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Published on: September 11, 2016
Enterovirus Central Nervous System Infection in Infancy, the Value of Routine Testing
Sheiniz Giva1, Rachel Barry2, Richard J Drew3,4,5
1From the Department of Infectious Diseases, Children's Health Ireland at Temple Street and Crumlin, Dublin, Ireland.
Insights
Human nonpolio enterovirus (EV) infections in infants often lack typical cerebrospinal fluid (CSF) findings. Consider EV testing in febrile infants, even with normal CSF results, for accurate diagnosis and management.
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Neurology
- Virology
Background:
- Human nonpolio enterovirus (EV) is a significant cause of infection in neonates and infants.
- Clinical presentations and cerebrospinal fluid (CSF) findings in EV infections vary widely.
- EV infections in infants can range from mild fever to severe systemic or neurological disease.
Purpose of the Study:
- To analyze the clinical presentation and CSF findings in infants with enterovirus central nervous system (CNS) infections.
- To determine if CSF pleocytosis is a consistent marker for EV CNS infections in infants.
- To guide diagnostic considerations for EV infections in young children.
Main Methods:
- Retrospective cohort analysis of infants diagnosed with EV CNS infection between 2017 and 2022.
- Inclusion of patient demographics, presenting symptoms, and laboratory data (blood and CSF).
- Analysis of CSF white blood cell count, C-reactive protein levels, and clinical presentation.
Main Results:
- Forty-one percent of infants with EV CNS infection had a normal CSF white blood cell count.
- Clinical symptoms were similar in infants with and without CSF pleocytosis.
- Median C-reactive protein levels were elevated in EV CNS infections without CSF pleocytosis.
Conclusions:
- Enterovirus CNS infections in infants frequently present without CSF pleocytosis.
- Diagnostic consideration for EV should extend to febrile infants with unexplained symptoms, irrespective of CSF parameters.
- Early and broad testing for EV can improve diagnosis in infants with potential CNS involvement.
Background:
Human nonpolio enterovirus (EV) is a major cause of infection in neonates and infants; however, the clinical presentation and cerebrospinal fluid findings vary significantly. Infection caused by EV in patients under 1 year of age can present with a broad clinical spectrum, from fever to severe systemic and/or neurological disease.
Methods:
Retrospective cohort analysis of infants with EV central nervous system (CNS) infection presenting to a tertiary center between January 2017 and December 2022. We recorded patient demographics, parent-reported symptoms at presentation, and blood and cerebrospinal fluid (CSF) testing at presentation.
Results:
Seventy-eight patients were included in the final study. Forty-one percent of infants with an EV CNS infection had a normal CSF white blood cell count. Clinical presentation was similar in infants with and without CSF pleocytosis. Median C-reactive protein was higher in cases of EV CNS infection without pleocytosis.
Conclusion:
EV CNS infection commonly presents without CSF pleocytosis. Testing for EV should be considered in febrile infants with no source regardless of CSF parameters.
