[Enteroviral meningitis in adults, underestimated illness: description of 30 observations from 1999 to 2000, and evolution of clinical practices during 2001].
Enteroviral meningitis is well documented in children but underestimated in adults. The analysis of 30 cases of adult meningitis prospectively diagnosed by enterovirus genome detection (RT-PCR) in cerebrospinal fluid (CSF) between 1999 and 2000 in routine practice showed diagnosis to be problematic. Characteristic symptoms were inconstant (the association of fever/headache/stiff neck absent in 41%) and sometimes misleading (the presence of peribuccal lesions). CSF data showed a predominance of lymphocytes in only 44% of patients. The most reliable criterion was normal constant CSF glucose levels. Thirty three per cent of patients were admitted during cold months. Management of patients varied markedly between departments, and included computed tomography (33%), and the prescription of aciclovir (20%) or antibiotics (53%). A report of positive enterovirus RT-PCR had only low impact on management because it took 6 days to obtain the results (versus 3 days in children during the same period). These findings were communicated to all hospital physicians concerned and as a result, the number of RT-PCR in adults increased significantly during 2001. Again, enteroviral meningitis was diagnosed in adults despite a much lower incidence of the illness in 2001 compared to 2000. Thus this pathology should not be underestimated in adults. Considerable medical expenditure might be avoided (cumulative numbers of 172 days in hospital and 82 days of antibiotics in this study), if rapid and accurate diagnostic techniques were available.
Peigue-Lafeuille
H
H
Laboratoire de virologie du CHRU, faculté de médecine, 28, Place Henri-Dunant, 63001 Cedex, Clermont-Ferrand, France. Helene.Lafeuille@u-clarmont1.fr
Archimbaud
C
C
De Champs
C
C
Croquez
N
N
Laurichesse
H
H
Clavelou
P
P
Aumaître
O
O
Schmidt
J
J
Henquell
C
C
Bailly
J L
JL
Chambon
M
M
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004770:Enterovirus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D015994:Incidence; D008587:Meningitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012621:Seasons
D000998:Antiviral Agents; D005947:Glucose; D000212:Acyclovir