Tan Natalie Woon Hui, Lee Elis Yuexian, Khoo Gloria Mei Chin, Tee Nancy Wen Sim, Krishnamoorthy Subramania, Choong Chew Thye
Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.
Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
J Neurovirol. 2016 Apr;22(2):213-7. doi: 10.1007/s13365-015-0387-2. Epub 2015 Oct 13.
Non-polio enteroviruses (EV) are the most common viruses causing aseptic meningitis in children. We aim to evaluate the cerebrospinal fluid (CSF) characteristics of neonates and children with EV meningitis with a view to determine whether it could be discriminatory or otherwise in making a positive diagnosis. We performed a 3-year (July 2008-July 2011) retrospective study of children ≤16 years, treated at a tertiary children's hospital, with positive CSF EV polymerase chain reaction (PCR) and negative blood and CSF bacterial cultures. A total of 206 children were studied. The median CSF white cell count was 79 cells/mm(3) (range 0-4608 cells/mm(3)). CSF pleocytosis was observed in 99/150 (66%) aged ≤90 days, 3/4 (75%) aged 90 days-1 year, and 49/52 (94%) children ≥3 years. There was a huge variability in CSF pleocytosis in infants ≤90 days, where 34% of them had no pleocytosis, while in 66%, a wide range of pleocytosis that might even suggest bacterial meningitis was noted. CSF red cells were low, and protein or sugar values were not discriminatory. CSF pleocytosis in relation to increasing age was found to be statistically significant (p < 0.001). Early lumbar puncture within 48 h of symptoms and absence of CSF pleocytosis was also statistically significant (p = 0.039). CSF pleocytosis in EV meningitis is commoner in older children. As there was a huge variability in CSF pleocytosis in infants ≤90 days particularly, CSF analysis including EV PCR could avoid unnecessary antibiotic therapy.
非脊髓灰质炎肠道病毒（EV）是导致儿童无菌性脑膜炎最常见的病毒。我们旨在评估患EV脑膜炎的新生儿和儿童的脑脊液（CSF）特征，以确定其在做出阳性诊断时是否具有鉴别性。我们对一家三级儿童医院收治的16岁及以下、脑脊液EV聚合酶链反应（PCR）呈阳性且血液和脑脊液细菌培养呈阴性的儿童进行了一项为期3年（2008年7月至2011年7月）的回顾性研究。共研究了206名儿童。脑脊液白细胞计数中位数为79个细胞/mm³（范围为0 - 4608个细胞/mm³）。在年龄≤90天的150名儿童中有99名（66%）观察到脑脊液细胞增多，90天至1岁的4名儿童中有3名（75%），≥3岁的52名儿童中有49名（94%）。年龄≤90天的婴儿脑脊液细胞增多情况差异极大，其中34%没有细胞增多，而在66%的婴儿中，观察到范围广泛的细胞增多，甚至可能提示细菌性脑膜炎。脑脊液红细胞数量较少，蛋白质或糖值无鉴别性。发现脑脊液细胞增多与年龄增长相关，具有统计学意义（p < 0.001）。症状出现后48小时内进行早期腰椎穿刺且无脑脊液细胞增多也具有统计学意义（p = 0.039）。EV脑膜炎中的脑脊液细胞增多在大龄儿童中更常见。特别是由于年龄≤90天的婴儿脑脊液细胞增多情况差异极大，包括EV PCR在内的脑脊液分析可避免不必要的抗生素治疗。
