Background In suspected meningitis, cerebrospinal fluid (CSF) examination for presence of white blood cells (WBCs), red blood cells (RBCs), and protein and glucose concentrations is routine. These CSF variables may help in suspicion of bacterial meningitis, but using polymerase chain reaction (PCR) will help in accurate diagnosis and management. Aseptic meningitis due to enterovirus is self-limiting. Therefore, a positive enterovirus PCR may save costs related to prolonged antibiotic treatment.
Methods A retrospective observational study of one hundred and fifty two patients admitted with suspected meningitis between 1st January 2011 and 31st December 2013 was conducted using an inpatient electronic database. A validated proforma was used to collect data. The outcomes with a positive lumbar puncture with or without PCR analysis were compared.
Results Forty seven patients (31%) had lumbar puncture performed between 1st January 2011 and 30th June 2012. Out of which, seven patients (23%) had an abnormal cell count but enterovirus PCR was not requested. They required intravenous antibiotics for at least seven days. One hundred and five patients (69%) had lumbar puncture performed between 1st July 2012 and 31st December 2013. Out of which, twenty nine patients (26%) had abnormal cell counts. Nineteen CSF samples (65%) were analysed for enterovirus PCR. Eleven (57%) were enterovirus positive and therefore, antibiotics were discontinued within 48–72 h. Nine patients did not have enterovirus PCR analysed and therefore required antibiotics for at least seven days. A cost-analysis will be provided.
Conclusion In suspected meningitis, CSF for viral PCR is a cost-effective adjunct.