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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
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Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children
Frederico Ribeiro Pires1, Andréia Christine Bonotto Farias Franco1, Alfredo Elias Gilio1
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Insights
Enterovirus detection in cerebrospinal fluid effectively differentiates bacterial from viral meningitis in children. Combining this test with the Bacterial Meningitis Score enhances diagnostic specificity for meningitis cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Meningitis is a serious infection requiring rapid diagnosis.
- Differentiating bacterial from viral meningitis is crucial for appropriate treatment.
- The Bacterial Meningitis Score is a clinical tool used to assess meningitis risk.
Purpose of the Study:
- To evaluate the effectiveness of enterovirus detection in cerebrospinal fluid (CSF) for diagnosing meningitis in children.
- To compare the diagnostic performance of enterovirus detection with the Bacterial Meningitis Score.
- To determine if combining these methods improves diagnostic accuracy.
Main Methods:
- A retrospective cohort study of 503 pediatric patients diagnosed with meningitis between 2011 and 2014.
- Patients with specific exclusion criteria (e.g., critical illness, recent neurosurgery, antibiotic use prior to lumbar puncture) were excluded.
- Data on enterovirus detection in CSF and Bacterial Meningitis Score were analyzed.
Main Results:
- Of 345 analyzed patients, 7 had bacterial meningitis and 338 had aseptic meningitis.
- Enterovirus detection in CSF showed 100% sensitivity and 64.2% specificity when compared to the Bacterial Meningitis Score alone.
- When enterovirus detection was combined with the Bacterial Meningitis Score, specificity increased.
Conclusions:
- Enterovirus detection in CSF is a reliable method for distinguishing between bacterial and viral meningitis.
- The combination of enterovirus detection and the Bacterial Meningitis Score offers improved specificity in diagnosing meningitis.
Objective:
To measure the role of enterovirus detection in cerebrospinal fluid compared with the Bacterial Meningitis Score in children with meningitis.
Methods:
A retrospective cohort based on analysis of medical records of pediatric patients diagnosed as meningitis, seen at a private and tertiary hospital in São Paulo, Brazil, between 2011 and 2014. Excluded were patients with critical illness, purpura, ventricular shunt or recent neurosurgery, immunosuppression, concomitant bacterial infection requiring parenteral antibiotic therapy, and those who received antibiotics 72 hours before lumbar puncture.
Results:
The study included 503 patients. Sixty-four patients were excluded and 94 were not submitted to all tests for analysis. Of the remaining 345 patients, 7 were in the Bacterial Meningitis Group and 338 in the Aseptic Meningitis Group. There was no statistical difference between the groups. In the Bacterial Meningitis Score analysis, of the 338 patients with possible aseptic meningitis (negative cultures), 121 of them had one or more points in the Bacterial Meningitis Score, with sensitivity of 100%, specificity of 64.2%, and negative predictive value of 100%. Of the 121 patients with positive Bacterial Meningitis Score, 71% (86 patients) had a positive enterovirus detection in cerebrospinal fluid.
Conclusion:
Enterovirus detection in cerebrospinal fluid was effective to differentiate bacterial from viral meningitis. When the test was analyzed together with the Bacterial Meningitis Score, specificity was higher when compared to Bacterial Meningitis Score alone.
Objetivo:
Avaliar o papel da pesquisa de enterovírus no líquido cefalorraquidiano em comparação com o Escore de Meningite Bacteriana em crianças com meningite.
MéTodos:
Coorte retrospectiva, realizada pela análise de prontuários, incluindo pacientes pediátricos, com diagnóstico de meningite e atendidos em um hospital privado e terciário, localizado em São Paulo, entre 2011 e 2014. Foram excluídos os pacientes com doença crítica, púrpura, derivação ventricular ou neurocirurgia recente, imunossupressão, outra infecção bacteriana concomitante que necessitasse de antibioticoterapia parenteral e aqueles que receberam antibiótico 72 horas antes da punção lombar.
Resultados:
Foram incluídos no estudo 503 pacientes. Destes, 64 foram excluídos e 94 não realizaram todos os exames para análise. Dos 345 pacientes restantes, 7 ficaram no Grupo de Meningite Bacteriana e 338 no Grupo de Meningite Asséptica. Não houve diferença estatística entre os grupos. Na análise do Escore de Meningite Bacteriana, dos 338 pacientes com possível meningite asséptica (culturas negativas), 121 deles tiveram um ou mais pontos para o Escore de Meningite Bacteriana, com valor de sensibilidade de 100%, especificidade de 64,2% e valor preditivo negativo de 100%. Dos 121 pacientes com Escore de Meningite Bacteriana positivo, 71% (86 pacientes) tiveram a pesquisa de enterovírus positiva no líquido cefalorraquidiano.
ConclusãO:
A pesquisa de enterovírus no líquido cefalorraquidiano mostrou-se eficaz em diferenciar a meningite bacteriana da viral. Analisada junto com o Escore de Meningite Bacteriana, a especificidade foi maior em comparação ao Escore de Meningite Bacteriana isolado.
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