Seyahat öyküsü olan pediatrik enteroviral menenjit olgusu

Year 2024, Volume: 8 Issue: 1, 71 - 75, 30.04.2024

Buket Baddal Burcin Sanlidag Tutku Aksoy Yaren Doğramacıoğlu

https://doi.org/10.34084/bshr.1451451

Abstract

Enteroviral menenjit dünya çapında yaygın görülen bir viral menenjit türüdür. Bu çalışmada, 3 gün boyunca devam eden mide bulantısı, kusma, ateş ve baş ağrısı şikayetleri ile başvuran ve seyahat öyküsü olan 5 yaşında erkek olgu sunulmaktadır. Hasta, semptomların başladığı ilk gün 39.5°C ateş, iştah kaybı ve başın sağ ön kısmında ağrı ile acil servise başvurdu. Fiziki muayenede, başlangıçta ense sertliği görülmese de ertesi gün ense sertliği belirlendi. Kernig ve Brudzinski bulguları pozitif idi. Başvuru sırasında yapılan testlerde C-reaktif proteinde hafif artış ve beyaz hücre sayısının normal olduğu görüldü. Pediatri servisine yatırılan hastaya lomber ponksiyon yapıldı. Ampirik olarak intravenöz seftriakson ve asiklovir uygulandı. Beyin omurilik sıvısı (BOS) analizinde normal protein ve glikoz konsantrasyonu ile birlikte lenfositik pleositoz saptandı. BOS moleküler analizi enterovirüs RNA açısından pozitif bulundu. Kontrastlı kraniyal manyetik rezonans görüntüleme normal idi. Tanının doğrulanmasının ardından seftriakson ve asiklovir tedavileri durdurularak destek tedavisi başlandı. Hasta başarılı bir şekilde iyileşti ve herhangi bir komplikasyon yaşanmadan taburcu edildi. Bu olgu sunumu, hızlı moleküler testlerin, intravenöz tedaviyi, yan etkilerini ve yatılı tedavi süresini azaltarak antimikrobiyal yönetimi iyileştirdiğini ve hasta yönetimini olumlu yönde etkilediğini vurgulamaktadır.

Keywords

Enterovirüs, menenjit, moleküler test, RT-PCR, hızlı tanı, hasta yönetimi

A case of pediatric enteroviral meningitis with a travel history

Abstract

Enterovirus meningitis represents a common cause of meningitis worldwide. In this case study, a 5-year-old male with a travel history presenting with persistent nausea, vomiting, fever and headache for 3 days is reported. The patient described a fever of 39.5°C on the first day of symptom onset as well as decreased appetite and pain in the front right side of head. In physical examination, initially there was no sign of stiff neck, however he had neck stiffness the following day, Kernig's sign and Brudzinski's signs were positive. On admission, blood tests showed a slightly increased C-reactive protein and a normal white cell count. He was admitted to the pediatrics service and a lumbar puncture was performed. Intravenous ceftriaxone and acyclovir were empirically administered. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, with normal protein and glucose concentration. CSF molecular analysis was positive for enterovirus RNA. Cranial magnetic resonance imaging with contrast was normal. Following confirmed diagnosis, ceftriaxone and acyclovir treatments were discontinued and he was given supportive care. He successfully recovered and was discharged without any complication. This case report highlights that rapid molecular testing favorably impacts patient management by improving antimicrobial stewardship through the reduction of intravenous therapy, side effects and inpatient bed-days.

Keywords

Enterovirus, meningitis, molecular testing, RT-PCR, rapid diagnosis, patient management

Ethical Statement

Due to the nature of this retrospective study and the preserved anonymity of the patient, a waiver of ethics committee approval was obtained from Near East University. All methods were carried out in accordance with the guidelines and regulations of Declaration of Helsinki. An informed consent was obtained from the patient.

References

• Encyclopedia of the Neurological Sciences 2nd Edition - April 29, 2014. Editors: Robert B. Daroff, Michael J. Aminoff Hardback ISBN: 9780123851574eBook ISBN: 9780123851581
• Bessaud M, Pillet S, Ibrahim W, Joffret ML, Pozzetto B, Delpeyroux F, Gouandjika-Vasilache I. Molecular characterization of human enteroviruses in the Central African Republic: uncovering wide diversity and identification of a new human enterovirus A71 genogroup. J Clin Microbiol. 2012;50(5):1650-8. DOI: 10.1128/JCM.06657-11
• Tapparel C, Siegrist F, Petty TJ, Kaiser L. Picornavirus and enterovirus diversity with associated human diseases. Infect. Genet. Evol. 2013;14:282–293. DOI: 10.1016/j.meegid.2012.10.016
• National Institute of Neurological Disorders and Stroke. Meningitis. Access date: 26 March 2024 Available from: https://www.ninds.nih.gov/health-information/disorders/meningitis
• Zhu Y, Zhou X, Liu J, Xia L, Pan Y, Chen J, Luo N, Yin J, Ma S. Molecular identification of human enteroviruses associated with aseptic meningitis in Yunnan province, Southwest China. Springerplus. 2016;5(1):1515. DOI: 10.1186/s40064-016-3194-1
• Cassidy H, Genne MV, Lizarazo-Forero E, Gard L, Niesters HGM. A discussion of syndromic molecular testing for clinical care. J. Antimicrob. Chemother. 2021;76(3):iii58–iii66. DOI: 10.1093/jac/dkab243
• Jafri L, Farooq Khan A, Arshad T, Kanwar D. A Case Series on Enteroviral Meningitis in Pakistan. Cureus. 2021;13(10):e19048. DOI: 10.7759/cureus.19048
• Lepow ML, Coyne N, Thompson LB, Carver DH, Robbins FC. A clinical, epidemiologic and laboratory investigation of aseptic meningitis during the four-year period, 1955-1958. II. The clinical disease and its sequelae. N Engl J Med. 1962;266:1188–1193. DOI: 10.1056/NEJM196206072662302
• Dawood N, Desjobert E, Lumley J, Webster D, Jacobs M. Confirmed viral meningitis with normal CSF findings. BMJ Case Rep. 2014; 2014:bcr2014203733. DOI: 10.1136/bcr-2014-203733
• Graf J, Hartmann C, Lehmann HC, et al. Meningitis gone viral: description of the echovirus wave 2013 in Germany. BMC Infect Dis. 2019;19(1):1010. DOI: 10.1186/s12879-019-4635-6