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Aseptic meningitis epidemic during a West Nile virus avian epizootic

Kathleen G Julian1, James A Mullins, Annette Olin

  • 1Centers for Disease Control and Prevention, Fort Collins, Colorado, USA. kjulian@psu.edu

Emerging Infectious Diseases
|October 2, 2003
PubMed

Insights

Enteroviruses, not West Nile virus (WNV), were the primary cause of aseptic meningitis during a 2001 epidemic in Baltimore. This highlights the continued importance of enteroviruses in causing meningitis, even during WNV outbreaks.

Area of Science:

  • Virology
  • Epidemiology
  • Infectious Diseases

Background:

  • Enteroviruses are common causes of aseptic meningitis in the US.
  • The role of West Nile virus (WNV), an emerging neurotropic virus, in aseptic meningitis is not well-defined.
  • A WNV epizootic occurred in Baltimore during the summer of 2001.

Purpose of the Study:

  • To investigate an aseptic meningitis epidemic in Baltimore, Maryland, during summer 2001.
  • To determine the relative contributions of WNV and enteroviruses to aseptic meningitis cases.
  • To assess the etiological agents responsible for the observed meningitis epidemic.

Main Methods:

  • Retrospective analysis of 113 aseptic meningitis cases with onsets between June 1 and September 30, 2001.
  • Testing for WNV immunoglobulin M (IgM) antibodies in patient serum.
  • Detection of enteroviruses using viral culture and polymerase chain reaction (PCR) on available specimens.

Main Results:

  • WNV IgM tests were negative for 69 of the investigated patients.
  • Enteroviruses were detected in 61% (43 of 70) of patients tested.
  • Echoviruses 13 and 18 accounted for the majority (76%) of serotyped enteroviruses.

Conclusions:

  • Enteroviruses, including less common echovirus serotypes, were the likely cause of most aseptic meningitis cases during the 2001 epidemic.
  • No cases of WNV meningitis were identified during the study period.
  • Enteroviruses remain significant causative agents of aseptic meningitis, even in regions experiencing WNV epizootics.

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