Reconsideration of Diagnostic Lumbar Puncture in Childhood Enteroviral Meningitis

Nam, Ji Woo; Kim, Tae Soon; Kim, Ju Young; Kim, Jon Soo

Abstract

PURPOSE
Despite the fact that enteroviral meningitis is the most common cause of meningitis in children with signs of meningeal irritation and has benign course, most clinicians routinely perform an invasive lumbar puncture (LP) that result in inadequate antibiotic therapy and unnecessary long-term hospitalization. This study was aimed to compare the clinical characteristics of childhood enteroviral meningitis according to LP.
METHODS
Children over 2 years of age who can clearly express signs of meningeal irritation in the pediatric department of Eulji university hospital from July 2013 and August 2016 were enrolled. The patients were diagnosed by reverse transcriptase polymerase chain reaction in stool and/or cerebrospinal fluid. We retrospectively reviewed their clinical records.
RESULTS
A total of 257 patients were diagnosed with enterovirus meningitis and median age was 6.3 (2.1-7.9) years. One hundred fifteen patients (44.7%) with confirmed enterovirus in the stools underwent supportive care without LP. Mostly, there was no statistically significant difference in age, sex, clinical symptoms, except gastrointestinal involvement (abdominal pain, diarrhea), and serologic findings when compared with patients who underwent LP. But patients who underwent LP had longer hospital stay (4 vs 3 days, P < 0.001). Four of them (2.8%) were re-admitted with back pain and persistent headache, probably related to LP procedure. All patients were discharged without neurologic complications.
CONCLUSION
Rapid detection of enteroviruses in stool specimens that can be easily obtained in children with signs of meningeal irritation may reduce invasive LP.