AN OUTBREAK AMONG CHILDREN OF ASEPTIC MENINGITIS CAUSED BY ECHOVIRUS TYPE 9 A Clinical and Serological Study

Abstract

There are several viral diseases, prevalent during summer and autumn among children and adults in temperate zones, which are characterized by high temperature, rash, gastrointestinal disturbances, and signs of meningeal irritation. Increasing evidence, based on improvement in laboratory technique, points to Echovirus 9 as one of the enteroviruses responsible for these diseases,The purpose of the present communication is to describe a small outbreak, caused by this virus, in which the sole clinical syndrome observed was that of meningitis. The outbreak occurred in the early summer of 1967 in Jerusalem, Israel, affecting a group of children living in a fairly limited area of a residential suburb. CASE REPORTSCase I F. Z., a 121/,-year-old male, was reportedly in good health until two days prior to admission to the hospital, when he developed irritability, headache and severe vomiting. No improvement was achieved with antibiotic and antipyretic drugs. Two weeks prior to the outbreak of these symptoms he had suffered from chickenpox and pneumonia, from which he had completely recovered.Physical examination on admissioc revealed a pa!e sick-looking child. Temperature was 37°C; pulse rate, 134 per minute; respiratory rate, 30 per minute; blood pressure, 100/65 mm Hg. There was some neck rigidity and Kernig's and Brudzinski's signs were negative. Tendon and cutaneous reflexes and plantar responses were normal. The tongue was wet and white. Systolic murmur grade I was found in the heart. There was no other abnormal findings in the physical examination. Two days later his condition became worse, fever remained high, headache was severe, and the child complained of vertigo and dizziness. Physical examination revealed a marked neck rigidity, and Kernig's and Brudzinski's signs were positive. Tendon and cutaneous reflexes were slightly diminished, and Babinski's sign was positive on both sides.Laboratory data. The urine was normal chemically and microscopically. The blood count showed: Hb, 12.7 g/ 100 ml; h e m a t o c r i t 4 0 % ; W.B.C., 11,500 per mm3 (72% neutrophils, of which 13% were bands, 25% lymphocytes, 4% monocytes). R.B.C. morphology was normal. E.S.R., 38/50. Serum glucose and electrolytes were normal. Findings in the cerebrospinal fluid (CSF) were as follows. Cells-2350 leucocytes (90 % lymphocytes) and 5 RBC, per cubic mm; sugar, 35 mg/100 ml; protein, 58 mg/100 ml; chloride, 113 mEq/l. Bacterial culture was negative. Viral culture of the CSF yielded echovirus 9.