Non-polio enteroviruses (EV) are the most common viruses causing aseptic meningitis in children. We aim to evaluate the cerebrospinal fluid (CSF) characteristics of neonates and children with EV meningitis with a view to determine whether it could be discriminatory or otherwise in making a positive diagnosis. We performed a 3-year (July 2008–July 2011) retrospective study of children ≤16 years, treated at a tertiary children’s hospital, with positive CSF EV polymerase chain reaction (PCR) and negative blood and CSF bacterial cultures. A total of 206 children were studied. The median CSF white cell count was 79 cells/mm3 (range 0–4608 cells/mm3). CSF pleocytosis was observed in 99/150 (66 %) aged ≤90 days, 3/4 (75 %) aged 90 days–1 year, and 49/52 (94 %) children ≥3 years. There was a huge variability in CSF pleocytosis in infants ≤90 days, where 34 % of them had no pleocytosis, while in 66 %, a wide range of pleocytosis that might even suggest bacterial meningitis was noted. CSF red cells were low, and protein or sugar values were not discriminatory. CSF pleocytosis in relation to increasing age was found to be statistically significant (p < 0.001). Early lumbar puncture within 48 h of symptoms and absence of CSF pleocytosis was also statistically significant (p = 0.039). CSF pleocytosis in EV meningitis is commoner in older children. As there was a huge variability in CSF pleocytosis in infants ≤90 days particularly, CSF analysis including EV PCR could avoid unnecessary antibiotic therapy.
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Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB, Mutton KJ (2002) Development and evaluation of a ‘real-time’ RT-PCR for the detection of enterovirus and parechovirus RNA in CSF and throat swab samples. J Med Virol 67:555–562
Graham AK, Murdoch DR (2005) Association between cerebrospinal fluid pleocytosis and enteroviral meningitis. J Clin Microbiol 43:1491
Hysinger EB, Mainthia R, Fleming A (2012) Enterovirus meningitis with marked pleocytosis. Hosp Pediatr 2:173–176
Klein-Kremer A, Nir V, Eias K, Nir R-R, Yakubov R, Gershon K (2014) Clinical investigation: the presence of viral meningitis without pleocytosis among pediatric patients. Open J Pediatr 4:276–282. doi:10.4236/ojped.2014.44038
Monpoeho S, Coste-Burel M, Costa-Mattioli M, Besse B, Chomel JJ, Billaudel S, Ferré V (2002) Application of a real-time polymerase chain reaction with internal positive control for detection and quantification of enterovirus in cerebrospinal fluid. Eur J Clin Microbiol Infect Dis 21:532–536
Mulford WS, Buller RS, Arens MQ, Storch GA (2004) Correlation of cerebrospinal fluid (CSF) cell counts and elevated CSF protein levels with enterovirus reverse transcription-PCR results in pediatric and adult patients. J Clin Microbiol 42:4199–4203
Ooi MH, Wong SC, Lewthwaite P, Cardosa MJ, Solomon T (2010) Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol 9:1097–1105. doi:10.1016/S1474-4422(10)70209-X
Rotbart HA (1990) Enzymatic RNA amplification of the enteroviruses. J Clin Microbiol 28:438–442
Shin SH, Choi CW, Lee JA, Kim EK, Choi EH, Kim HS, Kim BI, Choi JH (2009) Risk factors for serious bacterial infection in febrile young infants in a community referral hospital. J Korean Med Sci 24:844–848. doi:10.3346/jkms.2009.24.5.844
Spicher VM, Berclaz PY, Cheseaux JJ, Morandi PA, Suter S, Wunderli W, Siegrist CA (2000) Detection of enteroviruses in the cerebrospinal fluid by polymerase chain reaction: prospective study of impact on the management of hospitalized children. Clin Pediatr (Phila) 39:203–208
Tee WS, Choong CT, Lin RV, Ling AE (2002) Aseptic meningitis in children—the Singapore experience. Ann Acad Med Singapore 31:756–760
Verstrepen WA, Kuhn S, Kockx MM, Van De Vyvere ME, Mertens AH (2001) Rapid detection of enterovirus RNA in cerebrospinal fluid specimens with a novel single-tube real-time reverse transcription-PCR assay. J Clin Microbiol 39:4093–4096
Verstrepen WA, Bruynseels P, Mertens AH (2002) Evaluation of a rapid real-time RT-PCR assay for detection of enterovirus RNA in cerebrospinal fluid specimens. J Clin Virol 25(Suppl 1):S39–S43
Yun KW, Choi EH, Cheon DS, Lee J, Choi CW, Hwang H, Kim BI, Park KU, Park SS, Lee HJ (2012) Enteroviral meningitis without pleocytosis in children. Arch Dis Child 97:874–878. doi:10.1136/archdischild-2012-301884
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The authors declare that they have no competing interests.
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Tan, N.W.H., Lee, E.Y., Khoo, G.M.C. et al. Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children?. J. Neurovirol. 22, 213–217 (2016). https://doi.org/10.1007/s13365-015-0387-2
- Polymerase chain reaction (PCR)