Original articleEnterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: An essential tool in meningitis management in childhoodReacción en cadena de la polimerasa a tiempo real de Enterovirus en líquido cefalorraquídeo, una herramienta esencial para el estudio de meningitis en niños
Introduction
EV are the most important causative agents of aseptic meningitis in children.1, 2 These viruses are also associated with other diverse clinical syndromes as asymptomatic infection, fever in young infants, respiratory illness, gastroenteritis and severe neonatal sepsis-like disease.3, 4, 5, 6, 7, 8 EV meningitis in children are usually benign and require only symptomatic treatment.1, 3, 4 Sometimes clinical presentation can be quite similar to other meningitis that require specific treatment, so earlier diagnosis helps to avoid additional investigations to rule out other aetiological agents, prevents unnecessary antibiotic treatment and decreases hospitalization.9, 10
Classical diagnostic methods of EV meningitis were based on virus isolation, but viral cultures are not useful for treatment decisions because results take several days to weeks.11, 12, 13 During the last two decades, real-time polymerase chain reaction (RT-PCR), performed in CSF has proved to be faster, more sensitive than viral culture and highly specific for the diagnosis of EV-meningitis.13 Previous studies have described a significant impact of positive results in length of stay and duration of parenteral antibiotic therapy even in infants younger than 90 days.10, 14, 15, 16, 17 Even, some authors have communicated a significant correlation between decreasing length of hospital stay and RT-PCR test turnaround time.15
In our institution, EV RT-PCR test in CSF is available from November 2007, so we conducted the present study with the aim to describe the epidemiological, clinical, and laboratory characteristics of EV meningitis in our paediatric population and to evaluate the role of EV RT-PCR in CSF for the diagnosis and management of this infection in our hospital.
Section snippets
Methods
Our hospital is a tertiary care medical centre serving a paediatric population of approximately 102,600 children aged less than 11 years.
From December 2007 to July 2010 we recorded, epidemiological and clinical features, laboratory results, hospital admission, antimicrobial treatment, length of hospital stay and outcome of all children (aged 11 years or younger) with EV RT-PCR positive in CSF. Blood and CSF bacteriological cultures were obtained in all patients, and also a urine sample was
Results
We have studied 92 children aged 11 years or younger with EV RT-PCR positive in CSF. That represents 56% of patients (<11 years) with meningitis in our institution. The mean age was 2.5 years (5 days–10 years) and 32% (30 patients) were neonates (see Fig. 1). The majority (70%) of patients were male and 67% of newborn with EV meningitis had relatives (brothers and/or sisters) aged 3 years or younger. Though most cases (44 in June–July) presented during summer months many cases were also
Discussion
EV are the most frequent causative agents of aseptic meningitis in children during summer and fall months.2, 5 In our series, though most cases occurred in summer, cases presented during the whole year even in cold periods. Frequent outbreaks of EV infections have been reported worldwide20 but we only observed a clear epidemiologic linkage in four patients (two pairs of siblings).
In our study, EV-meningitis showed two peaks of incidence in childhood with different clinical presentations, “very
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
We would like to thank Guadalupe Ruiz for the statistical analysis support.
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