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Zoonotic Disease Testing Practices in Pediatric Patients with Meningitis and Encephalitis in a Subtropical Region

Timothy A Erickson1,2, Shannon E Ronca1, Sarah M Gunter1

  • 1Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.

Pathogens (Basel, Switzerland)
|May 28, 2022
PubMed

Insights

Diagnostic testing for pediatric neuroinvasive zoonotic diseases like West Nile virus (WNV) is underutilized. Factors like encephalitis presentation and arthropod contact influence testing, but seasonal increases are not observed.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Public Health

Background:

  • Emerging vector-borne and zoonotic pathogens pose a risk for neuroinvasive disease in children.
  • Low utilization of diagnostic testing hinders the diagnosis and management of these pediatric cases.
  • Understanding factors influencing healthcare providers' testing decisions is crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze factors associated with diagnostic testing for neuroinvasive zoonotic pathogens in pediatric meningitis and encephalitis cases.
  • To evaluate testing rates for West Nile virus (WNV), Bartonella spp., and Rickettsia spp. in children.
  • To identify predictors for ordering diagnostic tests for these zoonotic infections.

Main Methods:

  • Retrospective chart review of pediatric patients (90 days–18 years) diagnosed with meningitis or encephalitis between 2010 and 2017 in the southern United States.
  • Analysis of variables associated with testing for WNV, Bartonella spp., and Rickettsia spp.
  • Statistical analysis to identify factors predicting the utilization of diagnostic tests.

Main Results:

  • Of 620 cases, 34% were tested for WNV, 12% for Bartonella spp., and 8% for Rickettsia spp.
  • Positive cases identified: 7% for WNV, 9% for Bartonella spp., and 13% for Rickettsia spp.
  • Predictors for testing included encephalitis, focal neurologic symptoms, seizures, decreased Glasgow Coma Scale, and history of arthropod contact. Testing did not increase in summer.

Conclusions:

  • While testing for zoonotic neuroinvasive pathogens in children is higher than previously reported, further improvement is necessary.
  • Clinical presentation, neurologic symptoms, and arthropod exposure history are key indicators for testing.
  • Optimizing diagnostic strategies is essential for timely identification and management of pediatric neuroinvasive zoonotic diseases.
Keywords:
clinical diagnosticsencephalitismeningitispediatricvector-borne diseaseszoonotic diseases

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