Title : Seasonal and laboratory trends in enteroviral meningitis at a tertiary care setting
Abstract:
Introduction:Enterovirus is the most common cause of viral meningitis. It is more frequent in children and young adults. Traditional cerebrospinal fluid (CSF) tests like CSF culture and Latex Particle Agglutination (LPA) cannot detect viral causes and can lead to diagnostic uncertainty and unnecessary use of antibiotics.Polymerase chain reaction (PCR) based tests have greatly improved rapid diagnosis of viral infections; hence timely initiation of appropriate treatment.
Bio Fire FilmArray Meningitis/Encephalitis (ME) Panel is a multiplex PCR test and detects 14 common pathogens of meningitis/encephalitis. This study was conducted to see the prevalence and seasonal trend of Enterovirus in CSF samples tested on ME Panel.
Material and Method:All non-duplicate ME Panel tests carried out on CSF samples received from October 2024 to September 2025 in Microbiology laboratory Shifa International Hospital Islamabad, were included in the study and reviewed retrospectively for the detection of Enterovirus. Demographic details of patients, CSF routine examination (R/E) findings and CSF culture results were retrieved from laboratory information syste
Results:Total 342 non duplicate samples were tested on ME Panel during the study period, 114 were of age group 0-18 years while 228 were older than 18 years. Enterovirus was detected in 31 cases out of 342 CSF samples tested. Twenty-seven (87.1%) positive cases were of age less than 18 years while 4(12.9%) cases were 18 years or above (p value < 0.05). Twenty-eight Enteroviral cases were males (90.3%) while three were females, showing significantly high prevalence in males (Fisher’s exact test p < 0.05). Significantly more cases were detected in the month of July and August i-e 15(48.4%) and 7(22.6%) respectively (p value < 0.05). CSF culture was negative in all cases. White blood cells count in CSF R/E ranged from 83466 cells/µl with interquartile range (IQR) 101- 480 cells/µl. Neutrophils were predominant in 16(53.3%) cases. Glucose levels ranged from 28 to 84 mg/dl. Most cases were between 40-80mg/dl (28/31). Only one case was <30mg/dl. While proteins level ranged from 13 to 329 mg/dl with IQR 30.5-49 mg/dl. Conclusion: Enterovirus is prevalent in our set up mostly among children with clear seasonal trend in summer. Results support the importance of use of rapid molecular tests for better and rapid diagnosis and also for supporting antimicrobial stewardship. ME Panel helped in early identification of infection and detected rise in Enterovirus cases
Keywords: Enterovirus detection in CSF, Multiplex PCR, Viral meningitis.
