Viral meningitis outbreak in Gaza Clinical, epidemiologic and laboratory characterstics

ABSTRACT

During April-July 2004 an outbreak of viral meningitis occurred in Gaza strip. This report aimed to study some epidemiological characters of this outbreak and to find differentiating criteria between viral and bacterial meningitis. The result showed that aseptic meningitis is present all through the year with peak occurrence between April and July. The reported cases in our hospital during the year 2004 were 1686 [compared to 300 in 2003] of them 1371 occurred in this 4 month period. Male/ Female ratio was 6/4. In general, symptoms are mild, and no deaths. The main clinical manifestations were fever, vomiting, headache, lethargy and sore throat. Clinical manifestations of viral and bacterial were similar but toxic look was present in all cases of bacterial meningitis and in only 18% of cases in aseptic meningitis. CSF Neutrophils were high in 29% of cases in aseptic meningitis and CSF sugar was low in 21% of cases. Viral culture was done for 12 cases. Virus isolated Echo 4, Echo, Coxsackie A9 one from each and nonparalytic polio in 3 cases no viruses detected in 6 cases. Bacterial meningitis was confirmed in 36 cases, Neiseria meningitides, 24 Strept. pneumonia, 11 and H. influenza one case. Viral meningitis outbreak is common during early summer. The outbreak occurs every 3-4 years. Bacterial meningitis during the viral outbreak still causes concern, clinical picture and CRP in the CSF is helpful in differentiating between viral and bacterial meningitis but molecular methods of enterovirus detection as PCR is needed for rapid viral detection