viruses were isolated in cell culture from 164 (60%) of 274 cases identified over 5 years and in newborn mice from only 2 of 104 remaining cell culture-negative cases. Serologic tests identified the viral pathogen in 3 additional cases. The group B coxsackieviruses and the echoviruses were implicated in 156 (92%) of the 169 laboratory-diagnosed cases. Forty-eight percent of all diagnosed cases were due to group B coxsackievirus serotypes 2, 4, and 5; 78% of all cases were attributable to only 8 of the 67 known enterovirus serotypes. Polioviruses were the only viruses isolated from 7 children, including a cerebrospinal fluid isolate from 1 child and a urine isolate from another. Disease was attributable to the group A coxsackie-viruses for only 3 cases.

The Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) is a relatively new test of language, problem-solving abilities, and visual-motor skills for children ages 0 to 36 months of age. This instrument was compared to the Bayley Mental Developmental Index (MDI), the generally accepted standard of infant developmental tests. This study evaluates 328 normal children tested in infancy and then at 18 and 30 months of age. Specificity was excellent (95% to 100%) at both 18- and 30-month levels when compared to the Bayley MDI. Sensitivity, however, was 21% at the 18-month level and 67% at the 30-month level. Predictive validity (.65) and within-test validity (.69) are good. The CAT/CLAMS compares favorably with the Bayley MDI assessment of children between 18 and 30 months of age and can be used for clinical assessment of toddlers referred for development assessment prior to admission to early intervention programs.

Objective. We report the clinical features and cerebrospinal fluid (CSF) laboratory values for 277 children younger than 24 months of age with aseptic meningitis who were prospectively evaluated at three Baltimore hospitals between July 1986 and December 1990. A major objective was to define the incidence, etiology, and outcome of neurologic complications occurring during the acute illness. Methods. Cases were identified by surveillance in the ambulatory care departments of each of the three hospitals, pertinent historical and clinical data were obtained by interview of the parents and by review of the medical records, initial CSF laboratory values were recorded, and appropriate specimens were submitted to determine the viral etiology. A subset of 216 children who participated in a long-term natural history study were followed periodically with neurologic examinations and formal neurodevelopmental testing. Results. Most cases occurred in very young infants; 63.5% of patients were 8 weeks of age or younger, and 84.1% were younger than 16 weeks of age. In this very young cohort, the dominant symptoms were fever and irritability; only 8.7% had evidence of meningeal irritation at the initial examination. The acute illness was complicated by either complex seizures, physical evidence of increased intracranial pressure, or coma in 25 (9.0%) cases. Within the age group under study, these complications were each significantly more likely to occur in patients older than 12 weeks of age than in younger infants. The risk of neurologic complications was similar among infants infected with group B coxsackieviruses and echoviruses, the two major enterovirus classes observed to cause disease. Acute central nervous system (CNS) complications could not be correlated with extremely abnormal CSF laboratory indices. Importantly, there was no risk of long-term neurologic sequelae attributable to acute CNS complications. Conclusions. While approximately 9% of infants and children younger than 2 years of age with aseptic meningitis experience acute CNS complications in the form of complex seizures, increased intracranial pressure, or coma, the prognosis for long-term cognitive development appears to be as favorable as the prognosis for children with aseptic meningitis who do not experience these complications.