Evaluation of Clinical and Laboratory Findings of Children with Acute Bacterial and Enteroviral Meningitis

Abstract

Objective: Acute meningitis is one of the important infectious diseases that can result in mortality and morbidity in children despite effective treatment and vaccination. Early diagnosis of the disease, isolation of the causative agent, and appropriate treatment are important in preventing the development of complications. In this study, we aimed to examine the clinical, laboratory findings and agent distributions of patients with acute meningitis for the last seven years. In addition, findings that may be significant in the differentiation of bacterial-enteroviral meningitis were investigated. Material and Methods: Patients who underwent cerebrospinal fluid (CSF) examination with the pre-diagnosis of acute meningitis at Selçuk University Faculty of Medicine, Pediatric Infectious Diseases Service between September 2013 and September 2020 were evaluated retrospec-tively. The patients who were diagnosed as other than meningitis, chronic meningitis, and ventriculoperitoneal shunt meningitis were excluded from the study. Results: The data of 48 pediatric patients diagnosed with acute bacterial meningitis (n= 22) and enteroviral meningitis (n= 26) out of 177 patients who underwent CSF examination with the diagnosis of acute meningitis were retrospectively analyzed. The mean age of the patients was 83.46 ± 62.68 months, and 79.2% of them were male. S. pneumoniae, N. menin-gitidis, E. coli, H. influenzae type b were detected in patients with bacterial meningitis. All patients with enterovirus meningitis were diagnosed by CSF polymerase chain reaction (PCR). In patients with bacterial menin-gitis, posivity of CSF PCR, CSF culture and blood culture was 86.3%, 50%, and 27.3%, respectively. Although the CSF PCR of three patients with bacterial meningitis was negative, bacterial growth was detected in the blood culture. CSF glucose and protein levels, blood leukocyte count, C-reactive protein (CRP) and procalcitonin levels were significantly high-er in patients with bacterial meningitis compared to patients with en-teroviral meningitis. A procalcitonin value of 0.855 ng/mL and above was found in favor of bacterial meningitis (p= 0.001). Conclusion: CSF PCR test plays an important role in the diagnosis of acute meningitis and in distinguishing between viral and bacterial men-ingitis. Detection of enterovirus can provide allowing earlier discharges and decreasing avoidable inappropriate antibiotic treatments.