Clinical and analytical characteristics and short-term evolution of enteroviral meningitis in young infants presenting with fever without source

Pediatr Emerg Care. 2012 Jun;28(6):518-23. doi: 10.1097/PEC.0b013e3182587d47.


Objective: The objective of this study was to describe the characteristics of the enteroviral meningitis diagnosed in a pediatric emergency department among infants younger than 3 months with fever without source and its short-term evolution.

Methods: This was a retrospective, cross-sectional, 6-year descriptive study including all infants younger than 3 months who presented with fever without source and who were diagnosed with enteroviral meningitis.

Results: A lumbar puncture was practiced at their first emergency visit in 398 (29.5%) of 1348 infants, and 65 (4.8%) were diagnosed with enteroviral meningitis, 33 of them (50.7%) between May and July. Among these 65 infants, 61 were classified as well-appearing; parents referred irritability in 16 (25.3%) of them (without statistical significance when compared with infants without meningitis). Forty-one (63.0%) had no altered infectious parameters (white blood cell [WBC] count between 5000 and 15,000/μL, absolute neutrophil count less than 10,000/μL, and C-reactive protein less than 20 g/L), and 39 (60%) had no pleocytosis. All of the 65 infants recovered well, and none of them developed short-term complications.

Conclusions: The symptoms in infants younger than 3 months with enteroviral meningitis were similar to those in infants with a self-limited febrile process without intracranial infection. C-reactive protein and WBC count were not good enteroviral meningitis predictors. Cerebrospinal fluid WBC count was normal in many of these infants, so performing a viral test is recommended for febrile infants younger than 3 months in which a lumbar puncture is practiced during warm months. The short-term evolution was benign.

MeSH terms

  • Cross-Sectional Studies
  • Emergencies
  • Enterovirus Infections / complications*
  • Enterovirus Infections / diagnosis
  • Fever of Unknown Origin / virology*
  • Hematologic Tests*
  • Humans
  • Infant
  • Irritable Mood
  • Meningitis, Viral / complications*
  • Meningitis, Viral / diagnosis
  • Molecular Typing*
  • Polymerase Chain Reaction
  • Predictive Value of Tests
  • Retrospective Studies
  • Spain
  • Spinal Puncture
  • Virus Cultivation