TITLE:
Clinical Investigation: The Presence of Viral Meningitis without Pleocytosis among Pediatric Patients
AUTHORS:
Adi Klein-Kremer, Vered Nir, Kassem Eias, Rony-Reuven Nir, Renata Yakubov, Keren Gershon
KEYWORDS:
Cerebrospinal Fluid (CSF), Enteroviral Meningitis, Lumbar Puncture, Polymerase Chain Reaction (PCR), Viral Meningitis
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.4,
November
26,
2014
ABSTRACT: Background:Viral meningitis (VM) is mostly common
among infants. Its induction by enteroviruses (EVM) is associated with
morbidity and is primarily diagnosed by lumbar puncture, which may yield false
negatives. We evaluated the frequency of VM by polymerase chain reaction (PCR)
among infants with no detected pleocytosis. Furthermore, as literature suggests
EVM essentially occurs during summer and fall, we characterized the monthly
distribution of EVM cases. Methods:Infants
diagnosed with VM from June 2009 to May 2010 were enrolled in the current
prospective study. Following each lumbar puncture, CSF was tested for
enteroviruses by PCR. Outcome measures were i) the percentage of EVM cases
revealed solely by PCR; and ii) the monthly distribution of EVM cases. Results:Enrolled
were 173 VM-diagnosed infants, of whom 75 (43.4%) tested positive in CSF-PCR.
Of these, no pleocytosis was indicated in 43 (57%), specifically in 70% and 42%
of infants younger than 90 days and older than 1 year, respectively.
Furthermore, 119 (69%) infants were admitted during June-November while 54
(31%) during December-May. Conclusions:Current findings stress the high
frequency of infants who were tested negative for pleocytosis, yet were
diagnosed with VM by PCR. This was especially noticeable among infants younger
than 3 months, possibly reflecting their decreased ability to mount a robust
inflammatory response to EV infection. CSF-PCR may be warranted in pediatric
patients who test negative for pleocytosis. While most EVM cases occurred
during the summer and fall, EVM-infants were admitted to the hospital all
through the year.