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Enterovirus Meningitis in Adults: A Prospective Nationwide Population-Based Cohort Study
Jacob Bodilsen1, Helene Mens2, Sofie Midgley2
1From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark. jacob.bodilsen@rn.dk.
Objective:
To test the hypothesis that enterovirus meningitis (EM) is a frequent and self-limiting condition, the epidemiology of EM in adults was examined.
Methods:
Using a prospective, nationwide, population-based database, all adults with EM confirmed by PCR of the CSF from 2015 to 2019 were included. Unfavorable outcome was defined as Glasgow Outcome Scale scores of 1-4 at discharge. Modified Poisson regression was used to compute adjusted relative risks (RRs).
Results:
A total of 419 cases of EM in 418 adults (46% female, median age 31 years [interquartile range (IQR) 27-35]) yielded an incidence of 1.80/100,000/year. Admission diagnoses included CNS infection 247/397 (62%), other neurologic conditions 89/397 (22%), and cerebrovascular diseases 33/397 (8%). Genotype was available for 271 cases, of which echovirus 30 accounted for 155 (57%). Patients presented with headache 412/415 (99%), history of fever 303/372 (81%), photophobia 292/379 (77%), and neck stiffness 159/407 (39%). Fever (≥38.0°C) was observed in 192/399 (48%) at admission. The median CSF leukocyte count was 130 106/L (range 0-2,100) with polymorphonuclear predominance (>50%) in 110/396 (28%). Cranial imaging preceded lumbar puncture in 127/417 (30%) and was associated with non-CNS infection admission diagnoses and delayed lumbar puncture (median 4.8 hours [IQR 3.4-7.9] vs 1.5 [IQR 0.8-2.8], p < 0.001). Unfavorable outcome occurred in 99/419 (24%) at discharge; more often in female patients (RR 2.30 [1.58-3.33]) and less frequent in echovirus 30 (RR 0.67 [0.46-1.00]) in adjusted analyses. Outcome remained unfavorable in 22/379 (6%) after 6 months.
Conclusions:
EM is common among young, healthy adults. Although the long-term prognosis remains reassuring, a substantial proportion have moderate disability at discharge, especially female patients.
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