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Early diagnosis of enteroviral meningitis by a solid-phase reverse immunosorbent test and virus isolation
M Glimåker1, A Ehrnst, L Magnius
1Department of Infectious Diseases, Orebro Medical Center Hospital, Stockholm, Sweden.
Abstract:
45 cases of aseptic meningitis/meningoencephalitis were studied with regard to enteroviral etiology by virus isolation and solid-phase reverse immunosorbent test (SPRIST), a cross-reacting test for enterovirus IgM. An etiological diagnosis was reached in 37/45 (82%) patients. Etiological diagnoses other than enteroviruses were found in 8 patients: Borrelia burgdorferi in 4, varicella-zoster virus in 2, herpes simplex virus in 1 and mumps virus in 1 patient. Enteroviruses (echovirus 6, 21 and 30) were isolated from cerebrospinal fluid (CSF) in 26/37 (70%) and from stool samples of 20/21 (95%) of patients with no other etiology. Altogether enteroviruses were isolated from CSF and/or faecal samples in 29 patients. Echovirus 30 dominated as etiologic agent. In 34/40 (85%) of the samples with an enterovirus, a cytopathogenic effect was observed in cell culture within 4 days. In patients with an enterovirus isolate a SPRIST IgM response to echovirus 3, 5, 7 and/or coxsackievirus B3 was detected in 6/13 (46%) sera sampled 3-4 days after the onset of meningeal symptoms and in altogether 17/25 patients (68%). In 4 out of these virus isolation positive and SPRIST negative patients a single serum for SPRIST was available less than 4 days after onset of meningeal symptoms. Antigen from echovirus 5 gave the highest diagnostic yield. The SPRIST IgM test was positive in 2 cases where virus isolation, complement fixation and neutralization tests were negative. Epidemiological data however supported an enteroviral diagnosis in both of them. In conclusion, both SPRIST and virus isolation seem to be valuable for the early diagnosis of enteroviral meningitis.
Insights
This study found that both virus isolation and the solid-phase reverse immunosorbent test (SPRIST) are effective for diagnosing enteroviral meningitis. Echovirus 30 was the most common cause identified.
Area of Science:
- Virology
- Infectious Diseases
- Neuroscience
Background:
- Aseptic meningitis and meningoencephalitis can have various etiologies.
- Enteroviruses are a common cause of viral meningitis, particularly in children.
- Accurate and timely diagnosis is crucial for patient management and epidemiological surveillance.
Purpose of the Study:
- To investigate the enteroviral etiology of aseptic meningitis/meningoencephalitis.
- To evaluate the diagnostic utility of virus isolation and the solid-phase reverse immunosorbent test (SPRIST) for enteroviral IgM detection.
- To identify the predominant enteroviral serotypes causing meningitis in the studied cohort.
Main Methods:
- Studied 45 cases of aseptic meningitis/meningoencephalitis.
- Employed virus isolation from cerebrospinal fluid (CSF) and stool samples.
- Utilized solid-phase reverse immunosorbent test (SPRIST) for enterovirus IgM detection.
Main Results:
- An etiological diagnosis was reached in 82% of patients.
- Enteroviruses were identified as the cause in 37 patients, with Echovirus 30 being the most prevalent.
- Virus isolation detected enteroviruses in 29 patients, while SPRIST showed a significant IgM response in 68% of cases with enteroviral isolates.
- Non-enteroviral causes included Borrelia burgdorferi, varicella-zoster virus, herpes simplex virus, and mumps virus.
Conclusions:
- Both virus isolation and SPRIST are valuable tools for the early diagnosis of enteroviral meningitis.
- SPRIST can provide a diagnosis even when virus isolation is negative, especially when supported by epidemiological data.
- Echovirus 30 is a significant etiological agent in aseptic meningitis cases.