Clinical utility of stool polymerase chain reaction in pediatric patients with suspected enteroviral meningitis

The purpose of this study was to evaluate whether stool polymerase chain reaction (PCR) has a higher clinical sensitivity for detecting enterovirus compared with cerebrospinal fluid (CSF) PCR in pediatric patients suspected to have enteroviral meningitis. We retrospectively reviewed 139 pediatric patients with enteroviral meningitis diagnosed in our hospital during 2010-2012. Enteroviral meningitis was diagnosed based on detection of virus in CSF and/or stool samples in aseptic meningitis patients. Patients were divided into definitive enteroviral meningitis (positive CSF PCR) and highly probable enteroviral meningitis (negative CSF PCR, but positive stool PCR) groups. The clinical characteristics of the two groups were compared to identify the characteristics of patients with highly probable enteroviral meningitis. We also analyzed the influence of sampling time on the PCR results of the two specimen types. Patients with highly probable enteroviral meningitis had a lower white blood cell count in CSF(P < 0.01) and a longer latency between symptom onset and CSF sampling (P = 0.03) than did patients with definitive enteroviral meningitis. The CSF enterovirus positivity rate was lower in CSF specimens obtained > 1 day after clinical onset, whereas the majority of stool samples were PCR positive throughout the course of the disease. Our results suggest that PCR of stool specimens may be useful in pediatric patients with suspected enteroviral meningitis, particularly when the duration of symptoms is >1 day and/or a lower degree of CSF pleocytosis is observed.