Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children?
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.
['Tan|Natalie Woon Hui|NW|', 'Lee|Elis Yuexian|EY|', 'Khoo|Gloria Mei Chin|GM|', 'Tee|Nancy Wen Sim|NW|', 'Krishnamoorthy|Subramania|S|', 'Choong|Chew Thye|CT|']
D000293:Adolescent D000367:Age Factors D002648:Child D002675:Child, Preschool D003937:Diagnosis, Differential D004770:Enterovirus D004769:Enterovirus Infections D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D007958:Leukocyte Count D007964:Leukocytosis D008297:Male D008582:Meningitis, Aseptic D016920:Meningitis, Bacterial D008587:Meningitis, Viral D012189:Retrospective Studies
Meningitis Polymerase chain reaction (PCR) Pleocytosis Enterovirus Pediatrics