Aseptic Meningitis in Children: Analysis of 506 Cases

Abstract

BackgroundNon-polio human enteroviruses are the leading cause of aseptic meningitis in children. The role of enterovirus PCR for diagnosis and management of aseptic meningitis has not been fully explored.Methodology/Principal FindingsA retrospective study was conducted to determine the epidemiological, clinical, and laboratory characteristics of aseptic meningitis and to evaluate the role of enterovirus PCR for the diagnosis and management of this clinical entity. The medical records of children who had as discharge diagnosis aseptic or viral meningitis were reviewed. A total of 506 children, median age 5 years, were identified. The annual incidence rate was estimated to be 17/100,000 children less than 14 years of age. Most of the cases occurred during summer (38%) and autumn (24%). The dominant clinical symptoms were fever (98%), headache (94%) and vomiting (67%). Neck stiffness was noted in 60%, and irritation in 46% of the patients. The median number of CSF cell count was 201/mm3 with polymorphonuclear predominance (>50%) in 58.3% of the cases. Enterovirus RNA was detected in CSF in 47 of 96 (48.9%) children tested. Children with positive enterovirus PCR had shorter hospitalization stay as compared to children who had negative PCR or to children who were not tested (P = 0.01). There were no serious complications or deaths.ConclusionsEnteroviruses accounted for approximately one half of cases of aseptic meningitis. PCR may reduce the length of hospitalization and plays important role in the diagnosis and management of children with aseptic meningitis.

Molecular characterisation of enteroviruses and clinical findings from a cluster of paediatric viral meningitis cases in Tshwane, South Africa 2010–2011

“…In this cohort the median duration of hospitalisation was 5 days (1-8 days). This is comparable with a median of 4 days (1.9-8.5 days) in a large analysis of aseptic meningitis in children [38].…”

“…In conclusion, an accurate diagnosis of HEV-associated meningitis prevents the unnecessary use of antibiotics and/or antiviral medication, and pathogen specific infection prevention and control measures can be implemented [35,38]. Furthermore the characterisation of the circulating HEVs provides valuable epidemiological data which can be applied to identify and monitor outbreaks and can also be used to identify intercity [39] or intercountry spread of epidemic-related HEVs [29].…”

Enterovirus and herpesviridae family as etiologic agents of lymphomonocytary meningitis, Southern Brazil

“…Enteroviruses detected by molecular biology RT-PCR or Real Time PCR or cellular culture analysis show an incidence varying from 10 to 46% 9,12,15,17,19 . Herpesviruses, HHV6, VZV, and a mixed infection by HHV6/EV, were detected in a lower proportion [20][21][22] . In the present study in addition to enterovirus, positive samples for HSV (10%), EBV (3%) and HHV6 (3%) were observed.…”

Coxsackievirus B3 Is an Oncolytic Virus with Immunostimulatory Properties That Is Active against Lung Adenocarcinoma

“…Their use has several therapeutic advantages: these viruses immediately induce robust cytolytic changes during cell-to-cell infection, they do not possess oncogenes that may lead to tumorigenesis, and they can be easily genetically manipulated by reverse genetics systems for the rescue of positivestrand RNA viruses from complementary DNA (10,11). Furthermore, most nonpolio enteroviruses are common and highly prevalent and are mainly associated with asymptomatic infection or mild disease (12). Although CVA21 is reportedly a potent oncolytic enterovirus against miscellaneous human cancer cells (8,9,13), CVA21-treated mice died of lethal myositis with paralysis (14).…”