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Aseptic central nervous system infections in adults: what predictor for unknown etiological diagnosis?

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Abstract

Despite the availability of nucleic acid amplification tests (NAATs), most of aseptic acute meningitides, encephalitides, and meningoencephalitides (AAMEMs) in adults remain of unknown etiology so far. To shed light on such topic, we aimed to evaluate potential predictors for AAMEMs of unknown origin. We collected retrospectively data from all consecutive cases of AAMEMs in adults discharged from an Italian referral hospital, from January 2004 to December 2016. Laboratory analysis included common immunometric methods and NAATs. Potential predictors for unknown etiology (age, seasonality, serum C-reactive protein value, antibiotic use before lumbar puncture, immunodeficiency conditions, clinical symptoms and signs) were evaluated by a logistic regression analysis model. A p value ≤ 0.05 was considered to indicate statistical significance. The study included 92 patients (median age 39 years; 54.3% males) affected by meningitis (n = 57), encephalitis (n = 25), and meningoencephalitis (n = 10). The identified agents that cause AAMEMs were herpesviruses (20.7%), enteroviruses (5.4%), tick-borne encephalitis virus (3.3%), influenza virus A (2.2%), West Nile virus (1.1%), and parvovirus B19 (1.1%), while 66.3% of cases were of unknown etiology. No predictor was found to be significantly associated with AAMEMs of unknown etiology. We suggest that potential infectious agents causing undiagnosed cases should be investigated among non-bacterial, non-opportunistic, and non-seasonal organisms.

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Acknowledgments

We thank Mrs. Elena Samar for her excellent technical assistance.

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Authors and Affiliations

  1. Infectious Disease Unit, University Hospital “Azienda Sanitaria Universitaria Integrata di Trieste”, Piazza dell’Ospitale 2, 34125, Trieste, Italy

    Jacopo Monticelli, Nicholas Geremia & Roberto Luzzati

  2. Department of Reproductive, Developmental and Public Health Sciences, UCO Hygiene and Preventive Medicine, University of Trieste, Via dell’Istria 65, 34137, Trieste, Italy

    Pierlanfranco D’Agaro & Vincenzo Petix

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  1. Jacopo Monticelli
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  2. Nicholas Geremia
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  3. Pierlanfranco D’Agaro
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  4. Vincenzo Petix
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  5. Roberto Luzzati
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Correspondence to Jacopo Monticelli.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Monticelli, J., Geremia, N., D’Agaro, P. et al. Aseptic central nervous system infections in adults: what predictor for unknown etiological diagnosis?. Neurol Sci 39, 863–870 (2018). https://doi.org/10.1007/s10072-018-3274-9

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  • DOI: https://doi.org/10.1007/s10072-018-3274-9

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