title: Enterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: an essential tool in meningitis management in childhood.
abstract: BACKGROUND
  Enteroviruses (EV) are the main aetiological agents of aseptic meningitis in children and a common cause of febrile illnesses in young infants in summer. A rapid diagnosis is essential to rule out other conditions. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay performed in cerebrospinal fluid (CSF) has proved to be a very fast and useful tool.
  
  
  METHODS
  We collected demographic, clinical and laboratory data of children (aged 11-years or younger) with EV RT-PCR (Cepheid(®) Xpert EV) positive in CSF from December 2007 to July 2010, to describe EV meningitis in children and to determine the role of this assay.
  
  
  RESULTS
  We included 92 children (mean age 2.5 years), 32% of whom were neonates. There was no pleocytosis in the CSF of 18.5% (36% in newborn) of the patients, and 23 (25%) were discharged to home from the Emergency Room after the positive results. Length of hospital stay was 2 days (>2 years) versus 4.5 days in newborns (P<0.0001). Antibiotic treatment was prescribed in 38% (75% <3 months), but in 40% of these, it was stopped after the positive results. Mean EV RT-PCR information time was 7h (4-18h). All children had a good clinical outcome.
  
  
  CONCLUSIONS
  EV RT-PCR assay in CSF has played an essential role in the management of children with EV meningitis, allowing earlier discharges and decreasing avoidable inappropriate antibiotic treatments. This test should be considered as part of the initial study of children with aseptic meningitis, especially during epidemic seasons.
authors.affiliation: Unidad de Enfermedades Infecciosas-Servicio de Pediatría, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. amenasalvas@hotmail.com
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Menasalvas-Ruiz
authors.forename: Carme
authors.initials: C
authors.lastname: Salvador-García
authors.forename: Antonio
authors.initials: A
authors.lastname: Moreno-Docón
authors.forename: Santiago
authors.initials: S
authors.lastname: Alfayate-Miguélez
authors.forename: Carlos
authors.initials: C
authors.lastname: Pérez Cánovas
authors.forename: Manuel
authors.initials: M
authors.lastname: Sánchez-Solís
mesh_terms: D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000235:genetics*; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid* / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid* / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction