Clinical and laboratory characteristics of enteroviral meningitis in children, including qRT-PCR and sequencing analysis

Abstract

Aims. Enteroviruses (EVs) are the most common agents of aseptic meningitis. Some serotypes can cause serious neuroinfection leading to death. The aim of this study was to determine the representation of EVs in the etiology of aseptic meningitis in children and to analyze the demographic, clinical, laboratory, and epidemiological characteristics of patients with EV meningitis. Patients and Methods. This was a prospective study including 147 patients in three groups: EV meningitis, tick-borne encephalitis, and aseptic meningitis with unidentified agent. Results. Boys with EV meningitis predominated over girls. The average patient age was 11 years. Compared to the control group, these patients suffered more from stiff back (P=0.010), vomiting and nausea (P=0.009). They had shorter symptom duration (P<0.001), higher C-reactive protein in blood (P<0.001), higher predominance of polynuclears (P=0.026), and greater lactate (P=0.003) in cerebrospinal fluid (CSF). The serotype seen most frequently (68%) was ECHO virus (ECV) 30. Conclusions. Enteroviruses play the most important role in the differential diagnosis of aseptic meningitis. Short symptom duration, slightly higher inflammatory parameters in blood, predominance of polynuclears, and elevated CSF lactate have predictive value in diagnosing this disease. ECV 30 (frequently the agent of epidemics in the Czech Republic) was the aseptic meningitis agent most often seen.

Evaluation of enterovirus concentration, species identification, and cerebrospinal fluid parameters in patients of different ages with aseptic meningitis in São Paulo, Brazil

“…We observed a positive correlation between viral load and increased WBC count in infants and children, who also had higher WBC counts compared to preteen‐teenagers and adults. These findings are consistent with previous studies reporting pleocytosis and a median WBC count of approximately 103 cells/mm 3 in individuals with EV meningitis 11,31,32 . Pleocytosis with a predominance of lymphomonocytes and elevated protein levels are indicative of viral infections, but is not sufficient to determine the specific causative agent 31,33 .…”

“…Although slightly elevated lactate levels have been reported in cases of aseptic meningitis, there is limited research on lactate concentrations in patients with meningitis due to EV infection. A study by Braunova et al 32 reported higher CSF lactate levels in patients with EV meningitis compared to a control group with other CNS infections.…”

“…These findings are consistent with previous studies reporting pleocytosis and a median WBC count of approximately 103 cells/mm 3 in individuals with EV meningitis. 11,31,32 Pleocytosis with a predominance of lymphomonocytes and elevated protein levels are indicative of viral infections, but is not sufficient to determine the specific causative agent. 31,33 We also observed elevated levels of lactate in the majority of individuals, with no significant difference between age groups.…”

Enteroviral meningitis in children: Clinical and laboratory features with and without pleocytosis

“…The authors highlighted the possibility that this etiological cause could be more prevalent than currently understood due to the challenges in distinguishing between viral meningitis and encephalitis within this age group 15 . In other published studies, the frequency of male gender in EV meningitis was between 58–71% 4 6 8 16 17 18 19 20 . Similarly, the prevalence of male gender was 74% in our study.…”

“…Enteroviruses are the most common pathogen of etiologicallyknown aseptic meningitis in children worldwide [1,[6][7][8]. Many previous studies have been conducted to evaluate the epidemiology of viral meningitis.…”