title: Improving the diagnosis of meningitis due to enterovirus and herpes simplex virus I and II in a tertiary care hospital.
abstract: BACKGROUND
  Enterovirus and herpes simplex viruses are common causes of lymphocytic meningitis. The purpose of this study was to analyse the impact of the use molecular testing for Enteroviruses and Herpes simplex viruses I and II in all suspected cases of viral meningitis.
  
  
  METHODS
  From November 18, 2008 to November 17, 2009 (phase II, intervention), all patients admitted with suspected viral meningitis (with pleocytosis) had a CSF sample tested using a nucleic acid amplification test (NAAT). Data collected during this period were compared to those from the previous one-year period, i.e. November 18, 2007 to November 17, 2008 (phase I, observational), when such tests were available but not routinely used.
  
  
  RESULTS
  In total, 2,536 CSF samples were assessed, of which 1,264 were from phase I, and 1,272 from phase II. Of this total, a NAAT for Enterovirus was ordered in 123 cases during phase I (9.7% of the total phase I sample) and in 221 cases in phase II (17.4% of the total phase II sample). From these, Enterovirus was confirmed in 35 (28.5%, 35/123) patients during phase I and 71 (32.1%, 71/221) patients during phase II (p = 0.107). The rate of diagnosis of meningitis by HSV I and II did not differ between the groups (13 patients, 6.5% in phase I and 13, 4.7% in phase II) (p = 1.0), from 200 cases in phase I and 274 cases in phase II.
  
  
  CONCLUSIONS
  The number of cases diagnosed with enteroviral meningitis increased during the course of this study, leading us to believe that the strategy of performing NAAT for Enterovirus on every CSF sample with pleocytosis is fully justified.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casaroto
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil. alexandre.marra@einstein.br.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Fernando Morgadinho S
authors.initials: FM
authors.lastname: Coelho
authors.forename: Joao Renato Rebello
authors.initials: JR
authors.lastname: Pinho
authors.forename: Roberta
authors.initials: R
authors.lastname: Sitnik
authors.forename: Fernando
authors.initials: F
authors.lastname: Colombari
authors.forename: Elivane Silva
authors.initials: ES
authors.lastname: Victor
authors.forename: Nair Hideko
authors.initials: NH
authors.lastname: Muto
authors.forename: Carlos
authors.initials: C
authors.lastname: Senne
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis / Q000821:virology*; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000821:virology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis / Q000821:virology*; D018139:Simplexvirus / Q000302:isolation & purification; D063128:Tertiary Health Care; D055815:Young Adult