Enteroviral meningitis without pleocytosis in children.
OBJECTIVE
This study aims to describe the clinical characteristics of enteroviral meningitis in association with the absence of cerebrospinal fluid (CSF) pleocytosis.


METHODS
This was a retrospective analysis of databases of patients diagnosed with enteroviral meningitis by CSF reverse transcription-PCR testing. Presence of CSF non-pleocytosis at each age group was analysed by use of the two criteria. Clinical variables were compared with regard to the presence of CSF pleocytosis. Multiple logistic regression analysis was used to identify factors that were associated with CSF pleocytosis.


METHODS
Two hospitals in South Korea, between January 2008 and August 2011.


METHODS
390 infants and children with enteroviral meningitis.


METHODS
None.


METHODS
Proportion of enteroviral meningitis without CSF pleocytosis.


RESULTS
Among the 390 patients with enteroviral meningitis, 16-18% did not have CSF pleocytosis. In particular, CSF pleocytosis was not present in 68-77% of the neonates with enteroviral meningitis, demonstrating that the proportion of CSF pleocytosis decreased significantly with age (p<0.001). In multivariate models, younger age (adjusted OR 0.981; 95% CI 0.973 to 0.989), lower peripheral white blood cell count (adjusted OR 0.843; 95% CI 0.791 to 0.899), and shorter interval between onset and lumbar puncture (adjusted OR 0.527; 95% CI 0.315 to 0.882) were associated with the absence of CSF pleocytosis in enteroviral meningitis.


CONCLUSIONS
This study demonstrated high proportion of non-pleocytic enteroviral meningitis in young infants and identified several clinical factors that contributed to the absence of CSF pleocytosis. We suggest that CSF enterovirus PCR testing is likely to detect more cases of enteroviral meningitis, especially in young infants.
Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-769, Korea.
Ki Wook
KW
Yun
Eun Hwa
EH
Choi
Doo Sung
DS
Cheon
Jina
J
Lee
Chang Won
CW
Choi
Hee
H
Hwang
Beyong Il
BI
Kim
Kyoung Un
KU
Park
Sung Sup
SS
Park
Hoan Jong
HJ
Lee
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid* / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid* / Q000150:complications; D016015:Logistic Models; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid* / Q000150:complications; D016133:Polymerase Chain Reaction; D056910:Republic of Korea; D012189:Retrospective Studies