title: Characteristics of pediatric patients with enterovirus meningitis and no cerebral fluid pleocytosis.
abstract: Human non-polio enterovirus (EV) is the most important cause of aseptic meningitis in children. Only a few studies report the lack of cerobrospinal fluid (CSF) pleocytosis in children with confirmed EV meningitis; however, the characteristics of these children have not been well defined. This paper describes the clinical and laboratory features of EV meningitis in children with no CSF pleocytosis. Clinical, laboratory, and virological data of Dutch patients <16 years diagnosed with EV meningitis, between 2003 and 2008, were analyzed retrospectively. Data of children with and without CSF pleocytosis were compared. A total of 149 children were infected with EV. Patients presented mainly with fever (n = 113), malaise (n = 43), abdominal pain (n = 47), and irritability (n = 61). Of the 60 patients with EV meningitis, 23 had no pleocytosis. Those who lacked CSF pleocytosis were younger [odds ratio (OR) 1.00; 95% confidence interval (CI) 1.000-1.002; p = 0.001], had experienced drowsiness more (OR 9.60; 95% CI 2.24-41.15; p = 0.002), had lower white blood cell counts (OR 0.73; 95% CI 0.61-0.89; p = 0.001), and had higher C-reactive protein (OR 1.13; 95% CI 1.03-1.23; p = 0.006) than those with pleocytosis.
  
  
  CONCLUSIONS
  These findings show that EV meningitis occurs in the absence of CSF pleocytosis, particularly in young infants, meaning that EV meningitis in this age group cannot be solely excluded by the absence of CSF pleocytosis. They also confirm the importance of genome detection in the diagnosis of EV meningitis in young infants.
authors.affiliation: Department of Pediatrics, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 LC, Tilburg, The Netherlands. stephanie_de_crom@hotmail.com
authors.forename: Stephanie C M
authors.initials: SC
authors.lastname: de Crom
authors.forename: Marceline A M
authors.initials: MA
authors.lastname: van Furth
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Peeters
authors.forename: John W A
authors.initials: JW
authors.lastname: Rossen
authors.forename: Charles C
authors.initials: CC
authors.lastname: Obihara
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007964:Leukocytosis / Q000134:cerebrospinal fluid*; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000821:virology*; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis; D009426:Netherlands; D010372:Pediatrics; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies
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