Improving the diagnosis of meningitis due to enterovirus and herpes simplex virus I and II in a tertiary care hospital

Authors

Eduardo Casaroto, Hospital Israelita Albert Einstein
Alexandre R. Marra, Hospital Israelita Albert Einstein
Fernando Morgadinho S. Coelho, Hospital Israelita Albert Einstein
Joao Renato Rebello Pinho, Hospital Israelita Albert Einstein
Roberta Sitnik, Hospital Israelita Albert Einstein
Fernando Colombari, Hospital Israelita Albert Einstein
Elivane Silva Victor, Hospital Israelita Albert Einstein
Nair Hideko Muto, Hospital Israelita Albert Einstein
Carlos Senne, Hospital Israelita Albert Einstein
Oscar Fernando Pavão dos Santos, Hospital Israelita Albert Einstein
Michael B. Edmond, Virginia Commonwealth UniversityFollow

Document Type

Article

Original Publication Date

2013

Journal/Book/Conference Title

BMC Infectious Diseases

Volume

2013

DOI of Original Publication

10.1186/1471-2334-13-487

Comments

Originally published at http://dx.doi.org/10.1186/1471-2334-13-487

Date of Submission

September 2014

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.

Rights

© 2013 Casaroto et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Is Part Of

VCU Internal Medicine Publications