Circulation of enteroviruses and persistence of meningitis cases in the winter of 1999-2000

The seasonal incidence of enterovirus meningitis was analyzed in a prospective study of patients admitted for suspected meningitis from October 1, 1998 to April 30, 2000. In-house reverse transcription-polymerase chain reaction (RT-PCR) in cerebrospinal fluid (CSF) was used irrespective of cytological results. Fifty-two (45.2%) of the 115 patients had positive RT-PCR in CSF, including 44/86 children (51.2%) and 8/29 adults (27.6%). Six of the 52 (11.5%) had no pleocytosis. The numbers of CSF specimens with a predominance of lymphocytes or a predominance of neutrophils were closely similar. In 33 of the positive patients, an enterovirus, mainly echoviruses type 6 (48%) and 30 (24%), was recovered in one or more specimens. Sixteen cases of enteroviral meningitis were observed between November 1999 and March 2000 as against 2 cases between November 1998 and March 1999, showing that the disease persisted through the winter months of 1999-2000. During the same period, 96 enterovirus isolates were recovered from clinical specimens from other patients. The number of isolates was higher in the winter of 1999-2000 (P <0.01) than in the winter of 1998-1999, indicating that the risk of enterovirus infection increased significantly in winter 1999-2000. Sixteen patients had aseptic meningitis, made a rapid recovery and had an enterovirus in throat swabs and stools (9/16) or in one of the two (7/16). RT-PCR was not requested. Nine patients were admitted during the cold months. The clinical management of both adult and child patients could be improved by year-round use of enterovirus generic RT-PCR. (C) 2001 Wiley-Liss, Inc.