Clinical and Laboratory Detection of Non-Polio Enteroviruses among Different Age Groups of Aseptic Meningitis Patients in Alexandria, Egypt

Background: Viral meningitis is the most common type of meningitis. Worldwide, Non polio Enteroviruses (NPEV) account for 23 - 60% of all cases of viral meningitis. We aimed to detect NPEV among aseptic meningitis cases using RTPCR and evaluate molecular testing versus clinical and laboratory parameters.

Patients and methods: A two-year prospective study was conducted for all clinically suspected meningitis patients, who underwent lumbar puncture in Alshatby University and Alexandria Fever Hospitals. Clinical manifestations were reviewed, cytological, microbiological and biochemical examinations were done. One-step RT-PCR for NPEV was introduced to routine workflow using Pan-Enterovirus primers.

Results: Out of 2519 patients, 994 (40%) were found to have positive CSF findings, of which 716 (72%) had positive findings of aseptic meningitis. Ninety-four samples were randomly selected and divided across 4 age groups: neonates, infants, children and adults. Significant difference was found among adult patients regarding fever, vomiting, headache, signs of meningeal irritation, cranial nerve affection and focal neurological deficits (P≤ 0.05). Seven cases (7.4%) were found to be NPEV positive by RT-PCR. Positive NPEV PCR samples were shown to be statistically significance among neonates (P≤ 0.05). Statistical significance was found among NPEV group regarding length of hospital stay and duration of IV antibiotic intake while No statistical significance was found with any clinical or laboratory findings.

Conclusion: RTPCR was reliable to identify NPEV while clinical and laboratory findings were inconclusive. NPEV showed low incidence and slight seasonal variation which rings the bell to investigate other causes of viral meningitis throughout the year. This article is protected by copyright. All rights reserved.

Keywords: Aseptic meningitis; Cerebrospinal fluid; Lumbar puncture; Non polio Enteroviruses (NPEV); One-step Reverse transcriptase PCR (RT-PCR).