title: Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of aseptic meningitis.
abstract: BACKGROUND
  The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition.
  
  
  METHODS
  A retrospective chart review was completed of children presenting with aseptic meningitis to eight Canadian pediatric hospitals over a two-year period.
  
  
  RESULTS
  There were 233 cases of proven enteroviral (EV) meningitis, 495 cases of clinical aseptic meningitis and 74 cases of possible aseptic meningitis with most cases occurring July to October. Headache, vomiting, meningismus and photophobia were more common in children > or = 5 years of age, while rash, diarrhea and cough were more common in children < 5 years of age. Pleocytosis was absent in 22.3% of children < 30 days of age with proven EV meningitis. Enterovirus was isolated in cerebrospinal fluid (CSF) from 154 of 389 patients (39.6%) who had viral culture performed, and a nucleic acid amplification test for enterovirus was positive in CSF from 81 of 149 patients (54.3%). Imaging of the head by computerized tomography or magnetic resonance imaging was completed in 96 cases (19.7%) and 24 had abnormal findings that were possibly related to meningitis while none had changes that were definitely related to meningitis. There was minimal morbidity and there were no deaths.
  
  
  CONCLUSIONS
  The clinical presentation of aseptic meningitis varies with the age of the child. Absence of CSF pleocytosis is common in infants < 30 days of age. Enterovirus is the predominant isolate, but no etiologic agent is identified in the majority of cases of aseptic meningitis in Canadian children.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. bonitlee@ualberta.ca
authors.forename: Bonita E
authors.initials: BE
authors.lastname: Lee
authors.forename: Rupesh
authors.initials: R
authors.lastname: Chawla
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Langley
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Forgie
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Hosni
authors.forename: Krista
authors.initials: K
authors.lastname: Baerg
authors.forename: Entesar
authors.initials: E
authors.lastname: Husain
authors.forename: James
authors.initials: J
authors.lastname: Strong
authors.forename: Joan L
authors.initials: JL
authors.lastname: Robinson
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Law
authors.forename: Simon
authors.initials: S
authors.lastname: Dobson
authors.forename: H Dele
authors.initials: HD
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004770:Enterovirus / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008582:Meningitis, Aseptic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons