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

Jacob Bodilsen, Helene Mens, Sofie Midgley, Christian Thomas Brandt, Pelle Trier Petersen, Lykke Larsen, Birgitte Rønde Hansen, Hans Rudolf Lüttichau, Jannik Helweg-Larsen, Lothar Wiese, Christian Østergaard, Merete Storgaard, Henrik Nielsen, Danish Study Group of Infections of the Brain (DASGIB)

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: To test the hypothesis that enterovirus meningitis (EM) is a frequent and self-limiting condition, the epidemiology of EM in adults was examined.

METHODS: Using a prospective, nationwide, population-based database, all adults with EM confirmed by PCR of the CSF from 2015 to 2019 were included. Unfavorable outcome was defined as Glasgow Outcome Scale scores of 1-4 at discharge. Modified Poisson regression was used to compute adjusted relative risks (RRs).

RESULTS: A total of 419 cases of EM in 418 adults (46% female, median age 31 years [interquartile range (IQR) 27-35]) yielded an incidence of 1.80/100,000/year. Admission diagnoses included CNS infection 247/397 (62%), other neurologic 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 female patients (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 6 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 female patients.

Original languageEnglish
JournalNeurology
Volume97
Issue number5
Pages (from-to)e454-e463
ISSN0028-3878
DOIs
Publication statusPublished - 3. Aug 2021

Keywords

  • Adolescent
  • Adult
  • Databases, Factual
  • Denmark/epidemiology
  • Enterovirus Infections/cerebrospinal fluid
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Leukocyte Count
  • Male
  • Meningitis, Viral/cerebrospinal fluid
  • Middle Aged
  • Poisson Distribution
  • Polymerase Chain Reaction
  • Prospective Studies
  • Risk Assessment
  • Treatment Outcome
  • Young Adult

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