Key result
Pediatric enteroviral meningitis presents without CSF pleocytosis in ~55% of cases, linked to younger age.
Why the study?
The prevalence of enterovirus meningitis without cerebrospinal fluid pleocytosis and the patient factors and clinical features associated with it were not well understood.
Observational (n=305)
No
Absolute Event Rate: 2% vs 67%
p-value: p=<0.01
Enteroviral meningitis in young infants cannot be excluded by the absence of CSF pleocytosis, highlighting the need for RT-PCR confirmation.
EV meningitis without pleocytosis is common in young infants; leaves open whether routine RT-PCR should supplement standard CSF analysis in febrile neonates.
BACKGROUND: We aimed to study the prevalence of enterovirus (EV) meningitis without the presence of cerebrospinal fluid (CSF) pleocytosis and identify patient factors and clinical features associated with it. METHODS: This was a retrospective analysis of patients aged < 18 years old who were diagnosed with EV meningitis by CSF reverse-transcriptase polymerase chain reaction (RT-PCR) testing between January 2015 and December 2016. Clinical variables were compared with regard to the presence of CSF pleocytosis. RESULTS: , p < 0.01). Comparing three age groups, CSF apleocytosis was present in 106 of 128 patients (82.8%) aged ≤3 months, 7 of 13 patients (53.8%) aged 3 months-3 years and 56 of 164 patients (34.1%) aged > 3 years. Younger age groups had higher prevalence of CSF apleocytosis (p < 0.01). In patients aged ≤3 months, 94.5% underwent lumbar puncture within 24 h of symptom onset. The frequency of not having pleocytosis was higher than the frequency of having pleocytosis during peak EV infection prevalent months (summer and fall) (p < 0.01). CONCLUSION: This study shows that EV meningitis in young infants, with early lumbar puncture, or occurring during peak EV meningitis prevalent seasons cannot be solely excluded by pleocytosis. Also, a confirmation test for EV meningitis should be performed using RT-PCR.
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Ko et al. (2019) conducted an observational in Enteroviral meningitis (n=305). Absence of CSF pleocytosis vs. Presence of CSF pleocytosis was evaluated on Median age (months) (p=<0.01). Among children with enteroviral meningitis, 55.4% presented without cerebrospinal fluid pleocytosis, a finding significantly associated with younger age (median 2.0 vs 67.0 months, p<0.01).
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