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Enteroviral meningitis in infancy: potential role for polymerase chain reaction in patient management
Y Schlesinger1, M H Sawyer, G A Storch
1Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110.
Study Objective:
To evaluate the performance characteristics and potential clinical utility of a polymerase chain reaction (PCR) assay for enteroviral RNA in comparison to viral culture in infants under 3 months of age with meningitis. SPECIMENS AND TESTING: Specimens were obtained from a collection of cerebrospinal fluid specimens from infants under 3 months of age (excluding those in the neonatal intensive care unit) undergoing lumbar puncture at St. Louis Children's Hospital during a 12-month period. Those tested by PCR included all 27 with pleocytosis, 8 others from infants without pleocytosis but from whom an enterovirus was cultured, and 10 from infants who did not have pleocytosis and had a negative viral culture of cerebrospinal fluid. Viral cultures were performed at the discretion of physicians caring for individual patients.
Results:
PCR was positive for enteroviral RNA on cerebrospinal fluid (CSF) specimens from 11 of 12 patients with definite or probable enteroviral meningitis, as well as on 6 of 13 with possible enteroviral meningitis, and was negative on all 10 with absence of pleocytosis and negative enteroviral cultures. CSF viral cultures were negative in 6 of the patients in whom PCR was positive. Viral cultures had minimal impact on patient management. In contrast, under study assumptions, PCR could have saved an average of 1.2 days of hospitalization per patient in the 27 patients with CSF pleocytosis.
Conclusions:
Enterovirus PCR performed on CSF is a sensitive and specific method for the diagnosis of enteroviral meningitis. This method has the potential for improving the accuracy of diagnosis in young infants and for saving costs by allowing earlier diagnosis and discharge from the hospital when clinically appropriate.
Insights
Polymerase chain reaction (PCR) for enteroviral RNA in cerebrospinal fluid (CSF) is a sensitive and specific diagnostic tool for meningitis in infants. This method can lead to earlier diagnosis, reduced hospital stays, and cost savings.
Area of Science:
- Pediatric infectious diseases
- Molecular diagnostics
- Virology
Background:
- Enteroviral meningitis is a significant cause of illness in infants under 3 months.
- Accurate and timely diagnosis is crucial for appropriate patient management and outcomes.
- Traditional viral culture methods can be slow and less sensitive for detecting enteroviruses.
Purpose of the Study:
- To assess the performance of a polymerase chain reaction (PCR) assay for detecting enteroviral RNA in cerebrospinal fluid (CSF).
- To compare the diagnostic utility of PCR against conventional viral culture in infants with suspected meningitis.
- To evaluate the potential clinical and economic benefits of using PCR for diagnosing enteroviral meningitis in young infants.
Main Methods:
- Analysis of CSF specimens from infants under 3 months with suspected meningitis.
- Testing performed using a polymerase chain reaction (PCR) assay for enteroviral RNA.
- Comparison of PCR results with conventional viral culture findings.
Main Results:
- PCR demonstrated high sensitivity and specificity for enteroviral meningitis, correctly identifying 11 of 12 definite/probable cases.
- CSF viral cultures were negative in 6 patients where PCR was positive, indicating potential limitations of culture.
- PCR could potentially reduce hospitalization by an average of 1.2 days per patient with CSF pleocytosis.
Conclusions:
- Enterovirus PCR on CSF is a highly sensitive and specific diagnostic method for enteroviral meningitis in infants.
- This molecular assay offers improved diagnostic accuracy compared to viral culture.
- Early diagnosis via PCR can lead to cost savings through shorter hospitalizations and earlier discharge.