ENTEROVIRAL MENINGITIS IN INFANCY - POTENTIAL ROLE FOR POLYMERASE CHAIN-REACTION IN PATIENT-MANAGEMENT

Study objective. To evaluate the performance characteristics and poten tial clinical utility of a polymerase chain reaction (PCR) assay for e nteroviral RNA in comparison to viral culture in infants under 3 month s of age with meningitis. Specimens and testing. Specimens were obtain ed from a collection of cerebrospinal fluid specimens from infants und er 3 months of age (excluding those in the neonatal intensive care uni t) undergoing lumbar puncture at St. Louis Children's Hospital during a 12-month period. Those tested by PCR included all 27 with pleocytosi s, 8 others from infants without pleocytosis but from whom an enterovi rus was cultured, and 10 from infants who did not have pleocytosis and had a negative viral culture of cerebrospinal fluid. Viral cultures w ere performed at the discretion of physicians caring for individual pa tients. Results. PCR was positive for enteroviral RNA on cerebrospinal fluid (CSF) specimens from 11 of 12 patients with definite or probabl e enteroviral meningitis, as well as on 6 of 13 with possible enterovi ral meningitis, and was negative on all 10 with absence of pleocytosis and negative enteroviral cultures. CSF viral cultures were negative i n 6 of the patients in whom PCR was positive. Viral cultures had minim al impact on patient management. In contrast, under study assumptions, PCR could have saved an average of 1.2 days of hospitalization per pa tient in the 27 patients with CSF pleocytosis. Conclusions. Enteroviru s PCR performed on CSF is a sensitive and specific method for the diag nosis of enteroviral meningitis. This method has the potential for imp roving the accuracy of diagnosis in young infants and for saving costs by allowing earlier diagnosis and discharge from the hospital when cl inically appropriate.