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

Abstract

Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n ¼ 32) and those whose results were available > 24 hr after collection of CSF (n ¼ 14). Duration of antibiotic treatment (difference: 2.3 days; P ¼ 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.

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

“…The findings of the present study have contributed to a better understanding of the epidemiology of these viruses in this region. We showed here that enterovirus is the main etiologic agent of viral meningitis in Curitiba and probably in the south Brazil, which is in accordance with different reports for other geographic regions 11,12 . The circulation of the enterovirus occurred mainly in the summer and autumn similarly to that described for the northern hemisphere.…”

“…The incidence of the different viruses varies globally according to different populations, methodologies and objectives of the study. 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] .…”

Identification of 20 Common Human Enterovirus Serotypes by Use of a Reverse Transcription-PCR-Based Reverse Line Blot Hybridization Assay

“…These range from asymptomatic infection to serious illness, especially in children (20) and the immunocompromised. Clinical syndromes include aseptic meningitis (1,25), encephalitis (8,26), fever and rash, acute flaccid paralysis (29), and gastrointestinal and respiratory illness. Some HEVs (e.g., EV71) have caused large outbreaks in Southeast Asia (21).…”

Meningoencephalitis due to Enteroviral Infection – An Often Overlooked Etiology

“…The widespread availability of PCR has shown to save both time and money in the management of viral meningitis. PCR results can be obtained the same day the CSF is collected, whereas a bacterial culture may take several days and a viral culture even longer [10]. Patients who are rapidly diagnosed as having viral meningitis have also been shown to have shorter hospital stays and shorter duration of empiric treatment with antibiotics and/or acyclovir [8,10].…”