A Seasonal Outbreak of Pediatric Aseptic Meningitis in Eastern Taiwan: Clinical Presentations and Laboratory Analyses

Abstract

Objective: Aseptic meningitis is a common, benign and self-limiting disease. Only a few studies of outbreaks have been reported in Taiwan. We assessed a retrospective observational investigation into the clinical and laboratory features of a seasonal outbreak in Eastern Taiwan. Materials and Methods: One hundred and twelve pediatric cases of aseptic meningitis, confirmed by cerebrospinal fluid (CSF), were enrolled between April and June 2000. The symptoms/signs, laboratory data from CSF and peripheral blood, and bacterial/viral examination results were all collected. Results: The most common initial symptoms were fever, vomiting, headache and upper respiratory tract infection symptoms. Meningeal signs were expressed in 42.86% of the cases. The mean CSF white blood cell (WBC) count was 269.8 per uL(95% C.I., range 202.5-337.0), and percentage of CSF polymorphonuclear cells was 58.44% (95% C.I., range 53.7-63.2). Initial mean peripheral WBC count was 12702.7 per uL (95% C.I., range 12015.8-13389.6). Erythrocyte sediment rate revealed 24.212.8 mm/hr. Viral isolation was performed for 101 patients and only 5 positive enterovirus cultures were detected. All patients recovered completely. Conclusions: The diagnosis of aseptic meningitis can be made based on clinical and laboratory information. However, during an outbreak of meningitis, laboratory information does not allow discrimination between viral and bacterial pathogens initially because some findings seem conflicting. Further rapid diagnostic assays should be used in endemic areas or seasons.