Differentiating Enteroviral Meningitis from Bacterial Meningitis in Neonates
Objective To compare the demographical, clinical and laboratory features, and outcomes of neonates with enteroviral meningitis (EVM) with those with bacterial meningitis (BM).
Methods A retrospective two-center study was performed in La Réunion Island between January 2008 and December 2018 in hospitalized neonates aged less than 29 days. Patients positive for enterovirus real-time polymerase chain reaction from the cerebrospinal fluid (CSF) were diagnosed with EVM. Neonates with positive CSF culture results for a potentially pathogenic bacterium were diagnosed with BM.
Results Compared with their EVM peers (n = 20), BM-infected neonates (n = 14) had lower birth weight, and were more likely to present hypotension and neurological symptoms on admission. Thrombocytopenia, elevated serum procalcitonin, hyperproteinorachia, hypoglycorrhachia, CSF pleocytosis, a bacterial meningitis score >0 were more frequent in the BM-infected group. All BM-infected neonates had at least one abnormal cutoff value in the CSF, while nine neonates (45%) in the EVM group had no CSF abnormality (p = 0.004). BM-infected neonates also had a longer length of hospital stay, needed more supportive care, received more prolonged antimicrobial courses, and developed respiratory and neurological complications.
Conclusion Recognition of some clinical and laboratory features can help clinicians in differentiating BM from EVM when managing this high-risk patient group.
Eingereicht: 24. April 2020
Angenommen: 15. September 2020
02. November 2020 (online)
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- 1 Baud O, Aujard Y. Neonatal bacterial meningitis. Handb Clin Neurol 2013; 112: 1109-1113
- 2 Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs 2004; 6 (01) 1-10
- 3 Hawkes MT, Vaudry W. Nonpolio enterovirus infection in the neonate and young infant. Paediatr Child Health 2005; 10 (07) 383-388
- 4 Soudée S, Schuffenecker I, Aberchih J. et al. [Neonatal infections in France in 2012]. Arch Pediatr 2014; 21 (09) 984-989
- 5 Thomson J, Sucharew H, Cruz AT. Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) HSV Study Group. et al. Cerebrospinal fluid reference values for young infants undergoing lumbar puncture. Pediatrics 2018; 141 (03) e20173405
- 6 Nigrovic LE, Kuppermann N, Macias CG. Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA 2007; 297 (01) 52-60
- 7 Holt DE, Halket S, de Louvois J, Harvey D. Neonatal meningitis in England and Wales: 10 years on. Arch Dis Child Fetal Neonatal Ed 2001; 84 (02) F85-F89
- 8 Henry BM, Roy J, Ramakrishnan PK, Vikse J, Tomaszewski KA, Walocha JA. Procalcitonin as a serum biomarker for differentiation of bacterial meningitis from viral meningitis in children: evidence from a meta-analysis. Clin Pediatr (Phila) 2016; 55 (08) 749-764
- 9 Garges HP, Moody MA, Cotten CM. et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters?. Pediatrics 2006; 117 (04) 1094-1100
- 10 Yun KW, Choi EH, Cheon DS. et al. Enteroviral meningitis without pleocytosis in children. Arch Dis Child 2012; 97 (10) 874-878
- 11 Huizing KM, Swanink CM, Landstra AM, van Zwet AA, van Setten PA. Rapid enterovirus molecular testing in cerebrospinal fluid reduces length of hospitalization and duration of antibiotic therapy in children with aseptic meningitis. Pediatr Infect Dis J 2011; 30 (12) 1107-1109