Jacob Bodilsen1, Helene Mens2,3, Sofie Midgley4, Christian Thomas Brandt2, Pelle Trier Petersen2, Lykke Larsen5, Birgitte Rønde Hansen6, Hans Rudolf Lüttichau7, Jannik Helweg-Larsen3, Lothar Wiese8, Christian Østergaard6, Merete Storgaard9, Henrik Nielsen9,10. 1. Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark jacob.bodilsen@rn.dk. 2. Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark. 3. Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark. 4. Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark. 5. Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark. 6. Department of Infectious Diseases, Hvidovre University Hospital, 2650 Hvidovre, Denmark. 7. Department of Infectious Diseases, Herlev Gentofte Hospital 2730 Herlev, Denmark. 8. Department of Infectious Diseases, Sjælland University Hospital, 4000 Roskilde, Denmark. 9. Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark. 10. Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
Abstract
OBJECTIVE: To test the hypothesis that enterovirus meningitis (EM) is a frequent and self-limiting condition, the epidemiology of enterovirus meningitis (EM) in adults was examined. METHODS: Using a prospective, nationwide, population-based database, all adults with EM confirmed by PCR of the cerebrospinal fluid (CSF) from 2015-2019 were included. Unfavorable outcome was defined as Glasgow Outcome Scale (GOS) scores of 1-4 at discharge. Modified Poisson regression was used to compute adjusted relative risks (RRs). RESULTS: 419 cases of EM in 418 adults (46% female, median age 31 years [IQR 27-35]) yielded an incidence of 1.80/100,000/year. Admission diagnoses included CNS infection 247/397 (62%), other neurological conditions 89/397 (22%), and cerebrovascular diseases 33/397 (8%). Genotype was available for 271 cases, of which Echovirus 30 accounted for 155 (57%).Patients presented with headache 412/415 (99%), history of fever 303/372 (81%), photophobia 292/379 (77%), and neck stiffness 159/407 (39%). Fever (≥38.0 °C) was observed in 192/399 (48%) at admission. The median CSF leukocyte count was 130 106/L (range 0-2,100) with polymorphonuclear predominance (>50%) in 110/396 (28%). Cranial imaging preceded lumbar puncture in 127/417 (30%) and was associated with non-CNS infection admission diagnoses and delayed lumbar puncture (median 4.8 hours [IQR 3.4-7.9] vs. 1.5 [IQR 0.8-2.8], p<0.001). Unfavorable outcome occurred in 99/419 (24%) at discharge; more often in females (RR 2.30 [1.58-3.33]) and less frequent in Echovirus 30 (RR 0.67 [0.46-1.00]) in adjusted analyses. Outcome remained unfavorable in 22/379 (6%) after six months. CONCLUSIONS: EM is common among young, healthy adults. Although the long-term prognosis remains reassuring, a substantial proportion have moderate disability at discharge, especially females.
OBJECTIVE: To test the hypothesis that enterovirus meningitis (EM) is a frequent and self-limiting condition, the epidemiology of enterovirus meningitis (EM) in adults was examined. METHODS: Using a prospective, nationwide, population-based database, all adults with EM confirmed by PCR of the cerebrospinal fluid (CSF) from 2015-2019 were included. Unfavorable outcome was defined as Glasgow Outcome Scale (GOS) scores of 1-4 at discharge. Modified Poisson regression was used to compute adjusted relative risks (RRs). RESULTS: 419 cases of EM in 418 adults (46% female, median age 31 years [IQR 27-35]) yielded an incidence of 1.80/100,000/year. Admission diagnoses included CNS infection 247/397 (62%), other neurological conditions 89/397 (22%), and cerebrovascular diseases 33/397 (8%). Genotype was available for 271 cases, of which Echovirus 30 accounted for 155 (57%).Patients presented with headache 412/415 (99%), history of fever 303/372 (81%), photophobia 292/379 (77%), and neck stiffness 159/407 (39%). Fever (≥38.0 °C) was observed in 192/399 (48%) at admission. The median CSF leukocyte count was 130 106/L (range 0-2,100) with polymorphonuclear predominance (>50%) in 110/396 (28%). Cranial imaging preceded lumbar puncture in 127/417 (30%) and was associated with non-CNS infection admission diagnoses and delayed lumbar puncture (median 4.8 hours [IQR 3.4-7.9] vs. 1.5 [IQR 0.8-2.8], p<0.001). Unfavorable outcome occurred in 99/419 (24%) at discharge; more often in females (RR 2.30 [1.58-3.33]) and less frequent in Echovirus 30 (RR 0.67 [0.46-1.00]) in adjusted analyses. Outcome remained unfavorable in 22/379 (6%) after six months. CONCLUSIONS: EM is common among young, healthy adults. Although the long-term prognosis remains reassuring, a substantial proportion have moderate disability at discharge, especially females.