The impact of an enteroviral RT-PCR assay on the diagnosis of aseptic meningitis and patient management.
BACKGROUND
Enterovirus (EV) is a major cause of aseptic meningitis and non-specific febrile illness in children. Since the majority of patients are hospitalized for possible bacterial infection, a rapid test for the diagnosis of enteroviral meningitis (EVM) may reduce hospitalizations and unnecessary treatments.


OBJECTIVE
To review the impact of an EV reverse transcriptase-polymerase chain reaction (RT-PCR) assay for the diagnosis of EVM on patient management.


METHODS
CSF from 1056 patients admitted to the hospital between 1998 and 2001 was tested using EV RT-PCR. The results were correlated with CSF counts, diagnosis, test turnaround time (TAT) and length of hospital stay (LOS).


RESULTS
EV RT-PCR was positive for 113 patients (11%). Of these cases, 92% occurred during the summer months and 77% were in children <19 years of age. Children <3 years old with EVM frequently had non-specific clinical findings and lacked pleocytosis. There was a significant correlation between decreasing LOS and TAT (r(2)=0.97, P<0.001).


CONCLUSIONS
RT-PCR testing for EVM is an important tool to aid in the diagnosis of children with non-specific febrile illness. This test impacted patient management as measured by shortened patient stays, which should translate into significant health care savings.
Stellrecht
K A
KA
Department of Pathology and Laboratory Medicine, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA. stellrk@mail.amc.edu
Harding
I
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Woron
A M
AM
Lepow
M L
ML
Venezia
R A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D007964:Leukocytosis / Q000175:diagnosis; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012621:Seasons
D012367:RNA, Viral