Enteroviral meningitis without pleocytosis in children

(5) also looked at the diagnostic value of CSF protein levels. (5) also looked at the diagnostic value of CSF protein levels. The patient continued to be febrile despite 72 hours of antibiotic therapy. Among children with CSF pleocytosis, a prediction model based exclusively on age, CSF total protein and CSF neutrophils differentiates accurately between acute bacterial and viral meningitis. and Kurtz, J.B. / de Crom, Stephanie C. In clearing the test, the FDA cited a multicenter study in which 96% of patients who tested positive did have viral meningitis, and 97% of patients who tested negative did not have viral meningitis.

Mean length of stay for patients with aseptic meningitis was 2.3 days (SD, +/-1.4 days). CONCLUSIONS: Among infants with EV CNS infections, the absence of CSF pleocytosis is related to younger age and lower peripheral WBC counts, perhaps reflecting the decreased ability of younger infants to mount a robust inflammatory response to EV infection. Enterovirus was isolated 43 % of the CSF specimens. Pleocytosis of CSF was seen in 23% and 75% of EV positive neonates and children, respectively. We recognized an opportunity to examine the relationship between UTI, CSF pleocytosis and EV infection in a large population of febrile infants. Seventy-six (95%), 67 (83.7%), 51 (63.7), and 2 (2.5%) patients presented with fever, headache, vomiting, and seizure, respectively. Polymorphonuclear (PMN) dominance (PMN > 50%) of CSF was seen in 50% and 33% of EV positive neonates and children, respectively.

Louis, MO 63110. Mean length of stay for patients with aseptic meningitis was 2.3 days (SD, ±1.4 days). Statistical significance was determined as a 2-tailed p value of 0.05, data not shown). Human enteroviruses (HEV) are small, single-stranded RNA viruses, belonging to the large genus Enterovirus of the Picornaviridae family and classified into four distinct species according to their molecular properties: HEV-A, B, C, and D [26]. One hundred fifty-eight cases of meningitis were reviewed: 138 were aseptic and 20 were bacterial. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The data indicate that HPeV infection is predominant in young infants (22/mm3 in subjects aged under 4 weeks, >15/mm3 for subjects aged 4-7 weeks, >5/mm3 for subjects aged over 7 weeks.

© 2008 Wiley-Liss, Inc. Subsequently, it was recognized that aseptic meningitis was a syndrome that could have multiple causes, both infectious and noninfectious (Wallgren 1951). The Charlson comorbidity scale and data on IV drug use were not routinely recorded. Seven had fever and 5 had a stiff neck. 16.Robert L, Margaret AM, Thomas JM, Haldane EV. Whether CSF pleocytosis plays an important role in defining aseptic meningitis or in prioritizing the differential diagnosis has been investigated but is still not completely clear (7, 14, 17). Conclusions.

The finding of a predominantly polymorphonuclear (PMN) leukocyte pleocytosis in the CSF further suggested the possibility of a bacterial infection. Viral loads were associated with EV genotypes (P < .001). Subacute and chronic meningitis may result from a wide variety of organisms and conditions. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment. Of the 86 CSF samples collected in the acute phase, 11 had no pleocytosis (or=10 white blood cells/mm(3)). The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated. In 4 lymphoma cases (11.8%) a false-negative diagnosis and in 7 cases (10.6%) of viral meningitis a false-positive diagnosis were made. Although enterovirus infections themselves are generally benign, clinical features of enteroviral meningitis can overlap those of bacterial infections and herpes simplex virus infection, resulting in prolonged hospital stays and presumptive treatment until a diagnosis is established. 2000; 49:185. Our three decades data revealed that patient numbers of Group B Streptococcus, Streptoccus pneumoniae, and Haemophilus influenzae type b meningitis declined but Escheria coli meningitis increased in the late period [2]. In accordance with the work of Nigrovic et al. Only the peripheral white blood cell count was independently associated with sterile CSF pleocytosis, and patients with a peripheral white blood cell count of 15/μL or higher had twice the odds of having sterile CSF pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P = .001). ISSN 1413-8670. These findings may indicate that the inflammatory response is more likely responsible for dissections [15]. Treatment with daily high-dose IVIg was commenced, with significant clinical improvement. The median (range) beta-glucuronidase activity in UTI with sterile CSF pleocytosis was 44.1 (33.2-57.1), whereas in the controls without CSF pleocytosis it was 19.1 (7.0-22.7), in aseptic meningitis of apparently viral etiology it was 26.5 (21.0-30.0) and in bacterial meningitis it was 168 (70.0-1152). These criteria have been established to predict low-risk patients less than 3 months of age with serious bacterial infections and include the Rochester, Philadelphia, and Boston criteria.3-5 The purpose was to screen young infants at risk for serious bacterial infections that included bacteremia, urinary tract infection, or bacterial meningitis.

Enteroviral meningitis without pleocytosis in children

Test results for blood, urine, and CSF culture were negative. Clinical, laboratory, and virological data of Dutch patients <16 years diagnosed with EV meningitis, between 2003 and 2008, were analyzed retrospectively. All patients with suspected bacterial meningitis should be treated empirically with appropriate antibiotics. Concomitant bacterial infection is not rare in neonates and children with EVM. Probable bacterial meningitis was defined as either: 1) positive blood culture associated with CSF pleocytosis and treatment consistent with bacterial meningitis; or 2) antibiotic pretreatment prior to LP, CSF pleocytosis, and treatment consistent with bacterial meningitis5. Many of the neonates (50%) and almost all of the children with EVM did not require prolonged hospitalization. Beyond the immediate neonatal period (>28 days of life), enteroviral meningitis is associated with a benign clinical course.4,5 Current therapeutic interventions for central nervous system enteroviral infections are limited to supportive care, although new antiviral therapies are under development.

In order to identify all the serotypes of HEV, more recent studies target the region encoding capsid proteins such as the VP1 [4, 8, 39, 41, 42, 55], or the VP2 [23]. Because the majority of children with a PMN predominance during enteroviral season will have aseptic disease, a PMN predominance as a sole criterion does not discriminate between aseptic and bacterial meningitis. To this end, we performed a validation study by using a network of 20 academic medical centers, as part of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Nucleotides sequences were aligned using BioEdit v7.0 and are presented as a topology tree prepared in MEGA 4.1. Diagnosis of meningeal carcinomatosis required positive CSF cytology. Despite the enhanced performance characteristics and potential for improving the paradigms for diagnosis and patient management, until recently there was no U.S. The cutoffs to identify elevated levels of CSF protein were those determined by a study at our institution in which EV RT-PCR was performed on all specimens to eliminate any samples from patients with unsuspected EV infections (19).


Postsurgical ventriculitis and meningitis are additional diagnostic problems in large urban hospitals, accounting for up to 40% of cases of bacterial meningitis [6]. Diagnosis of EV infection in patients with suspected meningitis relies on examining cerebrospinal fluid (CSF) with rapid nucleic acid amplification tests (reverse-transcription polymerase chain reaction [RT-PCR]), a procedure that avoids unnecessary investigations and antimicrobial administration [7, 8]. The prevalence of BM has dramatically decreased in regions with high vaccination administration 1,2,4,5,8,10,11,12,13,14,15,16,17). Louis Children’s Hospital were also tested for the presence of enteroviral RNA using RT-PCR. Patients with aseptic meningitis were recruited as who had pleocytosis but negative bacterial growth in CSF. This information could shed light on the pathophysiology of sterile CSF pleocytosis in infants with UTIs and could inform the appropriate treatment of these patients, particularly regarding the duration of parenteral antibiotic treatment. Bacterial meningitis was caused by Neisseria meningi tidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%).

In summary, 20 of 35 patients with aseptic meningitis had confirmed enteroviral infections by culture (6) and/or PCR (7). Testing for Enterovirus PCR in the blood is not a standard laboratory procedure and may be difficult to obtain. Patients with aseptic meningitis syndrome usually appear clinically nontoxic, with no vascular instability. Physical examination revealed nuchal rigidity and a vesicular rash at the right T4–T6 dermatome region. We compared the clinical characteristics, laboratory findings, imaging results and clinical outcomes between two groups. Her presentation fits the diagnostic criteria for the previously described syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL). No significant differences were evident in white blood cell count; platelet count; levels of hemoglobin, alanine aminotransaminase, aspartate aminotransferase, albumin, and sodium; cerebrospinal fluid chemistry; or presence of a rash.

The samples were inoculated in fibroblasts MRC-5, RD and BGM. Evidence is presented that the oligoclonal IgG represents mumps virus-specific antibody synthesized locally in the brain. Six of these patients did not present with the typical lymphocytic pleocytosis often quoted when discussing a viral meningitis/encephalitis; rather most presented with a cerebrospinal fluid neutrophilia. Cerebrospinal fluid (CSF) samples were collected from 267 patients (age range, 1 day to 5 years) and assessed for HPeV and EV by performing reverse transcription polymerase chain reaction assay. In: UpToDate, Basow, D.S., Ed., UpToDate, Waltham. This work is licensed under the Creative Commons Attribution International License (CC BY). Methodology: It is an observational study, conducted at the infectious diseases Unit, Rashid hospital Dubai (JCI accredited), United Arab Emirates, from Jan 2005 to Dec 2007.

Nucleic acid amplification tests (NAATs) for enterovirus RNA in cerebrospinal fluid (CSF) have emerged as the new gold standard for diagnosis of enteroviral meningitis, and their use can improve the management and decrease the costs for caring for children with enteroviral meningitis. A septic meningitis refers to a nonbacterial inflammation of the leptomeninges.1 Viruses are the most common cause of aseptic meningitis, and the most common viruses that cause aseptic meningitis are enteroviruses.