Prospective comparison of culture vs genome detection for diagnosis of enteroviral meningitis in childhood

Objective: To assess the sensitivity and specificity of a new polymerase chain reaction (PCR) assay with uninterrupted reverse transcription and complementary DNA amplification (RT-PCR) for the diagnosis of enteroviral (EV) meningitis in children. Design: A prospective, cohort study. Settings: Two medical centers: 1 university hospital and 1 children's hospital in San Diego County, California, during a 5-week period. Patients: All pediatric patients younger than 16 years who underwent a lumbar puncture for evaluation of possible meningitis. Main Outcome Measures: The results of cerebrospinal fluid (CSF) RT-PCR were compared with viral cultures and clinical histories. Results: During the 5-week period, 90 patients were entered into the study. Nonpolio EVs were cultured from 10% (9/90) of the patients from the following sites: CSF, 6.7% (6/90) of the patients; stool, 19% (4/21) of the patients; and throat swabs, 5.6% (1/18) of the patients. The EV genome was detected in the CSF by using RT-PCR in 7 of 9 EV culture-positive patients. The sensitivity and specificity of the CSF RT-PCR assay to detect EV meningitis were 77.8% and 100%, respectively. This compared with a sensitivity of 66.7% for detection of EV in CSF by viral culture alone. Conclusion: The new RT- PCR assay is a rapid and reliable method for the detection of EV infection in childhood.