Circulation of enteroviruses and persistence of meningitis cases in the winter of 1999–2000

Abstract

The seasonal incidence of enterovirus meningitis was analyzed in a prospective study of patients admitted for suspected meningitis from October 1, 1998 to April 30, 2000. In-house reverse transcription-polymerase chain reaction (RT-PCR) in cerebrospinal fluid (CSF) was used irrespective of cytological results. Fifty-two (45.2%) of the 115 patients had positive RT-PCR in CSF, including 44/86 children (51.2%) and 8/29 adults (27.6%). Six of the 52 (11.5%) had no pleocytosis. The numbers of CSF specimens with a predominance of lymphocytes or a predominance of neutrophils were closely similar. In 33 of the positive patients, an enterovirus, mainly echoviruses type 6 (48%) and 30 (24%), was recovered in one or more specimens. Sixteen cases of enteroviral meningitis were observed between November 1999 and March 2000 as against 2 cases between November 1998 and March 1999, showing that the disease persisted through the winter months of 1999-2000. During the same period, 96 enterovirus isolates were recovered from clinical specimens from other patients. The number of isolates was higher in the winter of 1999-2000 (P< 0.01) than in the winter of 1998-1999, indicating that the risk of enterovirus infection increased significantly in winter 1999-2000. Sixteen patients had aseptic meningitis, made a rapid recovery and had an enterovirus in throat swabs and stools (9/16) or in one of the two (7/16). RT-PCR was not requested. Nine patients were admitted during the cold months. The clinical management of both adult and child patients could be improved by year-round use of enterovirus generic RT-PCR.

Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis

“…This study confirms some well-documented features of enterovirus meningitis [Rotbart, 1995;Chambon et al, 2001;Peigue-Lafeuille et al, 2002]: the illness is not rare in adults (23% of positive cases in the study), and occurs even in cold periods (28%). The pattern of EV serotypes responsible for meningitis in 2005 was marked by the predominance of echovirus 30 and was not greatly different from the circulating pattern of previous years.…”

Association between Cerebrospinal Fluid Pleocytosis and Enteroviral Meningitis

“…1 month of age and as Ն5 white cells/mm 3 for all other patients, and all of our cases had clinical features of meningitis with no Gram stain or culture evidence of bacterial infection.…”

Structural Analysis of Coxsackievirus A7 Reveals Conformational Changes Associated with Uncoating

“…Although most enterovirus infections are asymptomatic or result in only mild respiratory symptoms, clinical manifestations include rash, carditis, neonatal sepsis-like disease, and infections of the central nervous system such as acute flaccid paralysis, meningitis, and encephalitis (12,32,48,80). Enteroviruses have also been linked to chronic diseases such as type 1 diabetes mellitus (51,52,59,69).…”