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[Enterovirus diagnosis is important, but should be used cautiously]
1Infektionskliniken, Karolinska sjukhuset, Stockholm.
Abstract:
While the enterovirus diagnostic test positive rate is very low in Sweden, many enterovirus diagnoses are probably missed, owing to inappropriate testing, in patients with acute aseptic meningitis. In the article it is recommended that the cerebrospinal fluid PCR (polymerase chain reaction) test should be performed routinely in cases of acute aseptic meningitis. Serology and virus isolation in stool are indicated in cases of acute pericarditis or myocarditis, or certain chronic heart diseases. The PCR test should be performed in serum in the few cases of sepsis-like diseases in newborns or patients with hypogammaglobulinaemia. Otherwise, enterovirus diagnosis is very seldom justified on clinical grounds. For the purpose of poliovirus surveillance, enterovirus isolation may be important for virus typing, especially in cases of paralytic conditions.
Insights
Enterovirus diagnostic testing is often missed in acute aseptic meningitis cases. Routine cerebrospinal fluid PCR testing is recommended for accurate enterovirus diagnosis in these patients.
Area of Science:
- Virology
- Infectious Diseases
- Clinical Diagnostics
Context:
- Enterovirus infections can cause severe conditions like meningitis, myocarditis, and sepsis.
- Current diagnostic approaches for enteroviruses in Sweden show a low positive rate, suggesting underdiagnosis.
- Clinical presentation of enterovirus infections can be varied, complicating diagnosis.
Purpose:
- To recommend optimal diagnostic strategies for enterovirus infections based on clinical presentation.
- To improve the diagnostic yield of enterovirus testing in specific patient groups.
- To guide clinicians on appropriate laboratory testing for suspected enterovirus infections.
Summary:
- Cerebrospinal fluid PCR (polymerase chain reaction) testing should be routinely employed for acute aseptic meningitis to improve enterovirus detection.
- Serology and stool virus isolation are recommended for enterovirus diagnosis in cases of acute pericarditis, myocarditis, or chronic heart disease.
- Serum PCR is indicated for sepsis-like illnesses in newborns or hypogammaglobulinaemia patients; otherwise, enterovirus diagnosis is rarely clinically justified.
Impact:
- Increased accuracy in diagnosing enterovirus infections, particularly aseptic meningitis.
- Reduced missed diagnoses and improved patient management for enterovirus-related illnesses.
- Optimized utilization of laboratory resources for enterovirus diagnostics, reserving specialized tests for indicated conditions.