Improving the diagnosis of meningitis due to enterovirus and herpes simplex virus I and II in a tertiary care hospital

Abstract

BackgroundEnterovirus and herpes simplex viruses are common causes of lymphocytic meningitis. The purpose of this study was to analyse the impact of the use molecular testing for Enteroviruses and Herpes simplex viruses I and II in all suspected cases of viral meningitis.MethodsFrom November 18, 2008 to November 17, 2009 (phase II, intervention), all patients admitted with suspected viral meningitis (with pleocytosis) had a CSF sample tested using a nucleic acid amplification test (NAAT). Data collected during this period were compared to those from the previous one-year period, i.e. November 18, 2007 to November 17, 2008 (phase I, observational), when such tests were available but not routinely used.ResultsIn total, 2,536 CSF samples were assessed, of which 1,264 were from phase I, and 1,272 from phase II. Of this total, a NAAT for Enterovirus was ordered in 123 cases during phase I (9.7% of the total phase I sample) and in 221 cases in phase II (17.4% of the total phase II sample). From these, Enterovirus was confirmed in 35 (28.5%, 35/123) patients during phase I and 71 (32.1%, 71/221) patients during phase II (p = 0.107). The rate of diagnosis of meningitis by HSV I and II did not differ between the groups (13 patients, 6.5% in phase I and 13, 4.7% in phase II) (p = 1.0), from 200 cases in phase I and 274 cases in phase II.ConclusionsThe number of cases diagnosed with enteroviral meningitis increased during the course of this study, leading us to believe that the strategy of performing NAAT for Enterovirus on every CSF sample with pleocytosis is fully justified.

Evaluation of a Viral Microarray Based on Simultaneous Extraction and Amplification of Viral Nucleotide Acid for Detecting Human Herpesviruses and Enteroviruses

“…The epidemiology of viral infection in CNS has changed dramatically following the introduction of vaccination. Herpes simplex virus type 1 and type 2(HSV1 and HSV2), belonging to genus of human herpes viruses (HHVs), are currently the most common causes of sporadic viral encephalitis; more importantly, the average mortality rate for patients with herpes simplex encephalitis is approximately 70% if left untreated [ 1 , 2 ]. In addition, enteroviruses (EVs) are also the most common causes of viral meningitis [ 2 ].…”

“…Herpes simplex virus type 1 and type 2(HSV1 and HSV2), belonging to genus of human herpes viruses (HHVs), are currently the most common causes of sporadic viral encephalitis; more importantly, the average mortality rate for patients with herpes simplex encephalitis is approximately 70% if left untreated [ 1 , 2 ]. In addition, enteroviruses (EVs) are also the most common causes of viral meningitis [ 2 ]. Out of EVs, enterovirus 71 (EV71) and Coxsackievirus 16 (CA16) have often circulated alternatively or together in the Western Pacific region, causing Hand, Foot and Mouth Disease even serious CNS complications in infants and young children in recent years [ 3 , 4 ].…”

Epidemiology of Meningitis in Oman—Implications for Future Surveillance

“…They are treated empirically and remain without identified etiology. Increasing diagnostic capabilities such as the introduction of PCR including arboviral can improve diagnostic yield in patients with meningitis and a negative CSF gram stain [ 32 , 33 ]. We noted a considerably lower rate of diagnostic lumbar punctures (LPs) in our study, two-thirds of the cases without LP were children younger than 13 years of age.…”

Multi-assay investigation of viral etiology in pediatric central nervous system infections

“…The clinical presentation is referred to as meningitis, encephalitis, or meningoencephalitis, according to the presence of meningeal signs and altered brain function (mental status, behaviour changes or focal signs). A rapid etiologic diagnosis to differentiate viral and bacterial causes is crucial to guide the introduction of empirical antibiotic therapy or avoid its unnecessary use [1]. Furthermore, initiation of antiviral therapy is required in all suspected cases of sporadic encephalitis due to Herpes simplex virus (HSV) type 1, a prevalent, debilitating and potentially fatal virally-induced central nervous system infection [2].…”