Prospective Comparison of Culture vs Genome Detection for Diagnosis of Enteroviral Meningitis in Childhood

Tanel, Ronn E.; Kao, Shaw Yi; Niemiec, Tina M.; Loeffelholz, Michael J.; Holland, Diane T.; Shoaf, Lorraine A.; Stucky, Erin R.; Burns, Jane C.

doi:10.1001/archpedi.1996.02170340033006

Cited by 37 publications

(21 citation statements)

References 23 publications

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“…Finally, results of EV-PCR of CSF samples were negative for 68.8% of our patients, and most diagnoses were made on the basis of results of EV-PCR of upper respiratory and/or lower gastrointestinal tract specimens. In the United States, laboratory confirmation of enterovirusassociated neurologic disease is typically performed by PCR of CSF samples because of the greater sensitivity and rapid turnaround time, compared with culture [13,21]. For enteroviralassociated neurologic disease other than EV71-associated disease, the sensitivity of EV-PCR of CSF samples is reported to be 76%-100% [13,[22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Outbreak of Neurologic Enterovirus Type 71 Disease: A Diagnostic Challenge

Pérez-Vélez

Anderson

Robinson

et al. 2007

Clinical Infectious Diseases

181

114

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Background. Similar to poliovirus, enterovirus type 71 (EV71) causes severe disease, including aseptic meningitis, encephalitis, acute flaccid paralysis, and acute cardiopulmonary dysfunction. Large epidemics of EV71 infection have been reported worldwide.Methods. After recognition of a cluster of cases of EV71 disease, we reviewed records of patients with EV71 disease who required hospitalization at The Children's Hospital in Denver, Colorado, from 2003 through 2005. The presence of enterovirus was detected by reverse-transcriptase polymerase chain reaction (PCR) and/or viral culture of specimens from multiple sources, and the virus was typed as EV71 using genetic sequencing.Results. Eight cases of EV71 disease were identified in both 2003 and 2005. Fifty-six percent of patients with EV71 disease were р6 months of age (range, 4 weeks to 9 years). All 16 patients had EV71 central nervous system infection. Enterovirus PCR (EV-PCR) of cerebrospinal fluid specimens yielded positive results for only 5 (31.2%) of the 16 patients; all of these patients were !4 months of age and had less severe disease. However, EV-PCR of upper respiratory tract specimens yielded positive results for 8 (100%) of 8 patients, and EV-PCR of lower gastrointestinal tract specimens yielded positive results for 7 (87.5%) of 8 patients.Conclusions. An outbreak of neurologic EV71 disease occurred in Denver, Colorado, during 2003 and 2005. Likely, EV71 disease remains unrecognized in other parts of the United States, because EV-PCR of cerebrospinal fluid frequently yields negative results. EV-PCR of specimens from the respiratory and gastrointestinal tracts had higher diagnostic yields than did EV-PCR of cerebrospinal fluid. EV71 infection should be considered in young children presenting with aseptic meningitis, encephalitis, acute flaccid paralysis, or acute cardiopulmonary collapse. EV71 infection may be an underrecognized emerging disease in the United States.

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Section: Discussionmentioning

confidence: 99%

Outbreak of Neurologic Enterovirus Type 71 Disease: A Diagnostic Challenge

Pérez-Vélez

Anderson

Robinson

et al. 2007

Clinical Infectious Diseases

181

114

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“…[15][16][17][18][19][20] In febrile patients who had both types of testing, PCR was twice as sensitive as EV culture. Additionally, a prospective study was conducted concurrently in our laboratory during the 1997 EV season, in which positive PCR results were corroborated by clinical data.…”

Section: Discussionmentioning

confidence: 99%

A Polymerase Chain Reaction-based Epidemiologic Investigation of the Incidence of Nonpolio Enteroviral Infections in Febrile and Afebrile Infants 90 Days and Younger

et al. 1999

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ABSTRACT. Objective. Enteroviruses are important pathogens in infants, but their true contribution to febrile illness in infants <90 days old is unknown. The purpose of this study was to use the polymerase chain reaction (PCR) for diagnosis of enteroviral (EV) infection in febrile and afebrile infants <90 days of age to improve the understanding of the epidemiology of EV infection in this population.Methods. Patients included all unimmunized, febrile infants <90 days of age admitted to Primary Children's Medical Center (Salt Lake City, UT) for sepsis evaluation from December 1996 to December 1997. Blood, urine, cerebrospinal fluid, and throat swabs were tested for enteroviruses using a PCR assay (Roche Molecular Systems, Branchburg, NJ). Alternate PCR assays separated polio and nonpolio enteroviruses. Results of bacterial cultures, outcome, and hospital charges were obtained. Blood from afebrile, control infants <90 days old was tested for enteroviruses.Results. A total of 345 febrile infants were enrolled; 89 (25.8%) were positive for enterovirus. The incidence of EV infection ranged from 3.2% in January to 50% in August and October. Five EV-positive, febrile infants (5.6%) had concomitant urinary tract infections, and 1 (1.1%) had concomitant bacteremia. Infants with confirmed EV infection were significantly less likely to have bacterial infection than those who were EV-negative. All infants infected with an enterovirus recovered. Average length of stay was 3 days, average charges were nearly $4500. Eighty-six afebrile, control infants were enrolled; 6 (6.9%) were positive for enterovirus; 3 had received oral polio vaccine.Conclusions. Nonpolio EV infections commonly cause fever in infants <90 days of age. Rates of EV positivity are low in afebrile, unimmunized infants. The use of PCR to identify febrile infants with nonpolio EV infections may decrease length of hospital stay, unnecessary antibiotic administration, and charges. Pediatrics 1999;103(3). URL: http://www.pediatrics.org/cgi/content/ full/103/3/e27; enterovirus, PCR, febrile infants, bacterial infection, poliovirus.

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“…In most cases, viral meningitis, commonly referred to as 'aseptic meningitis', is associated with enterovirus infection, although other viral agents, such as arboviruses, herpes simplex viruses, lymphocytic choriomeningitis virus, mumps virus, and others, can also be implicated [1,2]. With the availability of new diagnostic tests for enterovirus meningitis [3][4][5][6] and ongoing development of new anti-enterovirus drugs [7], a better understanding of the burden of viral meningitis is important for developing and evaluating treatment, diagnostic, and prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Viral Meningitis-Associated Hospitalizations in the United States, 1988–1999

Khetsuriani¹,

Quiroz

Holman

et al. 2003

Neuroepidemiology

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We used the National Hospital Discharge Survey and the Nationwide Inpatient Sample of the Health Care Cost and Utilization Project to estimate disease burden associated with viral meningitis hospitalizations in the United States. During 1988–1999, viral meningitis accounted for an estimated 434,000 hospitalizations (annual average, 36,000; average annual hospitalization rate, 14/100,000), and 2.1 million hospital days (annual average, 175,000). The estimated mean charge for viral meningitis-associated hospitalization during 1993–1997 varied between USD 6,562 and 8,313, resulting in annual estimated hospitalization costs between USD 234 and 310 million and a total estimated cost of nearly USD 1.3 billion for the 5-year period. In summary, viral meningitis remains an important cause of morbidity and financial burden and merits efforts to improve diagnostic, treatment, and prevention options.

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Prospective Comparison of Culture vs Genome Detection for Diagnosis of Enteroviral Meningitis in Childhood

Cited by 37 publications

References 23 publications

Outbreak of Neurologic Enterovirus Type 71 Disease: A Diagnostic Challenge

Outbreak of Neurologic Enterovirus Type 71 Disease: A Diagnostic Challenge

A Polymerase Chain Reaction-based Epidemiologic Investigation of the Incidence of Nonpolio Enteroviral Infections in Febrile and Afebrile Infants 90 Days and Younger

Viral Meningitis-Associated Hospitalizations in the United States, 1988–1999

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