Abstract
Enteroviruses (EV) are responsible for a large number of meningoencephalitis cases, especially in children. The objective of this study was to identify modes of diagnosis including the significance of respiratory and cerebrospinal fluid samples, associated clinical characteristics, inpatient management, and outcome of individuals with EV infections of the central nervous system (CNS). Electronic medical records of individuals with enterovirus infections of the CNS who presented to the Columbia University Irving Medical Center and Children’s Hospital of New York between January 1, 2012 and December 31, 2017 were reviewed retrospectively for demographic, epidemiological, and clinical data. The median age overall was 1.7 months (interquartile range 14 years) and most (62.4%) were male. The majority of CNS infections presented as meningitis (95.7%) and occurred in the summer (45.2%) and fall seasons (37.6%). Eighty-five cases (91.4%) demonstrated EV positivity in cerebrospinal fluid, thirty cases (32.3%) exhibited both cerebrospinal fluid and respiratory positivity, and eight cases (8.6%) exhibited respiratory positivity with coinciding neurological findings. Eighty-nine individuals overall (95.7%) received antibiotics and 37 (39.8%) received antiviral treatment. All surviving individuals had favorable Modified Rankin Scores (MRS) within the zero to two ranges upon discharge. Testing respiratory samples in addition to cerebrospinal fluid was found to be an important diagnostic tool in EV-associated cases. While clinical outcomes were favorable for an overwhelming majority of cases, etiological understanding of CNS infections is essential for identifying ongoing and changing epidemiological patterns and aid in improving the diagnosis and treatment.
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Authors and Affiliations
Contributions
Sarah D. Torres, MS Contribution: Study conceptualization, data collection, initial analyses and writing, and review and revision of manuscript.
Dan Tong Jia, MD Contribution: Data collection, initial analyses and writing, and review and revision of manuscript.
Emily M. Schorr, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Brian L. Park, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Alexandra Boubour, BA Contribution: Data collection, initial analyses and writing, and review and revision of manuscript.
Amelia Boehme, PhD/MSPH Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Jyoti V. Ankam, MBBS/MPH Contribution: Data collection, initial analyses and writing, and review and revision of manuscript.
Jacqueline S. Gofshteyn, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Charles Tyshkov, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Daniel A. Green, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Wendy Vargas, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Jason Zucker, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Anusha K. Yeshokumar, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Kiran T. Thakur, MD Contribution: Conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
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This study was approved by the Columbia University Irving Medical Center (CUMC, New York, New York) Institutional Review Board (IRB). A waiver of consent was granted by the CUMC IRB.
Conflict of interest
Amelia Boehme is supported by NIH/ NINDS R03 NS101417 and NIH/NIMHD R21 MD012451. Jacqueline Gofshteyn, is supported by the NIH/NINDS NSADA-K12 Career Development Award (NS5250799523). Jason Zucker is supported by the training grant “Training in Pediatric Infectious Diseases” (National Institute of Allergy and Infectious Diseases T32AI007531). Kiran Thakur is supported by the National Institute of Health, NINDS K23 NS105935-01 and NIH/NICHD 1R01HD074944-01A1. The rest of the authors declare that they have no conflict of interest.
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Torres, S.D., Jia, D.T., Schorr, E. et al. Central nervous system (CNS) enterovirus infections: A single center retrospective study on clinical features, diagnostic studies, and outcome. J. Neurovirol. 26, 14–22 (2020). https://doi.org/10.1007/s13365-019-00784-5
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DOI: https://doi.org/10.1007/s13365-019-00784-5