Author(s)

Adi Klein-Kremer^1*, Vered Nir¹, Kassem Eias¹, Rony-Reuven Nir¹, Renata Yakubov¹, Keren Gershon²

¹Department of Pediatrics, Hillel-Yaffe Medical Center, Hadera, Israel.
²Unit of Infectious Diseases, Hillel-Yaffe Medical Center, Hadera, Israel.

Background: Viral meningitis (VM) is mostly common among infants. Its induction by enteroviruses (EVM) is associated with morbidity and is primarily diagnosed by lumbar puncture, which may yield false negatives. We evaluated the frequency of VM by polymerase chain reaction (PCR) among infants with no detected pleocytosis. Furthermore, as literature suggests EVM essentially occurs during summer and fall, we characterized the monthly distribution of EVM cases. Methods: Infants diagnosed with VM from June 2009 to May 2010 were enrolled in the current prospective study. Following each lumbar puncture, CSF was tested for enteroviruses by PCR. Outcome measures were i) the percentage of EVM cases revealed solely by PCR; and ii) the monthly distribution of EVM cases. Results:Enrolled were 173 VM-diagnosed infants, of whom 75 (43.4%) tested positive in CSF-PCR. Of these, no pleocytosis was indicated in 43 (57%), specifically in 70% and 42% of infants younger than 90 days and older than 1 year, respectively. Furthermore, 119 (69%) infants were admitted during June-November while 54 (31%) during December-May. Conclusions:Current findings stress the high frequency of infants who were tested negative for pleocytosis, yet were diagnosed with VM by PCR. This was especially noticeable among infants younger than 3 months, possibly reflecting their decreased ability to mount a robust inflammatory response to EV infection. CSF-PCR may be warranted in pediatric patients who test negative for pleocytosis. While most EVM cases occurred during the summer and fall, EVM-infants were admitted to the hospital all through the year.

Cerebrospinal Fluid (CSF), Enteroviral Meningitis, Lumbar Puncture, Polymerase Chain Reaction (PCR), Viral Meningitis

Klein-Kremer, A. , Nir, V. , Eias, K. , Nir, R. , Yakubov, R. and Gershon, K. (2014) Clinical Investigation: The Presence of Viral Meningitis without Pleocytosis among Pediatric Patients. Open Journal of Pediatrics, 4, 276-282. doi: 10.4236/ojped.2014.44038.