Diagnosis of Enteroviral Meningitis by Use of Polymerase Chain Reaction of Cerebrospinal Fluid, Stool, and Serum Specimens

INTRODUCTION: Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)-positive and -negative patients to determine those that were most influential in admission, discharge and in anti-infective administration.METHODS: Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three-year period.RESULTS: The oldest EV-positive patient was 34 years of age and the occurrence of the disease was highly seasonal. EV-positive patients were more likely to report fever, rash, photophobia, short onset and exposure to an ill contact. A positive polymerase chain reaction (PCR) result was associated with relatively short hospitalization. Seizure and neurological symptoms were more strongly associated with a negative PCR test result. CSF characteristics did not discriminate well between patients with positive and negative PCR tests. Patients with imperfect Glasgow Coma Scores or with neurological symptoms were more likely to be admitted to hospital than those without. Fever and recent onset predicted determinants of anti-infective use.CONCLUSION: The present retrospective study confirms previous reports regarding seasonality and the young age of positive patients. Factors that indicate nonenteroviral etiology were appropriately also those that influenced hospitalization. Patients with EV meningitis were likely to be treated with empirical anti-infectives, and a substantial proportion continued to take antibiotics for more than 24 h after receiving the positive EV PCR test result.

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Amplicor Enterovirus Polymerase Chain Reaction in Patients With Aseptic Meningitis

Archives of Pathology & Laboratory Medicine ◽

10.5858/1999-123-0882-aepcri ◽

1999 ◽

Vol 123 (10) ◽

pp. 882-884

Author(s):

Emilia Hadziyannis ◽

Nancy Cornish ◽

Colleen Starkey ◽

Gary W. Procop ◽

Belinda Yen-Lieberman

Keyword(s):

Cell Culture ◽

Polymerase Chain Reaction ◽

Cerebrospinal Fluid ◽

Chart Review ◽

Culture Method ◽

Final Diagnosis ◽

Rt Pcr ◽

Chain Reaction ◽

Polymerase Chain ◽

Enteroviral Meningitis

Abstract Objective.—To evaluate the sensitivity and specificity of reverse-transcription polymerase chain reaction (RT-PCR) and routine cell culture for the detection of enterovirus in cerebrospinal fluid. Methods.—Thirty-eight cerebrospinal fluid specimens were included. Cell culture was inoculated immediately and incubated for 14 days. An aliquot was kept frozen for Amplicor RT-PCR. Chart review was performed to determine the validity of the results. Results.—Nine of 38 specimens were positive for enterovirus by culture, and 14 were positive by RT-PCR. There were 7 discrepancies between the 2 methods. Six specimens were positive by RT-PCR and negative by the culture method. The 1 culture-positive but RT-PCR–-negative specimen was determined to contain PCR inhibitors. All discrepant results were confirmed as true positives by chart review. Patients whose cerebrospinal fluid was negative by both methods had a final diagnosis other than enterovirus infection. Conclusion.—Amplicor PCR is more sensitive than cell culture (93.3% vs 60%) and is very specific. With the incorporation of appropriate controls for the detection of amplification inhibitors, RT-PCR could be a valuable tool in the diagnosis of enteroviral meningitis.

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Enteroviral Meningitis in Infancy: Potential Role for Polymerase Chain Reaction in Patient Management

PEDIATRICS ◽

10.1542/peds.94.2.157 ◽

1994 ◽

Vol 94 (2) ◽

pp. 157-162 ◽

Cited By ~ 2

Author(s):

Yechiel Schlesinger ◽

Mark H. Sawyer ◽

Gregory A. Storch

Keyword(s):

Polymerase Chain Reaction ◽

Cerebrospinal Fluid ◽

Patient Management ◽

Specific Method ◽

Chain Reaction ◽

Study Objective ◽

Viral Culture ◽

Young Infants ◽

Polymerase Chain ◽

Enteroviral Meningitis

Study objective. To evaluate the performance characteristics and potential clinical utility of a polymerase chain reaction (PCR) assay for enteroviral RNA in comparison to viral culture in infants under 3 months of age with meningitis. Specimens and testing. Specimens were obtained from a collection of cerebrospinal fluid specimens from infants under 3 months of age (excluding those in the neonatal intensive care unit) undergoing lumbar puncture at St. Louis Children's Hospital during a 12-month period. Those tested by PCR included all 27 with pleocytosis, 8 others from infants without pleocytosis but from whom an enterovirus was cultured, and 10 from infants who did not have pleocytosis and had a negative viral culture of cerebrospinal fluid. Viral cultures were performed at the discretion of physicians caring for individual patients. Results. PCR was positive for enteroviral RNA on cerebrospinal fluid (CSF) specimens from 11 of 12 patients with definite or probable enteroviral meningitis, as well as on 6 of 13 with possible enteroviral meningitis, and was negative on all 10 with absence of pleocytosis and negative enteroviral cultures. CSF viral cultures were negative in 6 of the patients in whom PCR was positive. Viral cultures had minimal impact on patient management. In contrast, under study assumptions, PCR could have saved an average of 1.2 days of hospitalization per patient in the 27 patients with CSF pleocytosis. Conclusions. Enterovirus PCR performed on CSF is a sensitive and specific method for the diagnosis of enteroviral meningitis. This method has the potential for improving the accuracy of diagnosis in young infants and for saving costs by allowing earlier diagnosis and discharge from the hospital when clinically appropriate.

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