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Abstract
For the purpose of identifying the frequency that enterovirus, leptospires, arbovirus cause aseptic meningitis syndrome (AMS) during non-epidemic periods and comparing patients with and without laboratory evidence for an etiologic agent, 112 patients were selected aged between 3 months and 15 years and a clinical suspicion of AMS and were referred to Couto Maia Hospital, the Infectious and Parasitic Disease Reference Center for Salvador, Bahia. In 44.6% (n=50), the etiologic agent for the diagnosis was laboratory-confirmed: enterovirus was identified in 37.7% (n=42) of the cases by the PCR Amplicor diagnostic kit, cerebrospinal fluid or fecal culture isolation; Leptospira sp. in 7.12% (n=8) by the microagglutination test; and arbovirus in non of the cases by inhibition of passive hemagglutination. In 14 of the 22 enteroviral isolates that were evaluated, 6 different serotypes were identified with Echovirus-4 being the major serotype (27.2%; 6/22) among all found (Coxsackie B2, B3, B6 and B9; Enterovirus 71). In conclusion, enteroviruses were the most frequent etiologic agent of AMS and that leptospirosis should be included in the differential diagnosis. In addition, patients with and without laboratory-confirmed identification of the etiologic agent had similar demographic and clinical characteristics and cerebrospinal fluid findings (p >0.05), therefore suggesting that patients without a confirmed diagnosis had enteroviral or leptospiral etiologies.
Highlights
For the purpose of identifying the frequency that enterovirus, leptospires, arbovirus cause aseptic meningitis syndrome (AMS) during non-epidemic periods and comparing patients with and without laboratory evidence for an etiologic agent, 112 patients were selected aged between 3 months and 15 years and a clinical suspicion of AMS and were referred to Couto Maia Hospital, the Infectious and Parasitic Disease Reference Center for Salvador, Bahia
Outros agentes microbianos, focos parameningeos, abscessos cerebrais, alguns tumores do encéfalo, bem como certos agentes físicos e químicos, podem ter expressão clínica e liquórica semelhante a observada na SMA15
Multicenter evaluation of the Amplicor enterovirus PCR test with cerebrospinal fluid from patients with aseptic meningitis
Summary
As amostras de fezes e do líquor foram cultivadas para enterovírus no Laboratório de Virologia Geral do IEC, com identificação do sorotipo das amostras positivas e em 0,1ml da alíquota do líquor foi realizada, também, o Amplicor teste PCR do Laboratório Roche Farmacêutica (PCR-EV)[24]. O Amplicor teste PCR, para o diagnóstico de enterovírus no líquor, foi realizado de acordo as instruções do fabricante (RocheR). As amostras não-pólio foram submetidas a novo teste de neutralização com uma mistura de soros que identifica a maioria dos enterovírus (“pool” de Lim e Benyesh-Melnick). O diagnóstico de leptospirose pelo teste de micro-aglutinação[5], foi realizado no Laboratório de Leptospira do CPqGM (FIOCRUZ, Salvador-Bahia). Tabela 1 - Freqüência de enterovírus isolados de casos de síndrome de meningite asséptica, segundo os espécimes biológicos e os métodos diagnósticos realizados (Salvador-Bahia)
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