Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients

Wajnsztejn

et al. 2015

J. Hum. Growth Dev.

Abstract:Introduction: Meningitis is the leading infectious syndrome that affects the central nervous system, and most cases are caused by viral infections, mainly enterovirus. The clinical diagnosis for meningitis etiology still presents major challenges. The analysis of polymerase chain reaction (PCR), white blood cells, red blood cells, glucose, protein, and lactate in the cerebrospinal fluid (CSF) provides the first clues to the diagnosis. However, the reference values of some parameters can suffer changes. Objective: Analyze the laboratory parameters of CSF in patients with enterovirus meningitis, and then, theirrelationship by age group. Methods: A descriptive study was conducted based on data from a CSF reference service, located in São Paulo, Brazil, on 202 individuals who had enterovirus meningitis. Data was analysed by the Shapiro-Wilk and Kruskal-Wallis tests (CI = 95%, p < 0.05) and represented by the median and percentile 25 and 75, respectively. Results: The cytological and biochemical parameters of the CSF shows us that proteins had median concentrations of 33.0mg/ dL, glucose of 57.0mg/dl, lactate of 19.0mg/dL and the leukocyte of 119.0 cells/mm 3 , with a predominance of lymphocytes (42%). It was found that age can cause cytological and biochemical changes in the parameters of CSF. Children younger than 2 years had a range percentage of neutrophils and monocytes different then children aged < 2 and < 6 years, and aged < 6 and < 10 years. The protein concentration range in CSF as well as glucose track can also change according to age. Conclusion:The parameters of the CSF in patients with enteroviral meningitis showed similar median concentrations to those found in the literature. Age may lead to changes in cytological and biochemical parameters of CSF. CSF protein and glucose concentrations also change according to age.

Section: Discussionsupporting

confidence: 60%

“…They are single-stranded RNA viruses belonging to the Picornaviridae family. There are more than 100 serotypes, including poliovirus, A and B coxsackievirus, and echovirus 3,5,8,9,10,11 .…”

Section: Introductionmentioning

confidence: 99%

Laboratory Parameters of Cerebrospinal Fluid in Individuals With Enterovirus Meningitis: A Descriptive Study

Wajnsztejn

et al. 2015

J. Hum. Growth Dev.

Eur J Clin Microbiol Infect Dis

“…This study was designed to validate a diagnostic and therapeutic algorithm for the initial management of meningitis during the period November 2005 to October 2008 at the Lausanne University Hospital, a 1000-bed tertiary center, and in four university-affiliated hospitals of Western Switzerland [13].…”

Section: Patients and Settingmentioning

confidence: 99%

“…The indications for and sequential timing of lumbar puncture, empirical antibacterial therapy, cerebral CT scan, and corticosteroid therapy were established according to the severity of the clinical presentation [13].…”

Section: Patients and Settingmentioning

confidence: 99%

“…The bacterial PCR was developed at our institution by combining the multiplex PCR described by Corless et al [16] and a real-time PCR detecting Listeria monocytogenes targeting the virulence gene hly encoding the hemolysin listeriolysin [17]. Homemade viral PCRs were used [13]. Complementary diagnostic procedures were applied according to the clinical history and presentation: real-time CSF PCR for varicella-zoster virus, blood serologies for viruses (e.g., human immunodeficiency virus, tick-borne encephalitis virus) and bacteria (e.g., Borrelia burgdorferi, syphilis).…”

Section: Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

CSF lactate for accurate diagnosis of community-acquired bacterial meningitis

Giulieri¹,

Chapuis-Taillard²,

Jaton

et al. 2015

CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm(3)), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.

Journal of Medical Virology

The impact of cerebrospinal fluid viral polymerase chain reaction testing on the management of adults with viral meningitis: A multi‐center retrospective study

Kim

Gulholm

Lennard

et al. 2022

The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management. All cerebrospinal fluid samples collected in 1 year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS), and treatment were analyzed. Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs = 0.3822, p = 0.0003). Forty‐one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56% vs. 24%; p = 0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as human immunodeficiency virus and syphilis if the viral PCR panel was negative. The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes require further assessment.