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. 2012 Spring;23(1):e1-5.
doi: 10.1155/2012/378432.

Clinical presentation of patients with aseptic meningitis, factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing

Glenn Patriquin  1 , Jill Hatchette, Kevin Forward
Affiliations

Clinical presentation of patients with aseptic meningitis, factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing

Glenn Patriquin et al. Can J Infect Dis Med Microbiol. 2012 Spring.

Abstract
in English, French

Introduction: Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)-positive and -negative patients to determine those that were most influential in admission, discharge and in anti-infective administration.

Methods: Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three-year period.

Results: The oldest EV-positive patient was 34 years of age and the occurrence of the disease was highly seasonal. EV-positive patients were more likely to report fever, rash, photophobia, short onset and exposure to an ill contact. A positive polymerase chain reaction (PCR) result was associated with relatively short hospitalization. Seizure and neurological symptoms were more strongly associated with a negative PCR test result. CSF characteristics did not discriminate well between patients with positive and negative PCR tests. Patients with imperfect Glasgow Coma Scores or with neurological symptoms were more likely to be admitted to hospital than those without. Fever and recent onset predicted determinants of anti-infective use.

Conclusion: The present retrospective study confirms previous reports regarding seasonality and the young age of positive patients. Factors that indicate nonenteroviral etiology were appropriately also those that influenced hospitalization. Patients with EV meningitis were likely to be treated with empirical anti-infectives, and a substantial proportion continued to take antibiotics for more than 24 h after receiving the positive EV PCR test result.

Introduction: Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)-positive and -negative patients to determine those that were most influential in admission, discharge and in anti-infective administration.

Methods: Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three-year period.

Results: The oldest EV-positive patient was 34 years of age and the occurrence of the disease was highly seasonal. EV-positive patients were more likely to report fever, rash, photophobia, short onset and exposure to an ill contact. A positive polymerase chain reaction (PCR) result was associated with relatively short hospitalization. Seizure and neurological symptoms were more strongly associated with a negative PCR test result. CSF characteristics did not discriminate well between patients with positive and negative PCR tests. Patients with imperfect Glasgow Coma Scores or with neurological symptoms were more likely to be admitted to hospital than those without. Fever and recent onset predicted determinants of anti-infective use.

Conclusion: The present retrospective study confirms previous reports regarding seasonality and the young age of positive patients. Factors that indicate nonenteroviral etiology were appropriately also those that influenced hospitalization. Patients with EV meningitis were likely to be treated with empirical anti-infectives, and a substantial proportion continued to take antibiotics for more than 24 h after receiving the positive EV PCR test result.

Historique: Les caractéristiques cliniques et de laboratoire de la méningite entérovirale peuvent chevaucher celles de la méningite bactérienne. Dans la présente analyse rétrospective, les chercheurs ont comparé les caractéristiques des patients positifs et négatifs à l’entérovirus (EV) pour déterminer celles qui avaient le plus d’influence sur l’admission, le congé et l’administration d’anti-infectieux.

Méthodologie: Les chercheurs ont analysé les données tirées des dossiers de 117 patients pédiatriques et adultes qui avaient subi un test du liquide céphalorachidien (LCR) positif à l’EV sur une période de trois ans.

Résultats: La patiente positive à l’EV la plus âgée avait 34 ans. L’occurrence de la maladie était hautement saisonnière. Les patients positifs à l’EV étaient plus susceptibles de déclarer de la fièvre, des éruptions, de la photophobie, une apparition rapide et une exposition à un contact malade. Les résultats positifs de la réaction en chaîne de la polymérase (PCR) s’associaient à une hospitalisation relativement courte. Les conclusions et les symptômes neurologiques étaient liés plus fortement aux résultats d’un test de PCR négatif. Les caractéristiques du LCR distinguaient mal les patients ayant des tests de PCR positifs de ceux ayant des résultats négatifs. Les patients dont l’indice de coma de Glasgow était imparfait ou qui avaient des symptômes neurologiques étaient plus susceptibles d’être hospitalisés que les autres. La fièvre et une apparition récente étaient prédictives de l’utilisation d’anti-infectieux.

Conclusion: La présente étude rétrospective confirme les rapports antérieurs au sujet du caractère saisonnier et du jeune âge des patients positifs. Comme de juste, les facteurs indicateurs d’une étiologie non entérovirale étaient aussi ceux qui influaient sur l’hospitalisation. Les patients ayant une méningite EV étaient susceptibles d’être traités à l’aide d’anti-infectieux empiriques, et une forte proportion d’entre eux continuaient de prendre des antibiotiques pendant plus de 24 heures après avoir reçu le résultat du test PCR positif à EV.

Keywords: Aseptic; Cerebrospinal fluid; Diagnostic PCR; Enterovirus; Meningitis.

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Figures

Figure 1)
Figure 1)
The empirical isolation of patients with suspected meningitis and response to receipt of enterovirus polmerase chain reaction test result. Excluded patients include one who left against medical advice, and five who were isolated because of a positive routine methicillin-resistant Staphylococcus aureus test. EV Enteroviral
See this image and copyright information in PMC

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