Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of aseptic meningitis

Bonita E Lee,Joanne M Langley,Simon Dobson,Upton Allen,Rupesh Chawla,Joan L Robinson,Krista Baerg,H Dele Davies,Sarah E Forgie,Mohammed Al-Hosni,James Strong,Entesar Husain,Barbara J Law

doi:10.1186/1471-2334-6-68

Abstract

BackgroundThe seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition.MethodsA retrospective chart review was completed of children presenting with aseptic meningitis to eight Canadian pediatric hospitals over a two-year period.ResultsThere were 233 cases of proven enteroviral (EV) meningitis, 495 cases of clinical aseptic meningitis and 74 cases of possible aseptic meningitis with most cases occurring July to October. Headache, vomiting, meningismus and photophobia were more common in children ≥ 5 years of age, while rash, diarrhea and cough were more common in children < 5 years of age. Pleocytosis was absent in 22.3% of children < 30 days of age with proven EV meningitis. Enterovirus was isolated in cerebrospinal fluid (CSF) from 154 of 389 patients (39.6%) who had viral culture performed, and a nucleic acid amplification test for enterovirus was positive in CSF from 81 of 149 patients (54.3%). Imaging of the head by computerized tomography or magnetic resonance imaging was completed in 96 cases (19.7%) and 24 had abnormal findings that were possibly related to meningitis while none had changes that were definitely related to meningitis. There was minimal morbidity and there were no deaths.ConclusionThe clinical presentation of aseptic meningitis varies with the age of the child. Absence of CSF pleocytosis is common in infants < 30 days of age. Enterovirus is the predominant isolate, but no etiologic agent is identified in the majority of cases of aseptic meningitis in Canadian children.

Highlights

The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition
The use of nucleic acid amplification test (NAT) for enterovirus has allowed for rapid diagnosis of viral meningitis, which may decrease the use of empiric antibiotics and the length of hospital stay (LOS) [2,4,5]
Most of the proven EV meningitis and clinical aseptic meningitis occurred from July to October with sporadic cases in other months

Summary

Introduction

The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition. The most common cause in North America is viral meningitis, the differential diagnosis includes "partially-treated" bacterial meningitis, tuberculous or fungal meningitis, inflammation from a para-meningeal bacterial infection, collagen vascular diseases, and druginduced meningeal inflammation. The purpose of this study was to establish the seasonality, clinical and radiographic features, management and short term-outcomes of Canadian children presenting over a wide geographic area with aseptic meningitis of presumed viral origin in the modern era. Number of days if greater than 24 hours Complications such as seizures, hearing loss, subdural collections, and intensive care unit admission were recorded

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