Jonas Ahlbrecht1, Lilly Katrin Hillebrand2, Philipp Schwenkenbecher2, Tina Ganzenmueller3, Albert Heim3, Ulrich Wurster2, Martin Stangel2, Kurt-Wolfram Sühs2, Thomas Skripuletz4. 1. Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany. Electronic address: ahlbrecht.jonas@mh-hannover.de. 2. Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany. 3. Institute of Virology, Hannover Medical School, Hannover, Germany; German Centre for Infection Research (DZIF), Standort Hannover-Braunschweig, Hannover, Germany. 4. Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany. Electronic address: skripuletz.thomas@mh-hannover.de.
Abstract
OBJECTIVES: The aim of this study was to investigate the clinical and laboratory features of adults with nervous system infections caused by enteroviruses, with special emphasis on cerebrospinal fluid (CSF). METHODS: The data of 46 patients who were PCR-positive for enteroviruses in the CSF between 2002 and 2017 were evaluated. RESULTS: Meningitis was the most common clinical manifestation (89%), followed by encephalitis (7%) and isolated cranial nerve involvement (4%). Twenty percent of patients reported a sudden onset of severe headache that led to the initial suspected diagnosis of subarachnoid haemorrhage. General signs of infection, such as fever, elevated C-reactive protein, and an elevated white blood cell count, were found in only 61%. Most patients exhibited consistent inflammatory CSF changes, with elevated cell counts (85%) and blood-CSF barrier dysfunction (83%). Patients with normal CSF cell counts were significantly older, less frequently presented with meningitis, and exhibited lower peripheral white blood cell counts. Sequencing revealed species Enterovirus B in all patients, with most sequences related to echovirus 30. CONCLUSIONS: The absence of CSF pleocytosis, isolated cranial nerve involvement, and only infrequent general signs of infection may impede the diagnosis of enteroviral nervous system infections. A thorough CSF analysis including PCR is essential for a reliable diagnosis.
OBJECTIVES: The aim of this study was to investigate the clinical and laboratory features of adults with nervous system infections caused by enteroviruses, with special emphasis on cerebrospinal fluid (CSF). METHODS: The data of 46 patients who were PCR-positive for enteroviruses in the CSF between 2002 and 2017 were evaluated. RESULTS:Meningitis was the most common clinical manifestation (89%), followed by encephalitis (7%) and isolated cranial nerve involvement (4%). Twenty percent of patients reported a sudden onset of severe headache that led to the initial suspected diagnosis of subarachnoid haemorrhage. General signs of infection, such as fever, elevated C-reactive protein, and an elevated white blood cell count, were found in only 61%. Most patients exhibited consistent inflammatory CSF changes, with elevated cell counts (85%) and blood-CSF barrier dysfunction (83%). Patients with normal CSF cell counts were significantly older, less frequently presented with meningitis, and exhibited lower peripheral white blood cell counts. Sequencing revealed species Enterovirus B in all patients, with most sequences related to echovirus 30. CONCLUSIONS: The absence of CSF pleocytosis, isolated cranial nerve involvement, and only infrequent general signs of infection may impede the diagnosis of enteroviral nervous system infections. A thorough CSF analysis including PCR is essential for a reliable diagnosis.
Authors: Lars Hendrik Müschen; Alma Osmanovic; Camilla Binz; Konstantin F Jendretzky; Gresa Ranxha; Paul Bronzlik; Omar Abu-Fares; Flavia Wiehler; Nora Möhn; Martin W Hümmert; Stefan Gingele; Friedrich Götz; Martin Stangel; Thomas Skripuletz; Olivia Schreiber-Katz; Susanne Petri Journal: Brain Sci Date: 2021-02-26
Authors: Jonas Graf; Christian J Hartmann; Helmar C Lehmann; Carolin Otto; Ortwin Adams; Michael Karenfort; Christian Schneider; Klemens Ruprecht; Hans Martin Bosse; Sabine Diedrich; Sindy Böttcher; Alfons Schnitzler; Hans-Peter Hartung; Orhan Aktas; Philipp Albrecht Journal: BMC Infect Dis Date: 2019-11-29 Impact factor: 3.090