Zoonotic Disease Testing Practices in Pediatric Patients with Meningitis and Encephalitis in a Subtropical Region

Abstract

Emerging vector-borne and zoonotic pathogens can cause neuroinvasive disease in children; utilization of appropriate diagnostic testing can be low, hindering diagnosis and clinical management of these cases. We must understand factors that influence healthcare providers’ decisions to order diagnostic testing. We reviewed medical charts for pediatric meningitis and encephalitis patients (90 days–18 years) between 2010 and 2017 and analyzed variables associated with testing for known neuroinvasive zoonotic pathogens in the southern United States: West Nile virus (WNV), Bartonella spp., and Rickettsia spp. Among 620 cases of meningitis and encephalitis, ~1/3 (n = 209, 34%) were tested for WNV. Fewer cases were tested for Bartonella (n = 77, 12%) and Rickettsia (n = 47, 8%). Among those tested, 14 (7%) WNV, 7 (9%) Bartonella, and 6 (13%) Rickettsia cases were identified. Factors predicting testing were similar between all agents: clinical presentation of encephalitis, focal neurologic symptoms, new onset seizure, and decreased Glasgow Coma Scale on admission. Cases with a history of arthropod contact were more likely to be tested; however, we did not see an increase in testing during the summer season, when vector exposure typically increases. While our test utilization was higher than that reported in other studies, improvement is needed to identify zoonotic causes of neuroinvasive diseases.

A Potential Role for Substance P in West Nile Virus Neuropathogenesis

“…Symptomatic infections typically present with a combination of symptoms, including fever, fatigue, malaise, lymphadenopathy, periocular pain, myalgia, headache, maculopapular rash, and gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain [4][5][6]. Due to these nonspecific clinical manifestations of WNV infection, mild cases are often undiagnosed or misdiagnosed [7,8]. Of those infected, a small percentage will progress to neuroinvasive disease (WNND), with clinical presentations of meningitis, encephalitis, and/or acute flaccid paralysis [2].…”