Tags

Type your tag names separated by a space and hit enter

Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children?
J Neurovirol. 2016 Apr; 22(2):213-7.JN

Abstract

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.

Authors+Show Affiliations

Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore. Natalie.Tan.W.H@singhealth.com.sg. Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. Natalie.Tan.W.H@singhealth.com.sg. Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore. Natalie.Tan.W.H@singhealth.com.sg.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore.Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.Neurology Service, Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26463525

Citation

Tan, Natalie Woon Hui, et al. "Cerebrospinal Fluid White Cell Count: Discriminatory or Otherwise for Enteroviral Meningitis in Infants and Young Children?" Journal of Neurovirology, vol. 22, no. 2, 2016, pp. 213-7.
Tan NW, Lee EY, Khoo GM, et al. Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children? J Neurovirol. 2016;22(2):213-7.
Tan, N. W., Lee, E. Y., Khoo, G. M., Tee, N. W., Krishnamoorthy, S., & Choong, C. T. (2016). Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children? Journal of Neurovirology, 22(2), 213-7. https://doi.org/10.1007/s13365-015-0387-2
Tan NW, et al. Cerebrospinal Fluid White Cell Count: Discriminatory or Otherwise for Enteroviral Meningitis in Infants and Young Children. J Neurovirol. 2016;22(2):213-7. PubMed PMID: 26463525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children? AU - Tan,Natalie Woon Hui, AU - Lee,Elis Yuexian, AU - Khoo,Gloria Mei Chin, AU - Tee,Nancy Wen Sim, AU - Krishnamoorthy,Subramania, AU - Choong,Chew Thye, Y1 - 2015/10/13/ PY - 2015/06/24/received PY - 2015/09/21/accepted PY - 2015/09/18/revised PY - 2015/10/15/entrez PY - 2015/10/16/pubmed PY - 2016/12/15/medline KW - Enterovirus KW - Meningitis KW - Pediatrics KW - Pleocytosis KW - Polymerase chain reaction (PCR) SP - 213 EP - 7 JF - Journal of neurovirology JO - J Neurovirol VL - 22 IS - 2 N2 - 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. SN - 1538-2443 UR - https://www.unboundmedicine.com/medline/citation/26463525/Cerebrospinal_fluid_white_cell_count:_discriminatory_or_otherwise_for_enteroviral_meningitis_in_infants_and_young_children L2 - https://dx.doi.org/10.1007/s13365-015-0387-2 DB - PRIME DP - Unbound Medicine ER -