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

Abstract

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.

Enteroviral Central Nervous System Infections in Children of the Region of Monastir, Tunisia: Diagnosis, Laboratory Findings of Cerebrospinal Fluid and Clinical Manifestations

“…In the current study, sporadic cases of enteroviral meningitis were observed throughout the year even in winter months (a year-round EV distribution), with a peak in spring and summer which is in agreement of previous reports [15,17,24].…”

“…A higher prevalence of enteroviral meningitis in males versus females has been reported in the present study (2.33:1) and in others but there is no clear explanation [15,17,24].…”

An Outbreak of Aseptic Meningitis Due to Echovirus 30 in a High School Baseball Club-Possible Role of Severe Exercise for a High Attack Rate

“…Child-care centers sometimes became the place of outbreaks, but the attack rate ranged from 3 to 13% (23)(24)(25)29). Only 24% of people with serological evidence of recent E30 infection showed symptoms in one study (23).…”

Aseptic Meningitis Caused by Enteroviruses

“…Among the 43 members of the baseball club related to our case, 12 were admitted to our hospital, 5 to other hospitals, and all of the other members developed a fever and headache even though they were not admitted to hospitals. This attack rate was extraordinarily high; that in previous reports ranged from 3 to 13% (Akiyoshi et al, 2007;Dumaidi et al, 2006;Mohle-Boetani et al, 1999;Vieth et al, 1999). This extraordinarily high attack rate could be explained by the physically severe training the club members undertook before or just after virus infection.…”

“…When the patient is an infant who still needs diapers, caregivers should take special precautions to decrease the spread of infection. Indeed, child-care centers sometimes become the center of outbreaks (Akiyoshi et al, 2007;Dumaidi et al, 2006;Mohle-Boetani et al, 1999;Vieth et al, 1999). To use gloves is warranted.…”