Clinical characteristics, management strategies, and cost implications of a statewide outbreak of enterovirus meningitis.

A statewide outbreak of enterovirus meningitis occurred in Rhode Island in the summer of 1991. A comprehensive chart review was conducted for determining the demographic and clinical characteristics of the epidemic and for assessing the interinstitutional variation in treatment strategies. Four hundred eight cases were reported, and enteroviruses were recovered in 61 (68%) of 90 cases in which viral isolation was attempted. Of six isolates that were serotyped, all were echovirus 30. Analysis of cerebrospinal fluid revealed that an increased total white blood cell count and an increased protein concentration were associated with increasing patient age; however, the percentage of polymorphonuclear leukocytes in the cerebrospinal fluid decreased with increasing patient age and longer durations of illness. Marked variations in treatment strategies between institutions were noted in the use of computed tomography of the head, the administration of empirical antimicrobial agents, and the duration of hospitalization. Considerable health resources could have been saved by rapid detection of the virus, dissemination of information about the outbreak, and a conservative approach to clinical management.