Clinical and diagnostic findings of an echovirus meningitis outbreak in the north west of England

Abstract

Introduction An outbreak of echovirus meningitis occurred in the north west of England in 2001. This paper reviewed the clinical features and the role of different diagnostic methods. Methods This was a prospective study of adults admitted to a regional infectious disease unit with a probable diagnosis of meningitis, March to August 2001. Results Half the 40 cases were male; median age was 28 (range 16–51) years. Fifteen of 38 (39.5%) were smokers, and 20 of 24 (83.3%) had close contact with children. Median (range) duration of symptoms was 1.1 (0.25–7) days. Symptoms included headache (100%), photophobia (87.5%), and nausea (67.5%), and severity ranged from minimal signs to those consistent with a meningoencephalitis. The diagnosis was confirmed virologically in 29 of 40 (72%); echovirus 30 was isolated from six. Cerebrospinal fluid (CSF) enterovirus polymerase chain reaction (PCR) was positive in 26 of 32 (81%), and CSF virus culture in 3 of 16 (19%). Thirty one per cent of CSF samples had a neutrophil predominance, and 3 of 29 (10%) virologically confirmed cases had normal CSF microscopy and biochemistry. Conclusion CSF microscopy may be normal or suggest bacterial meningitis in a substantial minority of cases of echovirus meningitis. CSF PCR for enterovirus seems to be more sensitive than virus culture of CSF, although PCR does not yield information on circulating virus type. Early and accurate diagnosis could reduce both use of parenteral antibiotics and length of hospital stay with both morbidity and cost implications. Close contact with children may be a risk factor, particularly if good hygiene measures are not practised.

An Outbreak of Aseptic Meningitis Due to Echovirus 30 in a High School Baseball Club-Possible Role of Severe Exercise for a High Attack Rate

“…Although PMN predominance in CSF (Table 2) seems atypical for viral meningitis, previous reports also showed similar result (4,14,21,30 (27). Child-care centers sometimes became the place of outbreaks, but the attack rate ranged from 3 to 13% (23)(24)(25)29).…”

“…were of open community outbreaks (3,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The attack rate was, therefore, quite low.…”

Aseptic Meningitis Caused by Enteroviruses

“…However, many previous studies of enterovirus meningitis have reported results that contradict this rule (Bernit et al, 2004;Carrol et al, 2006;Kao et al, 2003;Lee & Davies, 2007). Our case series also revealed that 59.7±28.9% of the cells in the cerebrospinal fluid were of polymorphonuclear origin (Table 4).…”

Enterovirus infections in England and Wales, 2000–2011: the impact of increased molecular diagnostics

“…Echovirus 30 is one of the more common echovirus genotypes; it causes outbreaks every few years, and causes mainly meningoencephalitis in children and adults, with varying clinical severity [20]. Echovirus 13 is a rare genotype that was responsible for major global outbreaks in the early 2000s [18,21].…”