Differential diagnosis of acute central nervous system infections in children using modern microbiological methods.
OBJECTIVE
Except bacterial meningitis, the agents causing acute central nervous system (CNS) infections in children are disclosed in only approximately half of the cases, and even less in encephalitis. We studied the potential of modern microbiological assays to improve this poor situation.


METHODS
In a prospective study during 3 years, all children attending hospital with suspected CNS infection were examined using a wide collection of microbiological tests using samples from the cerebrospinal fluid, serum, nasal swabs and stool.


RESULTS
Among 213 patients, 66 (31%) cases suggested CNS infection and specific aetiology was identified in 56 patients. Of these microbiologically confirmed cases, viral meningitis/encephalitis was diagnosed in 25 (45%), bacterial meningitis in 21 (38%) and neuroborreliosis in 9 (16%) cases while 1 child had fungal infection. In meningitis patients, the causative agent was identified in 85% (35/41) cases and in encephalitis in 75% (12/16). The most common bacteria were Streptococcus agalactiae, Streptococcous pneumonie and Neisseria meningitidis, while the most frequently detected viruses were enteroviruses and varicella zoster virus.


CONCLUSIONS
In 75% to 85% of paediatric CNS infections, specific microbiological diagnosis was obtained with modern laboratory techniques. The results pose a basis for prudent approach to these potentially serious diseases.
Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, 00029 HUS, Helsinki, Finland. pasihut@iki.fi
Pasi
P
Huttunen
Maija
M
Lappalainen
Eeva
E
Salo
Tuula
T
Lönnqvist
Pia
P
Jokela
Timo
T
Hyypiä
Heikki
H
Peltola
D000208:Acute Disease; D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology; D002494:Central Nervous System Infections / Q000175:diagnosis* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000821:virology; D005158:Facial Paralysis / Q000209:etiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D007223:Infant; D020852:Lyme Neuroborreliosis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000382:microbiology; D008587:Meningitis, Viral / Q000175:diagnosis / Q000821:virology; D008828:Microbiological Techniques / Q000379:methods*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral