Clinical significance of enteroviruses in serious summer febrile illnessesof children

Background, Enteroviruses are common causes of aseptic meningitis and nonsp ecific febrile illnesses in young children. During the summer-fall months, enterovirus-infected children are frequently evaluated in emergency room se ttings to rule out bacterial sepsis and/or meningitis. Objectives. We sought to determine the clinical significance of enterovirus infections in children evaluated for serious febrile illnesses in pediatri c emergency rooms during the summer-fall season. Methods. Children admitted to emergency rooms at four university teaching h ospitals during a single summer-fall season who required blood culture and/ or lumbar puncture to rule out bacterial sepsis/meningitis were prospective ly studied. An extensive questionnaire was administered, and specimens of c erebrospinal fluid, serum, urine and throat were tested for enteroviruses b y viral culture and PCR. Patients were followed to determine the duration, management and outcome of their illnesses. Results. Of 203 patients studied 173 had no apparent explanation for their illness (e.g. bacterial sepsis, bacterial urinary tract infection, etc.). O f those 173 patients 79 (46%) were infected with enteroviruses, including 3 3 of 47 (70%) patients with aseptic meningitis, 13 of 25 (52%) patients wit h nonspecific febrile episodes and 33 of 101 (33%) patients with fever and focal findings (P < 0.0001 for aseptic meningitis vs. fever and focal findi ngs; P = 0.0001 for aseptic meningitis vs. combined nonspecific febrile epi sodes and fever/focal patients). Among 119 hospitalizes/patients 65 (55%) w ere enterovirus-infected. Children less than or equal to 90 days of age wer e more likely to be enterovirus-infected (66 of 122; 54%) than children old er than 90 days (13 of 51; 25%) (P = 0.0001). Enterovirus-infected children were more likely to be hospitalized as a result of the current emergency r oom visit (65 of 79 vs. 54 of 94; P = 0.0005) and were more likely to have had an additional hospitalization for the same illness (10 of 79 vs. 1 of 9 4; P = 0.003). Enterovirus-infected patients also had a shorter period from illness onset to presentation. Enterovirus-infected children were indistin guishable from those without enterovirus infection in their symptoms at ons et, signs at presentation and total duration of illness (>7 days in both gr oups). Enterovirus-infected children were almost all treated with antibioti cs (78 of 79; 99%), with 74 of 79 (94%) receiving parenteral antibiotics fo r a mean of 3.6 days. Conclusions. During the summer-fall months, 39% (79 of 203) of children for whom blood cultures and/or lumbar punctures were performed for suspected b acterial infection had enterovirus infection identified as the only explana tion for their illness. Of those patients with no alternative diagnosis, en terovirus infection was confirmed in 46% (79 of 179). The majority of those patients requiring hospitalization were infected with enteroviruses. The u se of PCR increases the number of children for whom a specific etiology of illness can be determined and may in the future reduce the hospitalization and use of unnecessary antibiotics in patients with enterovirus infections.