Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

Drysdale, Simon B.; Kelly, Dominic F.

doi:10.1136/archdischild-2016-310632

Cited by 13 publications

(13 citation statements)

References 43 publications

(38 reference statements)

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“…All children without concomitant bacterial infection underwent antibiotic therapy that lasted 5 or more days in approximately 2/3 of cases. C-reactive protein levels increased in only a few cases and could not account for the prolonged antibiotic treatments, since more recent literature suggests discontinuing therapy when EV infection is confirmed [33].…”

Section: Discussionmentioning

confidence: 99%

Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study

et al. 2019

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Background Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated. Methods We retrospectively investigated EV infections occurring at an Italian tertiary care center during 2006–2017. Cases were confirmed with a positive polymerase chain reaction on blood or cerebrospinal fluid. Clinical and laboratory findings according to age at presentation were analyzed. Results Among 61 cases of EV infection, 56 had meningitis, 4 had encephalitis, and 1 had unspecific febrile illness. Forty-seven cases (77.0%) presented at less than 1 year of age, and most were less than 90 days of age ( n = 44). Presentation with fever ( p < 0.01), higher median temperature ( p < 0.01), and irritability ( p < 0.01) were significantly more common among infants aged less than 90 days, who also had significantly higher peak temperatures during the course of the disease ( p < 0.01). In contrast, gastrointestinal symptoms were more common in infants and children aged over 90 days ( p = 0.02). Only 4 of 61 infections (6.5%) were severe and all affected younger infants ( p < 0.01). Conclusions We detail epidemiological, clinical, and laboratory findings in a cohort of 61 children. Infants aged less than 90 days have more severe disease; they are more likely to present with fever, higher median temperature, and irritability and less likely to develop gastrointestinal symptoms.

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Section: Discussionmentioning

confidence: 99%

Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study

et al. 2019

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“…A positive diagnosis of HPeV infection would allow cessation of antibiotic therapy and may thereby facilitate earlier discharge from hospital (86). In addition, testing HPeV using PCR in blood samples of infants who are being evaluated for infection would increase the diagnostic yield as higher viral loads are seen in serum compared with CSF (51).…”

Section: Improving Diagnosis Of Parechovirus Infectionsmentioning

confidence: 99%

Strategies to improve detection and management of human parechovirus infection in young infants

Kadambari

Harvala

Simmonds

et al. 2019

The Lancet Infectious Diseases

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Human parechovirus (HPeV) infections are the second most common cause of viral meningitis in children. HPeV's are most frequently seen in infants less than 90 days of age. Clinical manifestations include encephalitis, meningitis, myocarditis and sepsis syndrome, which can lead to significant neurodevelopmental sequelae in young infants. Molecular techniques, including polymerase chain reaction assays are the diagnostic tool of choice and have contributed to a marked increase in reported cases, along with an increasing awareness of the aetiological role of HPeV in infant disease. However, focused clinical and diagnostic investigations for HPeV in infants and the use of such information in management is variable due in part to the lack of robust incidence data and its range of clinical presentations. A better understanding of the pathogenesis and epidemiology of HPeV infections is required to inform an evidence-based approach to diagnosis and treatment in the future.

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“…At present clinical guidelines do not differentiate between the management of children presenting with EV versus HPeV infections. 3 This study demonstrates that differences in the severity of clinical illness can be seen between the HPeV and EV CNS infections, with a greater degree of severity in HPeV cases. Further studies are required to clarify and confirm these findings, which may then lead to more practical clinical guidelines for the immediate and longer-term management and followup of these patients.…”

Section: Discussionmentioning

confidence: 65%

“…Although some previous studies have found pediatric HPeV and EV infections clinically indistinguishable, 1,3 anecdotally, in our pediatric population, nurses who worked with children involved in our recent HPeV outbreak, 2 reported that they were able to distinguish which children had HPeV rather than EV, prior to any laboratory confirmation, on their clinical presentation alone. These HPeV cases were noted to be generally more irritable and persistently unconsolable, tachychardic and pyrexial than the more frequently encountered annual, seasonal EV cases with which the nurses were very familiar.…”

Section: Discussionmentioning

confidence: 74%

“…In recent years, the extent to which parechoviruses may be contributing to neonatal and infant morbidity and mortality has begun to emerge. [1][2][3] Enteroviruses ( Previous studies have found that the clinical presentation of the two viruses are often indistinguishable. 1,3 Our diagnostic virology laboratory has only relatively recently (since mid-2014)…”

Section: Introductionmentioning

confidence: 99%

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Comparing the Clinical Severity of Disease Caused by Enteroviruses and Human Parechoviruses in Neonates and Infants

Black

Bradley

Lai

et al. 2019

Pediatric Infectious Disease Journal

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Comparison of children hospitalized with enterovirus (EV) or human parechovirus (HPeV) detected in their cerebrospinal fluid (CSF) revealed that HPeV infections presented with more persistent fever, irritability and feeding problems, more frequent leukopenia and lymphopenia, and higher admission rates to high dependency or intensive care units. Few HPeV cases were followed-up, further studies on long-term outcomes are needed.

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Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

Cited by 13 publications

References 43 publications

Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study

Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study

Strategies to improve detection and management of human parechovirus infection in young infants

Comparing the Clinical Severity of Disease Caused by Enteroviruses and Human Parechoviruses in Neonates and Infants

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