Key result
Among adult patients with enterovirus meningitis confirmed by RT-PCR, 58.8% presented without cerebrospinal fluid pleocytosis, demonstrating that normal cell counts do not rule out the infection.
Why the study?
RT-PCR-confirmed enterovirus meningitis without pleocytosis had previously only been reported in children, leaving its frequency and clinical features in adults unknown.
Observational (n=17)
No
Absolute Event Rate: 58.8% vs 41.2%
A high frequency (58.8%) of enterovirus meningitis without pleocytosis occurs in adults, highlighting the need for RT-PCR testing when clinical suspicion is high despite normal CSF WBC counts.
EV meningitis without pleocytosis may occur in adults; extends pediatric reports but leaves open need for prospective validation.
Reverse-transcription polymerase chain reaction (RT-PCR)-confirmed enterovirus (EV) meningitis without pleocytosis has only been previously reported in children. In this study, we examined the frequency of EV meningitis without pleocytosis in adults and compared its clinical features. We retrospectively analyzed the data of adult patients with EV meningitis confirmed using cerebrospinal fluid (CSF) RT-PCR. Among the 17 patients included in this study, 58.8% showed no pleocytosis. The median age and clinical symptoms did not differ between the pleocytosis and non-pleocytosis groups. There were no statistically significant differences in seasonal variation or time from the onset of meningitis symptoms to lumbar puncture. The peripheral white blood cell (WBC) count in patients with pleocytosis was significantly higher than that in patients without pleocytosis. The median CSF pressure showed a higher trend in the non-pleocytosis group. Patients with CSF pressures higher than normal were more common in the non-pleocytosis group. The median CSF protein values were higher than the normal values in both groups. We confirmed the high frequency of EV meningitis without pleocytosis in adults. Accurate diagnosis using RT-PCR is necessary when meningitis symptoms are prominent during an EV epidemic, and CSF protein levels and pressure are high, even if the CSF WBC count is normal.
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Roh et al. (2023) conducted an observational in Enterovirus meningitis (n=17). Absence of cerebrospinal fluid pleocytosis vs. Presence of cerebrospinal fluid pleocytosis was evaluated on Proportion of enterovirus meningitis cases without cerebrospinal fluid pleocytosis. Among adult patients with enterovirus meningitis confirmed by RT-PCR, 58.8% presented without cerebrospinal fluid pleocytosis, demonstrating that normal cell counts do not rule out the infection.
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