Enterovirus Meningitis With Marked Pleocytosis

[摘要] In neonates and young infants, it can be difficult to distinguish bacterial from aseptic meningitis, especially in the setting of marked CSF (cere-brospinal fluid) pleocytosis. This case series and review of the literature explores the role of early CSF EV-PCR (enterovirus-polymerase chain reaction) in these patients' diagnostic workup, management, and overall hospital stay.Patient 1 was a 30-day-old female who presented with a fever of 102°F and increased irritability for 1 day. She was admitted to the hospital for an evaluation including complete blood cell count (CBC), blood culture, urine culture, urinalysis, and lumbar puncture (LP). Ampicillin, gentamicin, and acyclovir were initiated. Admission laboratory data included peripheral white blood cell (WBC) count of 9200 cells/μL and a normal urinalysis. Cerebrospinal fluid (CSF) was remarkable for pleocytosis of 1005 cells/μL with 53% lymphocytes, 0 red blood cells (RBCs), protein of 92.8 mg/dL, and glucose of 44 mg/dL (Table 1). Gram-stain of the CSF revealed Gram-positive cocci in pairs; however, no bacteria were cultured. Results of the urine culture were negative. The blood culture grew coagulase-negative Staphylococcus, which was believed to be a contaminant. The patient continued to be febrile despite 72 hours of antibiotic therapy. Therefore, a repeat LP was performed, revealing 80 WBC/μL with 63% lymphocytes, 700 RBC/μL, protein of 138 mg/dL, and glucose of 38 mg/dL. Enterovirus-polymerase chain reaction (EV-PCR) performed on the repeat CSF was positive. Herpes simplex virus polymerase chain reaction (PCR) was negative. Antibiotic therapy was discontinued, and the patient was discharged from the hospital.View this table:TABLE 1 Summary of Patient Laboratory DataPatient 2 was a 7-day-old female who presented with fever of 104°F for 1 day and jaundice. She was transferred from a referring hospital after undergoing an evaluation that included CBC, blood culture, urine culture, urinalysis, and LP. Ampicillin, gentamicin, and acyclovir were begun before patient …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob