Utility of enterovirus polymerase chain reaction testing in the diagnosis of aseptic meningitis: analysis of an outbreak with 17 confirmed cases

Objective: To describe the use of enterovirus polymerase chain reaction (PCR) testing in the diagnosis of meningitis and discuss the therapeutic implications. Methods: Retrospective, descriptive analysis of clinical and laboratory findings as well as the result of PCR analysis during an emergency department outbreak between June 28 and July 26, 2007. Results: Twenty-one cases of aseptic meningitis were treated during the outbreak. 11 patients (52%) were men, the mean age was 22 years (range, 4-39 years), and all patients were immnunocompetent. Seven were pediatric patients (mean age, 7 years, range, 4-10 years) Symptoms lasted 2 days on the average (4 days in adults). The main symptoms were headache (100%), fever (95%), vomiting (87%), and signs of meningeal infection (48%). The mean white blood cell count in whole blood was 9206/mu L (range, 3180-15 000/mu L) with a predominance of lymphocytes in 3 patients (14.2%). The mean white blood cell count in cerebrospinal fluid (CSF) was 144/mL; in 2 cases (9.5%) there was predominance of polynuclear cells The mean glucose concentration in CSF was 58 mg/dL; the mean protein concentration was 50 mg/dL. PCR testing in CSF confirmed that 17 of the meningitis cases were due to enterovirus (81%). In 4 patients (19%), the enterovirus PCR was negative but the virus grew in CSF cultures All patients were hospitalized (average stay, 3 days). Three patients (14%) initially received antibiotic and/or antiviral treatment None developed complications or sequelae Conclusions: Enterovirus PCR testing facilitates the rapid, reliable diagnosis of meningitis. Empirical treatment with antibiotics and antiviral drugs can be avoided. Testing is an aid to optimal, safe use of health resources as unnecessary admissions and fruitless treatment are avoided Our experience confirms the benign nature of this type of infection. [Emergencias 2010;22:199-202]