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EPA Method 1615. Measurement of Enterovirus and Norovirus Occurrence in Water by Culture and RT-qPCR. II. Total Culturable Virus Assay
Published on: September 11, 2016
Risk Classification for Enteroviral Infection in Children With Meningitis and Negative Gram Stain
Ramia Zakhour1, Elizabeth Aguilera1, Rodrigo Hasbun2
1From the Departments of Pediatrics and.
Insights
A predictive model identifies children with meningitis likely caused by Enterovirus. This can help avoid unnecessary hospitalizations and antibiotic use in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Clinical Diagnostics
Background:
- Enterovirus is a leading cause of aseptic meningitis in children.
- Accurate and timely diagnosis is crucial for appropriate patient management.
- Identifying predictive factors can optimize diagnostic testing strategies.
Purpose of the Study:
- To identify baseline variables associated with a positive cerebrospinal fluid (CSF) Enterovirus polymerase chain reaction (PCR).
- To develop a predictive model for Enterovirus PCR positivity in children with meningitis symptoms.
- To aid clinicians in outpatient management decisions for suspected viral meningitis.
Main Methods:
- Retrospective review of pediatric patients (2 months to 17 years) with meningitis symptoms.
- Analysis of CSF Enterovirus PCR results and clinical data.
- Development of a predictive model using logistic regression.
Main Results:
- A predictive model identified three key variables: seasonal presentation (May-November), low CSF protein (<100 mg/dL), and absence of focal neurologic signs.
- The model classified patients into low-risk (0% positive PCR) and high-risk (42% positive PCR) categories.
- Enterovirus PCR positivity was 37% in the study cohort; all confirmed cases had favorable outcomes.
Conclusions:
- A validated predictive model can identify children warranting Enterovirus PCR testing.
- This approach may reduce unnecessary hospitalizations and antibiotic administrations.
- Optimizing Enterovirus testing can improve resource allocation in pediatric meningitis cases.
Objectives:
Enterovirus is the most common cause of aseptic meningitis in children. This study aimed at identifying baseline variables associated with a positive cerebrospinal fluid (CSF) Enterovirus polymerase chain reaction (PCR) to aid clinicians in targeting patients who could be tested and treated as outpatients.
Methods:
We performed a retrospective review of children (2 months to 17 years old) admitted to the Children's Memorial Hermann Hospital in Houston, TX, between January 2005 and December 2010 with symptoms of meningitis, CSF white cell count of greater than 5 cells/mm, and a negative CSF Gram stain, who had a CSF Enterovirus PCR.
Results:
One hundred thirty-seven children were reviewed; median age was 4.7 (0.1-17.1) years, and 79 (58%) were male. Fifty patients (37%) had positive CSF Enterovirus PCR. Only 13 (15%) of the Enterovirus PCR-negative patients had an identifiable etiology. All patients were hospitalized. The mean hospital stay for patients with Enterovirus was 2.9 days; 88% received empiric antibiotics. Rates of antibiotic administration were not different between PCR-positive and PCR-negative groups (P > 0.05). All patients with Enterovirus had a favorable clinical outcome.A predictive model was created using 3 baseline variables independently associated with a positive Enterovirus PCR (P < 0.05): May to November presentation, CSF protein of less than 100 mg/dL, and absence of focal neurologic signs. The model classified patients into 2 risk categories for a positive Enterovirus PCR (low risk, 0% [0/17 patients]; high risk, 42% [50/120 patients]; P < 0.001).
Conclusions:
Our predictive model can be used to identify children for whom Enterovirus PCR testing is warranted. Such testing could avoid unnecessary hospitalization and antibiotic administration.
