Cerebrospinal fluid features in adults with enteroviral nervous system infection

Ahlbrecht, Jonas; Hillebrand, Lilly Katrin; Schwenkenbecher, Philipp; Ganzenmueller, Tina; Heim, Albert; Wurster, Ulrich; Stangel, Martin; Sühs, Kurt‐Wolfram; Skripuletz, Thomas

doi:10.1016/j.ijid.2018.01.022

Cited by 27 publications

(23 citation statements)

References 40 publications

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“…The findings of elevated white cell count in CSF coincided with the findings of the majority authors. The mean value of CSF cytosis in our study was 438±21.4.106/L, higher than that observed by Ahlbrecht J et al who found 115.106/L [13]. Predominance of plymorphonuclear cells in the first lumbar punctate was found in 23% of the patients in contrast with some studies that showed this feature in more than 50 % of cases [14,15].…”

Section: Resultscontrasting

confidence: 82%

Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

Pekova¹

2020

Ann Clin Anal Med

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Aim: Enteroviruses target various organs and systems of the human body, including the central nervous system (CNS). The aim of the present study was to better understand the clinical features of enteroviral infections of the CNS and the factors influencing the clinical course of disease.Material and methods: A total of 39 patients, aged 3-16 years, admitted to the Clinic of Infectious Diseases, University Hospital in Stara Zagora, Bulgaria, between 2012-2017 with confirmed enteroviral neuroinfection were enrolled in the study. Diagnosis was confirmed by laboratory and virological tests. Instrumental investigation was performed if needed. Results: In all cases the disease began suddenly and severely followed by hospitalization within 24 hours. Meningo-radicular syndrome was observed in 25 patients and sustained for average 4,1±1,9 days. Cerebrospinal fluid (CSF) showed pleocytosis in all cases ranging from 57 to 843.106/L, in 9 patients segmented cells predominated at the first lumbar puncture. Mild proteinorachie (0,50 to 0,76 g/L) was found in 17 of the patients. Virological tests revealed echovirus 30 and coxsackievirus B in 24 and 4 patients, respectively. Discussion: All cases in the study fulfill the criteria for a confirmed enteroviralinduced disease. Echovirus 30 was the predominant causative agent, affecting mainly children between 3 and 9 years old. All patients have gone as meningitis. The majority of them had moderate clinical course. Predominance of plymorphonuclear cells in the first lumbar punctate was found in 23% of the patients. All cases had a favorable outcome.

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Section: Resultscontrasting

confidence: 82%

Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

Pekova¹

2020

Ann Clin Anal Med

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“…The incidence of seizure was only 7.4%, as Berardi A et al reported the incidence of seizure was low both in infants <90 days of age and children older than 90 days of age . Meanwhile in adult, the incidence of seizure was also low to 4% . It seems enterovirus meningoencephalitis is associated with low seizure occurrence.…”

Section: Discussionmentioning

confidence: 94%

Cytokine characteristic of cerebrospinal fluid from children with enteroviral meningitis compared to bacterial meningitis

Jiang

Zhang

et al. 2020

Clinical Laboratory Analysis

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Background Enteroviruses are the most common etiological agent for viral encephalitis, but it is uncertain whether the cytokines have the ability to differentiate enteroviral meningitis (EVM) from bacterial meningitis (BM). Methods A retrospective study was performed at the Children's Hospital, Zhejiang University School of Medicine from August 2016 and August 2019. CSF and/or blood specimens were collected for microbiological culture, viruses, and cytokine detection. Results Forty‐three patients were confirmed with meningitis, 27 patients with EVM, and 16 with BM. Children with EVM were older compared with BM and Control group (P < .001). The most common presenting symptom in children with EVM was fever (96.3%) followed by headache (88.9%) and vomiting (66.7%). The occurrence of seizure was lower in both EVM and BM groups (P < .001). Serum IL‐6 and serum IL‐10 were lower in EVM group than BM (P = .02) and control group (IL‐6, P = .01; IL‐10, P < .001). IL‐6, IL‐10, and IFN‐γ levels showed obviously increase in CSF (P < .001, respectively) in EVM group, while only IL‐6 increased in CSF (P < .001) in BM group. CSF concentrations of cytokines IL‐6, IL‐10, TNF, and IFN‐γ in children with EVM and BM were both higher than Control group (P < .001). But compared EVM group to BM group, CSF IL‐2 (P = .13), IL‐6 (P = .37), IL‐10 (P = .98), TNF (P = .54), and IFN‐γ (P = .53) showed no difference between two groups. Conclusions CSF cytokines elevated in both virus and bacterial meningitis, while serum elevation only occurred in bacterial infection. Still, we could not distinguish enteroviral meningitis from bacterial meningitis with the parameters of CSF cytokines IL‐2, IL‐6, IL‐10, TNF, and IFN‐γ.

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“…Keywords: Biomarker, Brain, Diagnosis, Encephalitis, Infection, Lecithin, Lipids, Lipidomics, Meningitis, Metabolomics the following diagnoses: bacterial meningitis (BacM, n = 32), Borrelia burgdorferi neuroborreliosis (Borrelia, n = 34), herpes simplex encephalitis (HSE, n = 9), VZV meningoencephalitis (VZV ME, n = 15), enterovirus meningitis (EntM, n = 10), facial zoster (VZV fac, n = 16), segmental zoster (VZV seg, n = 14; also known as shingles), anti-NMDA-receptor autoimmune encephalitis (NMDA, n = 8), multiple sclerosis (MS, n = 17), Bell's palsy (Bell, n = 11), Gilles de la Tourette syndrome (GTS, n = 20), and normal pressure hydrocephalus (NPH, n = 35). The standard laboratory parameters of the enterovirus meningitis specimens are derived from a larger cohort study on this entity [11]. Case definitions (diagnostic criteria) are summarized in Additional file 1: Table S1, sociodemographic and standard clinical laboratory parameters in Additional file 2: Table S2, and the most likely causative pathogens isolated from the bacterial meningitis patients in Table 1.…”

Section: Study Population and Biosamplesmentioning

confidence: 99%

Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

et al. 2020

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Background: The timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis. Methods:We used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell's palsy, Tourette syndrome, normal pressure hydrocephalus).Results: PC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman's ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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Cerebrospinal fluid features in adults with enteroviral nervous system infection

Abstract: The absence of CSF pleocytosis, isolated cranial nerve involvement, and only infrequent general signs of infection may impede the diagnosis of enteroviral nervous system infections. A thorough CSF analysis including PCR is essential for a reliable diagnosis.

Cited by 27 publications

References 40 publications

Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

Cytokine characteristic of cerebrospinal fluid from children with enteroviral meningitis compared to bacterial meningitis

Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

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