Cerebrospinal fluid non‐pleocytosis in pediatric enteroviral meningitis: Large‐scale review

Song, Ji Yeon; Nam, Sang Ook; Kim, Young A; Kim, Kyung Min; Lyu, Soo Young; Ko, Ara; Kim, Young Mi; Yeon, Gyu Min; Lee, Yun-Jin

doi:10.1111/ped.13658

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…Studying its sensitivity and specificity in actual clinical practice has been limited by the relatively low prevalence of positive bacterial results. In this study, there were multiple positive ME panel results without corresponding pleocytosis; however, studies have revealed viral and bacterial meningitis can lack pleocytosis, [14][15][16] thus making it difficult to fully interpret these results without additional testing. Additionally, HHV-6 results may remain positive, indicating a previous infection but not accounting for the acute illness.…”

Section: Discussionmentioning

confidence: 63%

Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management

Nabower¹,

Miller

Biewen

et al. 2019

Hospital Pediatrics

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To determine the association of the use of the multiplex assay meningitis/ encephalitis panel with clinical management of suspected meningitis. METHODS:A cross-sectional study was conducted with children 0 to 18 years of age who received a lumbar puncture within 48 hours of admission for an infectious workup. Patient demographic and presenting information, laboratory studies, and medication administration were collected. The primary measure was length of stay (LOS) with secondary measures: time on antibiotics, time to narrowing antibiotics, and acyclovir doses. LOS and antibiotic times were stratified for outcomes occurring before 36 hours. Logistic regression analysis was used to account for potential confounding factors associated with both the primary and secondary outcomes. A value of P , .05 was considered statistically significant.

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Section: Discussionmentioning

confidence: 63%

Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management

Nabower¹,

Miller

Biewen

et al. 2019

Hospital Pediatrics

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“…С возрастом прослойка детей, имеющих антитела к циркулирующим на данной территории штаммам энтеровирусов увеличивается. Так, к первому году жизни порядка 50 % детей серопозитивны к наиболее распространенным серотипам энтеровирусов [6,7]. В первые дни инфицирования возбудитель в большом количестве выделяется из слизистых оболочек зева пациента, обнаруживается в крови, моче, носоглотке и фекалиях за несколько дней до появления клинических симптомов.…”

Section: Discussionunclassified

Семейные Очаги Энтеровирусной Инфекции (Клинические Случаи)

Matsiyeuskaya¹,

Sovkich²,

Амвросьева³

et al. 2021

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Неполиомиелитные энтеровирусы (НПЭВ) являются одними из наиболее распространенных вирусов в мире. Наиболее уязвимые группы пациентов по развитию тяжелых форм энтеровирусных инфекций (ЭВИ)-это люди с тяжелым преморбидным фоном, беременные женщины, новорожденные и недоношенные дети, а также пациенты, находящиеся в плохих социально-бытовых условиях (страдающие зависимостью от алкоголя и др.) [1-3]. НПЭВ-это повсеместно распространенные РНК-вирусы, которые могут вызывать широкий спектр клинических симптомовот неспецифических лихорадочных, респираторных заболеваний, сыпи, геморрагического конъюнктивита до тяжелого мио кардита и перикардита, миелита, менингита и энцефалита [4-6]. По данным информационно-аналитического бюллетеня «Эпидемиологическая ситуация по энтеровирусным инфекциям в Республике Беларусь за 2018 год», заболеваемость ЭВИ в Республике Беларусь с 2009 г. имеет умеренную тенденцию к росту со средним темпом +4,31 %. В течение 2018 г. зарегистрировано 1780 случаев ЭВИ, показатель заболеваемости составил 18,81 на 100 тыс. населения. При этом имело место выраженное типовое разнообразие циркулирующих возбудителей инфекции, включающее 18 различных серотипов с доминированием Коксаки-В5 (37 %), ECHO-30 (16 %), ECHO-6 (13 %). В разрезе

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“…The proportion of patients with CSF non-pleocytosis in the case of enteroviral meningitis was approximately 30% of infants < 2 months of age in New Zealand [13] and in Missouri (USA) [14], and 31% in Pennsylvania (USA) [15]. In Korea, approximately 28% of infants < 3 months of age [16], 63.3% of neonates, and 38.3% of young infants aged 29 to 56 days [8] had CSF non-pleocytosis in enteroviral meningitis. Mulford et al [17] reported that 30% of infants < 2 months of age with enteroviral meningitis did not have pleocytosis.…”

Section: Discussionmentioning

confidence: 99%

“…These results suggest that sufficient time may be needed for CSF pleocytosis to develop. In other words, in the early stages of central nervous system infections, results may indicate non-pleocytosis if sufficient time has not passed to allow pleocytosis to develop [8,18,19].…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of Meningitis in Febrile Infants Aged ≤90 Days

Cho

You

2021

Ann Child Neurol

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Fever is the most common symptom indicative of serious infections among young infants, including neonates [1]. Although most febrile young infants have simple viral infections [2], bacterial infections, such as urinary tract infections (UTIs), meningitis, and Purpose: This study evaluated the clinical and laboratory characteristics of infants ≤90 days old with meningitis who presented to the hospital with a fever. We also investigated whether initial C-reactive protein levels and white blood cell counts were reliable predictors of bacterial meningitis. Methods: The medical records of 1,151 infants aged ≤90 days who visited our hospital with a fever between October 2009 and October 2019 were retrospectively evaluated. Results: Of the 1,151 patients, 274 (23.8%) had meningitis (bacterial, n=7; viral, n=206; pleocytosis in the cerebrospinal fluid, n=136). Thirty-seven viral meningitis patients (18.0%) had a positive polymerase chain reaction result without pleocytosis in the cerebrospinal fluid. The patients without pleocytosis were significantly younger. Among the patients with only pleocytosis, 46 had a urinary tract infection, 22 had other viral infections, and the etiology was unknown in 68. Among patients with urinary tract infections, infants without pleocytosis were younger than those with pleocytosis. Low white blood cell counts (<5,000/mm 3) were more frequently found in bacterial meningitis patients (n=7) than in viral meningitis patients. Furthermore, there were normal C-reactive protein levels (42.9%) and no pleocytosis (20%) in some cases of bacterial meningitis. Conclusion: Our findings show that meningitis is not uncommon among infants ≤90 days old who were brought to the hospital with complaints of fever. Furthermore, younger patients may not have cerebrospinal fluid pleocytosis, even if they have bacterial meningitis. Therefore, the patient's condition should be monitored closely and, if necessary, a re-examination should be considered.

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Cerebrospinal fluid non‐pleocytosis in pediatric enteroviral meningitis: Large‐scale review

Abstract: CSF non-pleocytosis in childhood EVM was frequently observed, especially in young infants, regardless of season. We propose that CSF PCR testing for enterovirus can be helpful to recognize EVM in children with CSF non-pleocytosis.

Cited by 14 publications

References 28 publications

Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management

Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management

Семейные Очаги Энтеровирусной Инфекции (Клинические Случаи)

Characteristics of Meningitis in Febrile Infants Aged ≤90 Days

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