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Cerebrospinal fluid white blood cell counts and lactic acid dehydrogenase in Enterovirus type 71 meningitis

F Goldberg, L B Weiner

    Clinical Pediatrics
    |May 1, 1981
    PubMed

    Insights

    Enterovirus type 71 caused an aseptic meningitis outbreak in children. Cerebrospinal fluid analysis showed high white blood cells, but lactic acid dehydrogenase levels reliably distinguished it from bacterial meningitis.

    Area of Science:

    • Pediatrics
    • Infectious Diseases
    • Neurology

    Background:

    • Aseptic meningitis outbreaks can occur in pediatric populations.
    • Enterovirus type 71 is an emerging pathogen causing central nervous system and systemic illness in children.
    • Distinguishing viral from bacterial meningitis is critical for appropriate treatment.

    Purpose of the Study:

    • To describe an outbreak of aseptic meningitis caused by Enterovirus type 71 in children.
    • To evaluate cerebrospinal fluid (CSF) findings in differentiating Enterovirus type 71 meningitis from bacterial meningitis.
    • To assess the utility of CSF lactic acid dehydrogenase (LDH) in distinguishing these conditions.

    Main Methods:

    • Retrospective analysis of 36 pediatric cases of aseptic meningitis during an Enterovirus type 71 outbreak.
    • Examination of initial and repeat lumbar puncture CSF parameters, including white blood cell (WBC) count and differential.
    • Measurement of CSF lactic acid dehydrogenase (LDH) levels.

    Main Results:

    • Enterovirus type 71 was identified as the causative agent.
    • Initial CSF analysis revealed polymorphonuclear (PMN) predominance in 64% and elevated WBC counts (>200/mm3) in 25% of patients.
    • Repeat lumbar punctures showed a significant increase in CSF WBCs in 54% of patients.
    • CSF WBC findings alone were insufficient to differentiate from bacterial meningitis.
    • CSF LDH levels reliably distinguished Enterovirus type 71 meningitis from bacterial meningitis.

    Conclusions:

    • Enterovirus type 71 outbreaks pose a diagnostic challenge in pediatric meningitis.
    • CSF WBC counts and differentials can mimic bacterial meningitis.
    • CSF lactic acid dehydrogenase is a valuable biomarker for differentiating Enterovirus type 71 meningitis from bacterial meningitis in children.

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