Background and aims Meningitis due to Enterovirus infection is usually mild and self-limiting, particularly affecting young infants. We found that we were increasingly diagnosing the condition and undertook a retrospective review, exploring case characteristics and whether increasing use of virology detection reduced antibiotic course length, having previously rarely employed these techniques.
Methods All cases identified as being diagnosed with meningitis with a positive enterovirus polymerase chain reaction (PCR) result between January 2012 and December 2012, below 16 years of age, were retrospectively reviewed.
Results Nine cases of enterovirus meningitis were identified in the time period. Seven were infants aged 3 months or less, with two patients aged 11 and 15 years respectively. There were five females and four males. The infants presented with fever, lethargy or irritability. The older children presented with fever and headache. Following full infection screens, all of the infants were treated with intravenous antibiotics. One patient had raised inflammatory markers and one patient had a significant cerebrospinal fluid (CSF) pleocytosis, the majority had a normal or minimally raised CSF white cell count. Eight patients had positive CSF Enterovirus PCR results and one patient had a Coxsackievirus positive serum PCR (having not undergone lumbar puncture). In three patients a prolonged course of antibiotics was discontinued following the PCR result. One patient had episodes of tachycardia with subsequent diagnosis of supraventricular tachycardia requiring treatment.
Conclusion Positive enterovirus PCR results appear to have reduced antibiotic course length, limiting unnecessary antibiotic administration, and we advocate increasing use of this investigation.