Ability of Procalcitonin and C-Reactive Protein for Discriminating between Bacterial and Enteroviral Meningitis in Children Using Decision Tree

Bacterial meningitis (BM) is a public health burden in developing countries, including Central Asia. This disease is characterized by a high mortality rate and serious neurological complications. Delay with the start of adequate therapy is associated with an increase in mortality for patients with acute bacterial meningitis. Cerebrospinal fluid culture, as a gold standard in bacterial meningitis diagnosis, is time-consuming with modest sensitivity, and this is unsuitable for timely decision-making. It has been shown that bacterial meningitis differentiation from viral meningitis could be done through different parameters such as clinical signs and symptoms, laboratory values, such as PCR, including blood and cerebrospinal fluid (CSF) analysis. In this study, we proposed the method for distinguishing the bacterial form of meningitis from enteroviral one. The method is based on the machine learning process deriving making decision rules. The proposed fast-and-frugal trees (FFTree) decision tree approach showed an ability to determine procalcitonin and C-reactive protein (CRP) with cut-off values for distinguishing between bacterial and enteroviral meningitis (EVM) in children. Such a method demonstrated 100% sensitivity, 96% specificity, and 98% accuracy in the differentiation of all cases of bacterial meningitis in this study. These findings and proposed method may be useful for clinicians to facilitate the decision-making process and optimize the diagnostics of meningitis.

Striking Decrease of Enteroviral Meningitis in Children During the COVID-19 Pandemic

We report the unprecedented complete absence of pediatric enteroviral meningitis in 2020 in the area of Bern, Switzerland. Presumably an unintended effect of COVID-19 public health measures, this finding highlights the potential of community-wide non-pharmaceutical interventions (NPI) for controlling the circulation of a major pediatric pathogen, which is mainly transmitted by the fecal-oral route.

Decrease in Enteroviral Meningitis - An Unexpected Benefit of COVID-19 Mitigation?

Enteroviral meningitis is seasonal, typically exhibiting a rise in prevalence in late summer/early fall. Based on clinical microbiology laboratory testing data of cerebrospinal fluid, the expected August/September/October peak in enteroviral meningitis did not occur in 2020, possibly related to COVID-19 mitigation strategies.

Differentiating Enteroviral Meningitis from Bacterial Meningitis in Neonates

Objective To compare the demographical, clinical and laboratory features, and outcomes of neonates with enteroviral meningitis (EVM) with those with bacterial meningitis (BM). Methods A retrospective two-center study was performed in La Réunion Island between January 2008 and December 2018 in hospitalized neonates aged less than 29 days. Patients positive for enterovirus real-time polymerase chain reaction from the cerebrospinal fluid (CSF) were diagnosed with EVM. Neonates with positive CSF culture results for a potentially pathogenic bacterium were diagnosed with BM. Results Compared with their EVM peers (n = 20), BM-infected neonates (n = 14) had lower birth weight, and were more likely to present hypotension and neurological symptoms on admission. Thrombocytopenia, elevated serum procalcitonin, hyperproteinorachia, hypoglycorrhachia, CSF pleocytosis, a bacterial meningitis score >0 were more frequent in the BM-infected group. All BM-infected neonates had at least one abnormal cutoff value in the CSF, while nine neonates (45%) in the EVM group had no CSF abnormality (p = 0.004). BM-infected neonates also had a longer length of hospital stay, needed more supportive care, received more prolonged antimicrobial courses, and developed respiratory and neurological complications. Conclusion Recognition of some clinical and laboratory features can help clinicians in differentiating BM from EVM when managing this high-risk patient group.

Up-to-date approaches to forecast of epidemiological situation with incidence of enteroviral meningitis

This work evaluates the results of long-term dynamic monitoring of non-polio enteroviruses (NPEV) circulation in the indicator subpopulation in Yekaterinburg (children aged 3 to 6 years old), isolation of this group of viruses from specimens of sewage and the spectrum of causative agents detected in the liquor of patients with enteroviral meningitis (EVM). We established a high comparability rate of Coxsackie B and ECHO virus serotypes etiologically significant in EVM and isolated from healthy carriers. NPEV detected in sewage waters over the observation period were presented mainly by Coxsackie B viruses (84.0 %), while ECHO viruses (75.6 %) dominated among the causative agents of EVM. A conclusion was made about low informative value of the sewage study results for evaluation and forecast of the EVM epidemic situation as well as about the rationale for including the screening studies of NPEV circulation in the indicator subpopulation into the system of virological and molecular genetic monitoring.

Etiology, Clinical Presentation and Incidence of Infectious Meningitis and Encephalitis in Polish Children

Little is known about the causes and the frequency of meningitis and encephalitis in Poland. We did a retrospective single-center cohort study of children under 18 years old hospitalized with infectious meningitis or encephalitis. Incidence rates were calculated using collected data from patients from the North-East Poland only. A total of 374 children hospitalized between 1 January 2015 and 31 December 2019 were included in the study. A total of 332 (89%) children had meningitis, and 42 (11%) had encephalitis. The etiology of the infection was established in 331 (89%) cases. Enteroviruses accounted for 224 (60%) of all patients. A total of 68 (18%) cases were tick-borne infections. Bacterial pathogens were detected in 26 (7%) children. The median length of hospital stay for children with enteroviral meningitis was 7 days (IQR 7–9), increasing to 11 days (8–13) in those treated with antibiotics. The incidence of meningitis was estimated to be 32.22 (95% CI, 25.33–40.98) per 100,000 and that of encephalitis to be 4.08 (95% CI, 2.07–8.02) per 100,000. By the broad use of molecular diagnostic methods, we managed to identify etiology of the infection in the majority of children. Our data suggest that thorough diagnostics of central nervous system infections are needed to rationalize treatment.