Enterovirus Meningitis in Adults: A Prospective Nationwide Population-Based Cohort Study

Link to article at PubMed

Neurology. 2021 Jun 4:10.1212/WNL.0000000000012294. doi: 10.1212/WNL.0000000000012294. Online ahead of print.


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.

PMID:34088872 | DOI:10.1212/WNL.0000000000012294

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