Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
J Med Virol. 2021 Jun;93(6):3389-3396. doi: 10.1002/jmv.26480. Epub 2020 Sep 29.
Viral meningitis is the most common type of meningitis. Worldwide, nonpolio enteroviruses (NPEVs) account for 23%-60% of all cases of viral meningitis. We aimed to detect NPEV among aseptic meningitis cases using reverse transcription-polymerase chain reaction (RT-PCR) and evaluate molecular testing versus clinical and laboratory parameters.
A 2-year prospective study was conducted for all clinically suspected meningitis patients, who underwent lumbar puncture in Alshatby University and Alexandria Fever Hospitals. Clinical manifestations were reviewed; cytological, microbiological, and biochemical examinations were done. One-step RT-PCR for NPEV was introduced to a routine workflow using Pan-Enterovirus primers.
Out of 2519 patients, 994 (40%) patients were found to have positive cerebrospinal fluid findings, out of which 716 (72%) patients had positive findings of aseptic meningitis. Ninety-four samples were randomly selected and divided across four age groups: neonates, infants, children, and adults. The significant difference was found among adult patients regarding fever, vomiting, headache, signs of meningeal irritation, cranial nerve affection, and focal neurological deficits (p ≤ .05). Seven cases (7.4%) were found to be NPEV positive by RT-PCR. Positive NPEV PCR samples were shown to be statistically significant among neonates (p ≤ .05). The statistical significance was found among the NPEV group regarding the length of hospital stay and duration of IV antibiotic intake while no statistical significance was found with any clinical or laboratory findings.
RT-PCR was reliable to identify NPEV while clinical and laboratory findings were inconclusive. NPEV showed low incidence and slight seasonal variation which rings the bell to investigate other causes of viral meningitis throughout the year.
病毒性脑膜炎是最常见的脑膜炎类型。在全球范围内，非脊髓灰质炎肠道病毒（NPEV）占所有病毒性脑膜炎病例的 23%-60%。我们旨在通过逆转录-聚合酶链反应（RT-PCR）检测无菌性脑膜炎病例中的 NPEV，并评估分子检测与临床和实验室参数的关系。
对 Alshatby 大学和亚历山大发热医院所有疑似临床脑膜炎的患者进行了为期 2 年的前瞻性研究，所有患者均接受了腰椎穿刺。回顾了临床表现；进行了细胞学、微生物学和生物化学检查。使用 Pan-Enterovirus 引物将一步 RT-PCR 引入 NPEV 的常规工作流程。
在 2519 例患者中，994 例（40%）患者脑脊液检查结果阳性，其中 716 例（72%）患者无菌性脑膜炎检查结果阳性。随机选择了 94 个样本，并分为四个年龄组：新生儿、婴儿、儿童和成人。在发热、呕吐、头痛、脑膜刺激征、颅神经受累和局灶性神经功能缺损方面，成人患者之间存在显著差异（p≤0.05）。通过 RT-PCR 发现 7 例（7.4%）为 NPEV 阳性。NPEV PCR 阳性样本在新生儿中具有统计学意义（p≤0.05）。在 NPEV 组中，住院时间和静脉抗生素使用时间存在统计学意义，而与任何临床或实验室检查结果均无统计学意义。
RT-PCR 是一种可靠的识别 NPEV 的方法，而临床和实验室检查结果则不明确。NPEV 的发病率较低，季节性变化轻微，这提醒我们全年都要调查病毒性脑膜炎的其他病因。
