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Outbreak of aseptic meningitis in Taipei in spring 1993
1Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Abstract:
An outbreak of aseptic meningitis in the Taipei area occurred from January to August 1993. A total of 114 cases were identified by cerebrospinal fluid (CSF) examination at National Taiwan University Hospital. Most of the cases were found from February to May 1993. The peak of age distribution was 3 to 11 years. The male-to-female ratio was 2.1 to 1. Most patients had fever, headache, and vomiting and nausea. On initial CSF examination, protein concentrations > 400 mg/L were noted in 38 of 93 CSF samples, while 19 of 70 initial samples had hypoglycorrhachia (CSF/serum glucose ratio < 0.5). CSF white cell counts of the initial lumbar puncture were 0-9 x 10(6) cells/L in 4 patients, 10-99 x 10(6) cells/L in 42 patients, 100-199 x 10(6) cells/L in 27 patients, 200-499 x 10(6) cells/L in 24 patients, 500-999 x 10(6) cells/L in 12 patients and > or = 1,000 x 10(6) cells/L in 5 patients. Polymorphonuclear cells predominated in 73 of 114 cases. Viral cultures from CSF, throat swabs and rectal swabs were done with a majority yielding enteroviruses. Enterovirus as a definite etiology was found in 58 of 114 cases and was the presumptive etiology in 15 of 114 cases. The serotypes of the enteroviruses isolated were mostly echovirus type 30. All patients recovered without obvious sequelae.
Insights
An aseptic meningitis outbreak in Taipei was caused by echovirus type 30, primarily affecting children. All patients recovered fully, highlighting the importance of viral surveillance.
Area of Science:
- Epidemiology
- Virology
- Clinical Medicine
Background:
- Aseptic meningitis outbreaks pose significant public health challenges, particularly in densely populated areas.
- Understanding the causative agents and clinical characteristics of meningitis outbreaks is crucial for effective management and prevention.
Purpose of the Study:
- To investigate an aseptic meningitis outbreak in Taipei during 1993.
- To identify the causative agent, epidemiological features, and clinical presentation of the outbreak.
Main Methods:
- Retrospective analysis of 114 aseptic meningitis cases identified via cerebrospinal fluid (CSF) examination.
- Clinical data collection, including patient demographics, symptoms, and CSF analysis (protein, glucose, cell counts, differential).
- Viral isolation and identification from CSF, throat, and rectal swabs.
Main Results:
- The outbreak occurred from January to August 1993, with a peak from February to May.
- The most affected age group was 3 to 11 years, with a male-to-female ratio of 2.1:1.
- Enterovirus, predominantly echovirus type 30, was identified as the causative agent in 73 of 114 cases.
- Common symptoms included fever, headache, vomiting, and nausea. CSF analysis revealed elevated protein and white blood cell counts, with polymorphonuclear cells predominating in most cases.
Conclusions:
- Enterovirus, specifically echovirus type 30, was the primary cause of the 1993 aseptic meningitis outbreak in Taipei.
- The outbreak predominantly affected young children and demonstrated typical clinical and CSF findings of viral meningitis.
- All patients recovered without sequelae, underscoring the generally benign course of enteroviral meningitis in this population.