Rittichier Kristine R, Bryan Paul A, Bassett Kathlene E, Taggart E William, Enriquez F Rene, Hillyard David R, Byington Carrie L
Divisions of Pediatric Emergency Medicine, the University of Utah, Salt Lake City, USA.
Pediatr Infect Dis J. 2005 Jun;24(6):546-50. doi: 10.1097/01.inf.0000164810.60080.ad.
Enterovirus (EV) infections commonly cause fever in infants younger than 90 days of age. The polymerase chain reaction (PCR) has improved our ability to diagnose EV infections.
To evaluate the utility of blood and cerebrospinal fluid (CSF) specimens for the diagnosis of EV infections by PCR and to describe a large cohort of EV-infected infants.
DESIGN/METHODS: Febrile infants younger than 90 days of age evaluated for sepsis at Primary Children's Medical Center in Salt Lake City, UT, were enrolled in a prospective study designed to identify viral infections from December 1996 to June 2002. All patients had bacterial cultures of blood, urine and CSF. Testing for EV was performed by PCR and/or viral cultures. Patients who were positive for EV were identified for this study.
Of 1779 febrile infants enrolled, 1061 had EV testing and 214 (20%) were EV-positive. EV infections were diagnosed by PCR of blood, CSF or both in 93% of infants. PCR testing was positive in blood in 57%, and blood was the only positive specimen for 22% of EV infected infants. PCR of CSF was positive in 74%. The mean age of infants with EV infection was 33 days, with 18% younger than 14 days and 5% younger than 7 days. Fifty percent of EV-positive infants had CSF pleocytosis. Of EV PCR-positive infants, 91% were admitted, and 2% required intensive care. Possible serious EV disease was diagnosed in <1%, and there were no deaths. Twelve infants (5.6%) had concomitant urinary tract infection, and 3 (1%) had bacteremia.
EV infections are common in febrile infants younger than 90 days. Blood and CSF are equally likely to yield positive results by PCR, but the combination of both specimens improved the diagnostic yield.
肠道病毒（EV）感染通常会导致90日龄以下婴儿发热。聚合酶链反应（PCR）提高了我们诊断EV感染的能力。
评估血液和脑脊液（CSF）标本用于通过PCR诊断EV感染的效用，并描述一大群EV感染婴儿的情况。
设计/方法：1996年12月至2002年6月期间，在犹他州盐湖城的 Primary Children's Medical Center 因败血症接受评估的90日龄以下发热婴儿被纳入一项前瞻性研究，该研究旨在识别病毒感染。所有患者均进行了血液、尿液和脑脊液的细菌培养。通过PCR和/或病毒培养进行EV检测。本研究确定了EV呈阳性的患者。
在纳入的1779名发热婴儿中，1061名进行了EV检测，214名（20%）EV呈阳性。93%的婴儿通过血液、脑脊液或两者的PCR诊断为EV感染。57%的血液PCR检测呈阳性，22%的EV感染婴儿血液是唯一的阳性标本。脑脊液PCR阳性率为74%。EV感染婴儿的平均年龄为33天，18%小于14天，5%小于7天。50%的EV阳性婴儿脑脊液有细胞增多。在EV PCR阳性婴儿中，91%入院，2%需要重症监护。诊断出可能的严重EV疾病的比例不到1%，且无死亡病例。12名婴儿（5.6%）伴有尿路感染，3名（1%）有菌血症。
EV感染在90日龄以下发热婴儿中很常见。血液和脑脊液通过PCR获得阳性结果的可能性相同，但两种标本联合使用可提高诊断率。
