Enterovirus Meningitis in Neonates

Background: Enterovirus infection is common in children, but less prevalent in neonates. It causes nonspecific febrile disease, aseptic meningitis, hepatitis with coagulopathy and/or myocarditis.

Objective: To evaluate the burden and clinical characteristics of enterovirus meningitis in a tertiary neonatal unit from 2006 to 2016.

Methods: We included neonates with positive lumbar puncture (21 ± 10 leukocytes/mm³) and enterovirus RNA detected in the cerebrospinal fluid (CSF). We analysed maternal and perinatal history, clinical and laboratory data, therapy and short-term outcomes.

Results: A total of 21 neonates were included, all were term, all but one had appropriate birth measures, 15 were male (71%). Most patients presented during the summer and autumn months. We found two peaks of disease onset: 5 to 9 and 18 to 29 days (median values 7 and 21). 8 patients were in contact with siblings, who had signs of viral disease. 3 mothers were ill at delivery or shortly after. 20 neonates presented with irritability, 16 with fever (median 38.6°C (37.5-39.5)), 16 with feeding intolerance, 15 with diarrhoea, 6 with nonspecific rash, 1 had seizures. 7 neonates had mildly elevated CRP (range 9-31 mg/L) and 7 had elevated PCT (range 0.53-10 ug/L). All had elevated leukocyte count in the CSF (median 11/mm³ (3-1739)). None had clinical or laboratory signs of SIRS, hepatitis with coagulopathy and/or myocarditis. In 15 neonates antibiotics were started, median time of treatment was 1 day. All patients had good outcome.

Conclusions: Enterovirus infection is an important cause of meningitis in neonates during summer and autumn months, particularly with positive history of contact with ill persons, with persistent fever, irritability and normal or mildly elevated CRP and/or PCT values. Males have a higher risk of disease. Our findings suggest that enterovirus meningitis in neonates may be transmitted in two ways and carries a good prognosis.