Background: Young infants with fever commonly present to the emergency department. Given the risk for serious bacterial infection, including meningitis, many undergo invasive testing, receive empiric antibiotics and are hospitalized. Yet most infections in this age group are viral, with enterovirus the predominant pathogen but parechovirus becoming increasingly recognized. We report on molecular diagnostic testing of the CSF of young febrile infants.
Methods: 147 febrile infants, up to 3 months of age, 1/1/2016 through 12/11/2018 had a sepsis work-up at our hospital. Fifty-nine frozen samples underwent multiplex PCR [Allplex meningitis V1-V2, Seegene (12 viral pathogens)]. Meningitis was defined by the detection of a pathogen and /or a pathological cell count. Six bloody CSF samples precluded pleocytosis evaluation.
Results: Forty-three of the fifty-nine infants (73%; 95% CI: 61%-84%) had meningitis whereas 16/59 (27%; 95% CI: 15-39%) had other infectious diagnoses. All CSF bacterial cultures were negative. Allplex detected viral meningitis in 38/43 (88%) of the CNS infections - 33/43 (77%) enterovirus, 5/43 (12%) parechovirus. Of the samples appropriate for evaluation, 4/4 of the parechovirus and 15/29 of the enterovirus were without pleocytosis. There were no significant differences between clinical features and laboratory testing of patients with enterovirus and parechovirus meningitis.
Conclusions: Enterovirus meningitis constitutes a common cause of meningitis in the young febrile infant. Given the absence of pleocytosis in some viral meningitis cases, clinicians should consider multiplex array of CSF with normal cell count. An expedient viral meningitis diagnosis has the potential to decrease antibiotic use and length of stay.
