Enteroviral meningitis in children: Clinical and laboratory features with and without pleocytosis

Area of Science:

• Pediatric infectious diseases
• Clinical virology
• Neuroimmunology

Background:

• Enteroviruses (EV) are a leading cause of aseptic meningitis in children.
• Polymerase chain reaction (PCR) is a sensitive method for detecting EV in cerebrospinal fluid (CSF).
• Understanding clinical and laboratory characteristics of PCR-confirmed EV meningitis is crucial for patient management.

Purpose of the Study:

• To evaluate the clinical and laboratory characteristics of children with PCR-confirmed enterovirus meningitis (EVM).
• To compare EV-positive patients with and without CSF pleocytosis.
• To assess the impact of PCR diagnosis on patient outcomes.

Main Methods:

• Retrospective analysis of pediatric patients (1 month to 17 years) with suspected meningitis.
• Inclusion criteria: CSF viral PCR and culture results between September 2012 and January 2021.
• Patients were categorized into EV PCR-positive and PCR-negative groups, with further stratification of EV-positive cases based on CSF pleocytosis.

Main Results:

• 78 (38.2%) patients were EV PCR-positive; 126 (61.8%) were PCR-negative.
• Convulsions were more frequent in EV PCR-positive patients without pleocytosis (p=0.017).
• Higher CSF protein and lactate levels were observed in EV PCR-positive patients with pleocytosis (p=0.048, p=0.001). Median hospital stay was significantly longer in the PCR-negative group (p<0.001).

Conclusions:

• PCR confirmation of enteroviral meningitis (EVM) is vital for accurate diagnosis.
• Early diagnosis through PCR can prevent prolonged hospitalization and reduce unnecessary antibiotic administration.
• PCR testing facilitates better management of pediatric meningitis cases, minimizing healthcare-related complications.