title: Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children?
abstract: Non-polio enteroviruses (EV) are the most common viruses causing aseptic meningitis in children. We aim to evaluate the cerebrospinal fluid (CSF) characteristics of neonates and children with EV meningitis with a view to determine whether it could be discriminatory or otherwise in making a positive diagnosis. We performed a 3-year (July 2008-July 2011) retrospective study of children ≤16 years, treated at a tertiary children's hospital, with positive CSF EV polymerase chain reaction (PCR) and negative blood and CSF bacterial cultures. A total of 206 children were studied. The median CSF white cell count was 79 cells/mm(3) (range 0-4608 cells/mm(3)). CSF pleocytosis was observed in 99/150 (66%) aged ≤90 days, 3/4 (75%) aged 90 days-1 year, and 49/52 (94%) children ≥3 years. There was a huge variability in CSF pleocytosis in infants ≤90 days, where 34% of them had no pleocytosis, while in 66%, a wide range of pleocytosis that might even suggest bacterial meningitis was noted. CSF red cells were low, and protein or sugar values were not discriminatory. CSF pleocytosis in relation to increasing age was found to be statistically significant (p < 0.001). Early lumbar puncture within 48 h of symptoms and absence of CSF pleocytosis was also statistically significant (p = 0.039). CSF pleocytosis in EV meningitis is commoner in older children. As there was a huge variability in CSF pleocytosis in infants ≤90 days particularly, CSF analysis including EV PCR could avoid unnecessary antibiotic therapy.
authors.affiliation: Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore. Natalie.Tan.W.H@singhealth.com.sg.|Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. Natalie.Tan.W.H@singhealth.com.sg.|Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore. Natalie.Tan.W.H@singhealth.com.sg.
authors.forename: Natalie Woon Hui
authors.initials: NW
authors.lastname: Tan
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore.
authors.forename: Elis Yuexian
authors.initials: EY
authors.lastname: Lee
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore.
authors.forename: Gloria Mei Chin
authors.initials: GM
authors.lastname: Khoo
authors.affiliation: Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.|Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Nancy Wen Sim
authors.initials: NW
authors.lastname: Tee
authors.affiliation: Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Subramania
authors.initials: S
authors.lastname: Krishnamoorthy
authors.affiliation: Neurology Service, Department of Pediatrics, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Chew Thye
authors.initials: CT
authors.lastname: Choong
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004770:Enterovirus / Q000472:pathogenicity / Q000502:physiology; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies
keywords: Enterovirus; Meningitis; Pediatrics; Pleocytosis; Polymerase chain reaction (PCR)