Aseptic meningitis: aetiologic diagnosis
Abstract number: p551
Santos L., Simões J., Conde S., Costa R.
Although aseptic meningitis is in general a benign clinical situation, a rapid etiological diagnosis can have an important impact on patient care. With the implementation of polymerase chain reaction techniques (PCR) in cerebrospinal fluid (CSF) analysis, it is now possible to identify not only usual but also emerging pathogenic microorganisms.
To investigate the aetiology of aseptic meningitis.
Aseptic meningitis was defined when CSF cytosis exceeded 6 leukocytes/ml and a negative standard bacterial culture. Herpes simplex virus 1/2 (HSV), Epstein barr virus (EBV), Cytomegalovirus (CMV), West Nile virus (WNV), and Enterovirus (EV) were detected with commercial available PCR reagents and Leptospira spp. with an "in house" real time PCR test. An "in house" and commercial PCR test were used to detect Toscana virus (TV). Varicella zoster virus (VZV), mumps virus and Coxiella burnetii infections diagnosis were based on clinical signs and/or serology.
During 3 years we studied 315 CSF samples. Two hundred and nineteen (70%) patients were younger than 15 years and 187 (59%) were males. CSF pleocytosis ranged from 6 to 2100 cells/ml. Bacteriological study was negative in all samples. Etiological diagnosis was achieved with molecular methods in 148 (47%) patients. PCR detected 110 (35%) EV, 20 (6.3%) HSV, 6 (1.9%) Leptospira, 4 (1.3%) EBV, 5 (1.6%) TV and 3 (0.9%) CMV infections. All samples tested negative for West Nile virus. Serology detected one EBV and one Coxiella burnetii infection and in eighteen patients a diagnosis of VZV (13) or mumps (5) infection was based on clinical grounds. Overall the diagnosis was clarified in 168 (53%).
The sensitivity, specificity and versatility of PCR make this methodology an ideal tool to investigate the aetiology of central nervous system infections. In this study EV is the more common aetiology of aseptic meningitis. The investigation of Toscana virus, although less frequent should go on in summer cases of aseptic meningitis in Portugal as in other Mediterranean regions. The vector of West Nile virus is present in our country but no cases of infection by this virus was detected. Other agents need to be considered in future studies to further clarify this clinical situation.
|Session name:||XXIst ISTH Congress|
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