Abstract
Enteroviruses (EVs) are the most common cause of viral meningitis with a peak incidence between late summer and fall. The onset of symptoms is characteristically abrupt and typically includes headache, fever, nausea or vomiting, malaise, photophobia, and meningismus. In addition, diarrhea, upper respiratory symptoms, and a rash may also be present. The clinical presentation and epidemiologic features help in the diagnosis and it is confirmed by the detection of RNA in the cerebrospinal fluid (CSF) by polymerase chain reaction (PCR). We present the clinical description, diagnosis, and management of five consecutive cases of viral meningitis secondary to enterovirus that presented to the emergency department at a tertiary care center in Karachi, Pakistan, over a span of five weeks during the monsoon season. These cases or outbreaks have not been reported previously in Pakistan and, hence, this case series is the first of its kind.All of our patients were young males, with ages between 18-35 years, did not have any prior co-morbidities, and resided in different localities of Karachi, Pakistan. The presenting complaints were severe headache in all five patients (100%), fever in all five patients (100%), and diarrhea in two out of five patients (40%). On examination, neck stiffness was present in all patients (100%). After the required workup and detection of RNA in the CSF by PCR, diagnosis of enteroviral meningitis was confirmed. The patients were given symptomatic treatment and discharged home with no neurologic complications. Aseptic meningitis occurring during the summer or fall is most likely to be caused by non-polio EVs (eg. coxsackievirus, echovirus, etc.). It is self-limiting and only requires supportive treatment. However, clinically it cannot be differentiated from other central nervous system infections and significant morbidity has been reported, including hospitalization and impairment of routine activities.
Highlights
Enteroviruses (EVs) are the most common cause of viral meningitis in all ages[1]
To the best of our knowledge, this is the first set of cases of enteroviral meningitis reported in Pakistan
We present five consecutive cases of meningitis associated with acute non-polio EV infection managed at the Aga Khan University Hospital, Karachi, Pakistan
Summary
Enteroviruses (EVs) are the most common cause of viral meningitis in all ages[1]. An EV is a singlestranded RNA virus that is part of the family of Picornaviridae which comprises 10 species of true EVs and three species of rhinoviruses [2]. The diagnosis of enteroviral meningitis was confirmed and antibiotics were stopped, while IV hydration and anti-emetics were continued He remained afebrile and was sent home the day. The patient remained clinically stable throughout admission and on the third day he was sent home on oral analgesics, to be taken as needed He visited the neurology clinic a week later and his symptoms had completely resolved . IV hydration was continued and he was treated with analgesics and antipyretics as needed, to which he responded well He was discharged home a day later to follow up in the neurology clinic in a week. The rest of the systemic examination was unremarkable He was admitted to neurology service with a clinical diagnosis of meningitis and was started on IV hydration and antibiotics in meningitic doses. On a follow-up visit at the neurology clinic in the following week, he showed complete recovery and had resumed his routine activities
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
