title: Clinical and diagnostic findings of an echovirus meningitis outbreak in the north west of England.
abstract: BACKGROUND
  An outbreak of echovirus meningitis occurred in the north west of England in 2001. This paper reviewed the clinical features and the role of different diagnostic methods.
  
  
  METHODS
  This was a prospective study of adults admitted to a regional infectious disease unit with a probable diagnosis of meningitis, March to August 2001.
  
  
  RESULTS
  Half the 40 cases were male; median age was 28 (range 16-51) years. Fifteen of 38 (39.5%) were smokers, and 20 of 24 (83.3%) had close contact with children. Median (range) duration of symptoms was 1.1 (0.25-7) days. Symptoms included headache (100%), photophobia (87.5%), and nausea (67.5%), and severity ranged from minimal signs to those consistent with a meningoencephalitis. The diagnosis was confirmed virologically in 29 of 40 (72%); echovirus 30 was isolated from six. Cerebrospinal fluid (CSF) enterovirus polymerase chain reaction (PCR) was positive in 26 of 32 (81%), and CSF virus culture in 3 of 16 (19%). Thirty one per cent of CSF samples had a neutrophil predominance, and 3 of 29 (10%) virologically confirmed cases had normal CSF microscopy and biochemistry.
  
  
  CONCLUSIONS
  CSF microscopy may be normal or suggest bacterial meningitis in a substantial minority of cases of echovirus meningitis. CSF PCR for enterovirus seems to be more sensitive than virus culture of CSF, although PCR does not yield information on circulating virus type. Early and accurate diagnosis could reduce both use of parenteral antibiotics and length of hospital stay with both morbidity and cost implications. Close contact with children may be a risk factor, particularly if good hygiene measures are not practised.
authors.affiliation: Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK.
authors.forename: E D
authors.initials: ED
authors.lastname: Carrol
authors.forename: M B J
authors.initials: MB
authors.lastname: Beadsworth
authors.forename: N
authors.initials: N
authors.lastname: Jenkins
authors.forename: L
authors.initials: L
authors.lastname: Ratcliffe
authors.forename: I
authors.initials: I
authors.lastname: Ashton
authors.forename: B
authors.initials: B
authors.lastname: Crowley
authors.forename: F J
authors.initials: FJ
authors.lastname: Nye
authors.forename: N J
authors.initials: NJ
authors.lastname: Beeching
mesh_terms: D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D004457:Echovirus Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D029822:Enterovirus B, Human / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000453:epidemiology*; D008875:Middle Aged; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction