Meningitis gone viral: Description of the Echovirus Wave 2013 in Germany [post]

2019 unpublished
BACKGROUND: Aseptic meningitis epidemics may pose various health care challenges. OBJECTIVE: We describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1 st and December 31 st , 2013 in order to scrutinize clinical differences from other aseptic meningitis cases. RESULTS: A total of 72 enterovirus (EVpositive) meningitis cases were detected in our multicenter cohort, corresponding to 5.8% of all EVpositive cases
more » ... EVpositive cases which were voluntarily reported within the National Enterovirus surveillance (EVSurv, based on investigation of patients with suspected aseptic meningitis/encephalitis and/or acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18 pediatric and 20 adult cases, median age 18.5 years; echovirus 18 (1), echovirus 2 (1), echovirus 30 (31), echovirus 33 (1), echovirus 9 (4)). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EVnegative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and one EVnegative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home. CONCLUSION: Voluntary syndromic surveillance, such as provided by the EVSurv in our study may be a valuable tool for epidemiological research. Our analyses suggest that EV-positive meningitis predominantly affects younger patients and may be associated with a rather benign clinical course, compared to EV-negative cases. Background Periodic aseptic meningitis epidemics can be a challenge in patient-and health care. A large retrospective analysis of a US-American cohort revealed that in 21% of cases the etiology of aseptic meningitis remains unknown 1 . Aseptic meningitis is defined 2 by an inflammation of the leptomeninx in which the causative agent cannot be identified by cerebrospinal fluid culture 3 . Viruses are the most common causes of this disease 1,3 . Viral meningitides are predominantly caused by enteroviruses 4 , which belong to the picornaviridae consisting of species A-D. The main route of infection is fecal-oral, 4 but infestation of the respiratory tract and a droplet infection are also possible. In previous studies, viral meningitis in adults was rather associated with herpes simplex and West Nile virus, whereas children were more likely to be tested positive for enterovirus (EV) 5 . Therefore, multiple studies have been conducted in order to better understand this phenomenon: A Danish nation-wide prospective observational study between 1 st of January 2015 and 30 th of June 2016 revealed an unfavorable outcome of viral meningitis in 17% of all patients 6 . According to a UK study, the infection rates of viral meningitis are mainly driven by an EV predominance of echovirus 30 7 . EV meningitis epidemics in Shandong (People's Republic of China, 2014 8 ) and Finland (2009 and 2010 9 ) and the clinical pattern of viral central nervous system (CNS) infections in Italy 10 have previously been characterized: EV-positive patients presented with fever, nausea and vomiting, were most likely to be children, and had no clear gender predominance. The treatment is symptomatic, employing analgetic drugs and antipyretic therapy to control body temperature. Pleconaril has been considered as potential specific treatment for EV-associated meningitis. However, it was not approved, given its just modest efficacy and considerable side-effect and interaction profile 11,12 . In particularly severe cases, administration of immunoglobulins may positively influence the course of the disease 13 . Cerebrospinal fluid (CSF) and clinical features of EV-positive meningitis patients in Germany 14 and the differences in adult and pediatric EV-positive meningitis patients in Switzerland 15 have already been analyzed, but there is still a paucity of data describing the differences in EV-positive meningitis and EV-negative meningitis patients.
doi:10.21203/rs.2.11283/v4 fatcat:zkljitg6tvbbvolgvnybbyblsq