title: A season of aseptic meningitis in Germany: epidemiologic, clinical and diagnostic aspects.
abstract: OBJECTIVE
  We assessed epidemiologic, clinical and laboratory features of aseptic meningitis during one season of multiserotype enteroviral meningitis in East Germany in 70 consecutive patients with aseptic meningitis admitted to the Children's University Hospital Leipzig.
  
  
  RESULTS
  Patients, age 1 to 16 years, typically presented with headache, emesis and fever, whereas signs of meningeal irritation were only moderately expressed in one-half of the patients. The median number of leukocytes in the CSF was 151 cells/mm(3) (range, 2 to 1,820) with a high percentage of polymorphonuclear cells (PMNs). Initial blood counts showed mild leukocytosis and pronounced PMN predominance (78.9 +/- 1.3%). The percentage of PMNs in the peripheral blood decreased in favor of mononuclear cells after 3 days to a pattern more compatible with viral infection as opposed to that suggestive for bacteria in the beginning. Mean cerebrospinal fluid values of protein, glucose and lactate and the C-reactive protein were mildly elevated or normal. Nonpolio enteroviruses were detected in 30 of 70 patients. Subsequent serotyping revealed echovirus type 13 (13 patients), type 6 (2), type 30 (1) and coxsackie B virus type 5 (2). There were no differences in demographic or clinical data between enterovirus positive and negative patients.
  
  
  CONCLUSIONS
  Even though individual laboratory values do not solely allow discrimination between viral and bacterial meningitis, the combined epidemiologic, clinical and laboratory data facilitate the diagnosis of aseptic meningitis in most cases. Viral diagnostics, identifying echovirus type 13 that thus far has not been associated with epidemics of meningitis, adds important epidemiologic information.
authors.affiliation: Children's Hospital, University of Leipzig, Germany. antje.boettner@gmx.net
authors.forename: Antje
authors.initials: A
authors.lastname: Böttner
authors.forename: Said
authors.initials: S
authors.lastname: Daneschnejad
authors.forename: Werner
authors.initials: W
authors.lastname: Handrick
authors.forename: Volker
authors.initials: V
authors.lastname: Schuster
authors.forename: Uwe Gerd
authors.initials: UG
authors.lastname: Liebert
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001483:Base Sequence; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003384:Coxsackievirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004196:Disease Outbreaks; D004457:Echovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004769:Enterovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction / Q000379:methods; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D018570:Risk Assessment; D012621:Seasons; D017678:Sex Distribution; D018709:Statistics, Nonparametric
chemical_list: D012367:RNA, Viral