Key result
Rectal swab PCR yields ~90% sensitivity for pediatric enterovirus CNS infections, outperforming CSF testing.
Why the study?
The study aimed to evaluate the diagnostic utility of enterovirus PCR testing on throat and rectal swab/stool samples, along with neuroimaging, in diagnosing pediatric enterovirus CNS infections.
Does enterovirus PCR testing on non-CSF samples (throat and rectal swab/stool) and neuroimaging improve diagnostic accuracy compared to CSF PCR in pediatric enterovirus CNS infections?
Observational (n=430)
Does enterovirus PCR testing on non-CSF samples (throat and rectal swab/stool) and neuroimaging improve diagnostic accuracy compared to CSF PCR in pediatric enterovirus CNS infections?
Rectal swab/stool PCR testing combined with neuroimaging significantly improves the diagnosis of pediatric enterovirus CNS infections compared to CSF PCR alone.
May support adjunctive throat/rectal swab PCR when CSF access is limited in suspected pediatric EV CNS infection; leaves open need for prospective validation.
OBJECTIVE The current study aims to evaluate the diagnostic utility of enterovirus PCR testing on throat and rectal swab /stool samples, along with neuroimaging, in the diagnosis of pediatric enterovirus (EV) Central Nervous System (CNS) infections. METHODS This prospective observational study recruited 380 children aged <12 years with suspected CNS infection and 50 age-matched controls with non-infectious neurological disorders. All the patients underwent enterovirus real-time PCR testing on CSF, throat, and rectal swab samples, alongside brain MRIs. The diagnostic accuracy was assessed using EV-positive cases as true positives and patients with confirmed non-enteroviral or non-infectious aetiologies as true negatives. MRI patterns were classified as typical or atypical based on brainstem involvement. RESULTS Infectious agents could be detected in 123/380 (32.3%) cases, out of these 33 (8.7%) had infections attributed to enterovirus while 90 (23.7%) were labelled as non-enterovirus CNS infections. In 257 (67.6%), no infectious agent could be identified, hence they were excluded from further analysis. Among the samples used for enterovirus testing, rectal swab/stool samples showed highest sensitivity (90.32%) followed by throat swab samples (32.3%). CSF PCR showed the lowest sensitivity (11.1%). MRIs were available for 26/33 patients, with characteristic brainstem involvement observed across probable and possible cases. CONCLUSION Rectal swab/stool PCR, together with neuroimaging, may improve the diagnosis of pediatric EV CNS infections and identify cases missed by CSF PCR alone.
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Sharma et al. (2026) conducted an observational in Pediatric enterovirus Central Nervous System (CNS) infections (n=430). Enterovirus PCR testing on throat and rectal swab/stool samples, along with neuroimaging vs. CSF PCR was evaluated on Diagnostic sensitivity for enterovirus CNS infections. Rectal swab/stool PCR demonstrated 90.32% sensitivity for detecting pediatric enterovirus CNS infections, outperforming throat swabs (32.3%) and CSF PCR (11.1%).
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