ABSTRACT
Non-polio enteroviruses (EV) are the most common viruses causing aseptic meningitis in children. We aim to evaluate the cerebrospinal fluid (CSF) characteristics of neonates and children with EV meningitis with a view to determine whether it could be discriminatory or otherwise in making a positive diagnosis. We performed a 3-year (July 2008-July 2011) retrospective study of children ≤16 years, treated at a tertiary children's hospital, with positive CSF EV polymerase chain reaction (PCR) and negative blood and CSF bacterial cultures. A total of 206 children were studied. The median CSF white cell count was 79 cells/mm(3) (range 0-4608 cells/mm(3)). CSF pleocytosis was observed in 99/150 (66%) aged ≤90 days, 3/4 (75%) aged 90 days-1 year, and 49/52 (94%) children ≥3 years. There was a huge variability in CSF pleocytosis in infants ≤90 days, where 34% of them had no pleocytosis, while in 66%, a wide range of pleocytosis that might even suggest bacterial meningitis was noted. CSF red cells were low, and protein or sugar values were not discriminatory. CSF pleocytosis in relation to increasing age was found to be statistically significant (p < 0.001). Early lumbar puncture within 48 h of symptoms and absence of CSF pleocytosis was also statistically significant (p = 0.039). CSF pleocytosis in EV meningitis is commoner in older children. As there was a huge variability in CSF pleocytosis in infants ≤90 days particularly, CSF analysis including EV PCR could avoid unnecessary antibiotic therapy.
Subject(s)
Enterovirus Infections/diagnosis , Leukocytosis/diagnosis , Meningitis, Aseptic/diagnosis , Meningitis, Bacterial/diagnosis , Meningitis, Viral/diagnosis , Adolescent , Age Factors , Child , Child, Preschool , Diagnosis, Differential , Enterovirus/pathogenicity , Enterovirus/physiology , Enterovirus Infections/cerebrospinal fluid , Enterovirus Infections/pathology , Enterovirus Infections/virology , Female , Humans , Infant , Infant, Newborn , Leukocyte Count , Leukocytosis/cerebrospinal fluid , Leukocytosis/pathology , Leukocytosis/virology , Male , Meningitis, Aseptic/cerebrospinal fluid , Meningitis, Aseptic/pathology , Meningitis, Aseptic/virology , Meningitis, Bacterial/cerebrospinal fluid , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/pathology , Meningitis, Viral/cerebrospinal fluid , Meningitis, Viral/pathology , Meningitis, Viral/virology , Retrospective StudiesABSTRACT
The objective of the study was to compare aciduricity (ability, to live in acid), acidogenicity (ability to produce acid), and intracellular polysaccharide production of mutans streptococci (MS) strains isolated from caries-active (CA, with one or more cavitated lesions) and caries-free (CF, with no clinically observable new caries in the last five years) adults. Forty-three MS strains from 17 of 17 CA adults, and 14 strains from eight of 12 CF adults were investigated. MS isolates' growth, survival, and pH reduction in pH 3.5-7.0 broths were evaluated to compare their acidogenicity and aciduricity. Extracellular water-soluble polysaccharide (WSP) and water-insoluble polysaccharide (WISP) was extracted from MS culture in BHI broth with 5 percent sucrose and assessed by a colorimetric anthrone-sulfuric acid microassay. No significant differences in mean aciduricity were found between CA and CF MS isolates (P>0.05, t test). However, significantly more CA subjects (29 percent) were colonized by MS strains with aciduricity above the average than CF subjects (13 percent, Fisher's exact test, P<0.05). Furthermore, CA MS strains produced significantly more acid at pH<5 (Mann-Whitney, P<0.05) and significantly more CA subjects were colonized with more acidogenic MS at pH<4.5 (Fisher's exact test, P<0.01). Similarly, CA MS isolates produced significantly more WISP than CF (Mann-Whitney test, P<0.01) while no statistical difference was found in WSP between the two groups. More CA subjects were colonized by multiple strains with aciduricity, acidogenicity, and polysaccharide synthesis ability above average. The study indicated that differences in acidogenicity, aciduricity, and polysaccharide synthesis in strains of MS may partially contribute to increased caries activity.
