Abstract
BackgroundAseptic meningitis epidemics may pose various health care challenges.MethodsWe describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013 in order to scrutinize clinical differences from other aseptic meningitis cases.ResultsA total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 5.8% of all EV-positive cases which were voluntarily reported within the National Enterovirus surveillance (EVSurv, based on investigation of patients with suspected aseptic meningitis/encephalitis and/or acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18 pediatric and 20 adult cases, median age 18.5 years; echovirus 18 (1), echovirus 2 (1), echovirus 30 (31), echovirus 33 (1), echovirus 9 (4)). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and 1 EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home.ConclusionsVoluntary syndromic surveillance, such as provided by the EVSurv in our study may be a valuable tool for epidemiological research. Our analyses suggest that EV-positive meningitis predominantly affects younger patients and may be associated with a rather benign clinical course, compared to EV-negative cases.
Highlights
Aseptic meningitis epidemics may pose various health care challenges
Aseptic meningitis is defined [2] by an inflammation of the leptomeninx in which the causative agent cannot be identified by cerebrospinal fluid culture [3]
Viral meningitis in adults was rather associated with herpes simplex and West Nile virus, whereas children were more likely to be tested positive for enterovirus (EV) [5]
Summary
Aseptic meningitis epidemics may pose various health care challenges. Periodic aseptic meningitis epidemics can be a challenge in patient- and health care. A large retrospective analysis of a US-American cohort revealed that in 21% of cases the etiology of aseptic meningitis remains unknown [1]. Aseptic meningitis is defined [2] by an inflammation of the leptomeninx in which the causative agent cannot be identified by cerebrospinal fluid culture [3]. Multiple studies have been conducted in order to better understand this phenomenon: A Danish nation-wide prospective observational study between 1st of January 2015 and 30th of June 2016 revealed an unfavorable outcome of viral meningitis in 17% of all patients [6]. According to a UK study, the infection rates of viral meningitis are mainly driven by an EV predominance of echovirus 30 [7]
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