Enterovirus meningitis in adults in 1999–2000 and evaluation of clinical management

Peigue-Lafeuille, H.; Croquez, N.; Laurichesse, H.; Clavelou, Pierre; Aumaître, O.; Schmidt, Jeannot; Maillet-Vioud, Marcel; Henquell, Cécile; Archimbaud, Christine; Bailly, Jean‐Luc; Chambon, M.

doi:10.1002/jmv.2191

Cited by 38 publications

(29 citation statements)

References 24 publications

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“…This study confirms some well-documented features of enterovirus meningitis [Rotbart, 1995;Chambon et al, 2001;Peigue-Lafeuille et al, 2002]: the illness is not rare in adults (23% of positive cases in the study), and occurs even in cold periods (28%). The pattern of EV serotypes responsible for meningitis in 2005 was marked by the predominance of echovirus 30 and was not greatly different from the circulating pattern of previous years.…”

Section: Discussionsupporting

confidence: 90%

“…The pattern of EV serotypes responsible for meningitis in 2005 was marked by the predominance of echovirus 30 and was not greatly different from the circulating pattern of previous years. In addition, CSF data showed no pleocytosis in about 18% (12/68) of the patients (seven children and five adults), which is consistent with other reports [Ramers et al, 2000;Henquell et al, 2001;Peigue-Lafeuille et al, 2002;Lee et al, 2006]. Cytologic analysis was also shown to have no predictive value, since neutrophils predominated in up to 50% of cases.…”

Section: Discussionsupporting

confidence: 89%

“…In our study, the real-time EV-PCR results were obtained within 3 hr [Archimbaud et al, 2004], and were available on the same day from Monday to Friday in 44% of patients, and within the first 24 hr in 70%. This assay gave a shorter TAT than the classic PCR assay used before 2003, 1 day versus 3 days, respectively [Peigue-Lafeuille et al, 2002].…”

Section: Discussionmentioning

confidence: 91%

“…Previous studies of children suggested that the use of the enterovirus PCR assay has a clinical benefit by reducing antibiotic or antiviral therapy, and avoiding ancillary tests, and also it reduces hospital related costs allowing earlier discharge [Hamilton et al, 1999;Ramers et al, 2000;Robinson et al, 2002;Stellrecht et al, 2002]. Children are the primary victims of enterovirus meningitis, but the illness is not uncommon in adults [Rotbart et al, 1998;Peigue-Lafeuille et al, 2002]. However, there is a paucity of published reports on the management of meningitis in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis

Archimbaud

Chambon

Bailly

et al. 2008

Journal of Medical Virology

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Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n ¼ 32) and those whose results were available > 24 hr after collection of CSF (n ¼ 14). Duration of antibiotic treatment (difference: 2.3 days; P ¼ 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis

Archimbaud

Chambon

Bailly

et al. 2008

Journal of Medical Virology

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“…The infections are most clinically noticeable in children, but they are also clearly present in adults (9). The viruses are maintained within the human population in tropical climates year-round and at low but detectable levels in both children and adults during the cold months in temperate climates (3).…”

mentioning

confidence: 99%

Correlation of Cerebrospinal Fluid (CSF) Cell Counts and Elevated CSF Protein Levels with Enterovirus Reverse Transcription-PCR Results in Pediatric and Adult Patients

Mulford

Buller²,

Arens³

et al. 2004

J Clin Microbiol

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We found that in the group of patients aged >2 months, the absence of pleocytosis was highly predictive of a negative RT-PCR result. Elevated CSF protein level was not a good predictor of RT-PCR positivity for enterovirus and did not add to the diagnostic sensitivity or specificity of pleocytosis.Enteroviruses (EVs) cause annual seasonal epidemics of aseptic meningitis in temperate climates and are the most common cause of this clinical syndrome in the United States. The infections are most clinically noticeable in children, but they are also clearly present in adults (9). The viruses are maintained within the human population in tropical climates year-round and at low but detectable levels in both children and adults during the cold months in temperate climates (3).Reverse transcription (RT)-PCR has become the method of choice for the rapid and efficient diagnosis of EV infections from cerebrospinal fluid (CSF). The use of commercially available (6,11,12,20) and in-house assay methods (6) is currently common in molecular diagnostic virology laboratories and often results in fewer tests being performed, less medication being used, and earlier release from the hospital than with previous diagnostic methods for patients with CSF samples with positive RT-PCR results for EV (EV RT-PCR) and negative Gram stains (4,8,10,14,15).Whether CSF pleocytosis plays an important role in defining aseptic meningitis or in prioritizing the differential diagnosis has been investigated but is still not completely clear (7,14,17). In this era of rapidly rising health care costs, it is important, if possible, to limit laboratory-based testing by encouraging syndrome-directed testing and actively discouraging testing that is not consistent with the clinical picture or with other laboratory results. Additionally, quality control within the laboratory can be enhanced by monitoring laboratory-based data to look for important correlations that will provide insight for clinicians and laboratory workers with regard to future testing requests.During the 2001, 2002, and 2003 EV seasons, we collected all available CSF cell count data and CSF protein data (available for 2001 and 2002 only) for patients for whom EV RT-PCR of CSF samples had been requested. Our suspicion that CSF with a nucleated cell count of Յ5 per mm 3 from patients more than 2 months old was not likely to be RT-PCR positive proved to be true, although a large number of CSF samples with high cell counts did not test positive for EV. MATERIALS AND METHODSCSF specimens (n ϭ 1,706) were submitted to the St. Louis Children's Hospital Virology Laboratory during the 2001, 2002, and 2003 EV seasons (roughly May to November of each year) for EV RT-PCR testing. Relevant CSF cell count data was available from the laboratory information system for 728 of the patients who were seen at Washington University Medical Center and tested by EV RT-PCR. Of the patients included in the study, 549 were pediatric (Յ18 years of age) and 179 were adults. The data analyzed included patient age, EV RT-PC...

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Enterovirus meningitis in Greece from 2003–2005: diagnosis, CSF laboratory findings, and clinical manifestations

Dumaidi

Frantzidou

Papa

et al. 2006

Clinical Laboratory Analysis

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Enteroviruses (EVs) are the most commonly identified cause of aseptic meningitis. Rapid detection and characterization of EV meningitis is essential in making decisions for patient management and treatment. A total of 52 cases of acute aseptic meningitis that occurred from March 2003 to April 2005 were investigated for EVs using viral culture and/or molecular methods directly in the cerebrospinal fluid (CSF). EVs were detected in 21 out of 52 (40.4%) patients using reverse transcription-PCR (RT-PCR) and/or tissue culture. EVs were isolated from six out of 37 (16.2%) cultured specimens, while 20 out of 52 (38.4%) specimens yielded positive results when 5'non-coding region (5'NCR) RT-PCR assay was used. One specimen that was culture-positive was RT-PCR-negative. Using the VP1-2A RT-PCR and sequence analysis, 14 of the 21 positive EVs were identified as: four strains of Coxsackie virus B5, five echovirus 11, two echovirus 9, one echovirus 5, one echovirus 14, and one Coxsackie virus A9. Fever, headache, vomiting, and stiff neck were the most pronounced symptoms. Pleocytosis with the predominance of lymphocytes and mild elevated protein levels characterized the CSF specimens. Coxsackie virus B5 and echovirus 11 were the predominant serotypes during the study period. Although there was seasonal enteroviral activity (April-November), cases also occurred in the cold months. The 5'NCR and VP1-2A RT-PCR with sequence analysis were found to be superior to conventional methods for direct diagnosis and the typing of EVs.

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Enterovirus meningitis in adults in 1999–2000 and evaluation of clinical management

Cited by 38 publications

References 24 publications

Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis

Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis

Correlation of Cerebrospinal Fluid (CSF) Cell Counts and Elevated CSF Protein Levels with Enterovirus Reverse Transcription-PCR Results in Pediatric and Adult Patients

Enterovirus meningitis in Greece from 2003–2005: diagnosis, CSF laboratory findings, and clinical manifestations

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