Key result
In pediatric patients with enteroviral aseptic meningitis, cerebrospinal fluid pleocytosis was absent in 30.5% of cases, and cerebrospinal fluid cell counts significantly increased with age (p=0.02).
Why the study?
Non-polio enteroviruses are the most common pathogens of pediatric aseptic meningitis, prompting an evaluation of clinical findings and the utility of CSF enterovirus PCR testing.
Does cerebrospinal fluid enterovirus PCR testing improve the clinical management of pediatric patients with aseptic meningitis?
Observational (n=23)
No
Does cerebrospinal fluid enterovirus PCR testing improve the clinical management of pediatric patients with aseptic meningitis?
p-value: p=0.02
Rapid CSF EV-PCR testing in pediatric aseptic meningitis can reduce unnecessary antibiotic use and shorten hospitalization, which is particularly useful since CSF pleocytosis may be absent in young infants.
May support EV-PCR to limit antibiotics in young infants without pleocytosis; observational data leaves open prospective validation.
Background: Non-polio enteroviruses (EVs) are emerged as the most common pathogens of aseptic meningitis in children. In this study we aimed to evaluate clinical, laboratory, cerebrospinal fluid (CSF) findings and the usefulness of CSF EV polymerase chain reaction on management of pediatric patients diagnosed as EV aseptic meningitis. Material-methods:This study included the pediatric patients with aseptic meningitis between January 2014 and January 2016. Results: A total of 23 patients (69.5% boys) diagnosed with EV aseptic meningitis with a median age of 57 months old (range; 1-168 months) were included. The most common months of the patients' admission to hospital were July and May. The most common clinical complaints were womiting (77.2%), fever (73.9%), headache (59%), neck stiffness (36.3%), seizure (22.7%) and altered consciousness (22.7%). CSF pleocytosis was observed in 16 (69.5%) patients and the median CSF white blood cell (WBC) count was 50 cells/mm3 ranged from 0 to 500 cells/mm3. It was found that, CSF cell count was significantly increased with age (p=0.02), whereas acute phase reactant levels and CSF biochemical components were statistically similar according to age (p>0.05). Median duration for hospitalization was 6 days (range: 1-28 days). Eight patients (34.7%) did not receive any antibiotics. Conclusion: Absence of pleocytosis may be a diagnostic challange in very young infants with aseptic meningitis and CSF cell count significantly increases with age. By using rapid EV-PCR assays in the initial diagnosis of aseptic meningitis, the unnecessary usage of antibiotics in viral meningitis can be reduced and also the duration of hospitalization can be shortened.
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Akcan et al. (2020) conducted an observational in Enteroviral aseptic meningitis (n=23). Cerebrospinal fluid enterovirus polymerase chain reaction (EV-PCR) was evaluated on Cerebrospinal fluid cell count association with age (p=0.02). In pediatric patients with enteroviral aseptic meningitis, cerebrospinal fluid pleocytosis was absent in 30.5% of cases, and cerebrospinal fluid cell counts significantly increased with age (p=0.02).
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