UMEM Educational Pearls

Category: Pediatrics

Title: Enterovirus Meningitis

Keywords: Enterovirus, infant, CSF (PubMed Search)

Posted: 7/15/2011 by Mimi Lu, MD (Updated: 7/22/2011)
Click here to contact Mimi Lu, MD

Now that summer is in full swing, the question is: Should the evaluation of the febrile young infant change during the summer and fall months?  And can that affect length of hospitalization and antibiotic use?

Two retrospective cohort studies from the Children’s Hospital of Philadelphia (CHOP) suggest yes!  The addition of enterovirus polymerase chain reaction (PCR) testing to cerebrospinal fluid (CSF) may improve the care of infants with fever during enterovirus season (early June through late October). 

Of note, at CHOP: 1) infants 56 days or younger routinely undergo lumbar puncture during evaluation for fever.  2) Most CSF enterovirus PCR test results (90%) were available within 36 hours; 95% of results were available within 48 hours.

In the King study, having positive enterovirus PCR CSF results decreased the length of hospitalization and the duration of antibiotic use for young infants less than 90 days, supporting the routine use of this test during periods of peak enterovirus season.  In multivariate
analysis, a positive CSF enterovirus PCR result was associated with a 1.54-day decrease in the length of stay and a 33.7% shorter duration of antibiotic use.

Bottom line: Consider adding enterovirus PCR testing to CSF obtained during the evaluation of febrile young infants during enterovirus season, as this may reduce length of hospitalization and duration of antibiotic use.  The effects, however, may be limited at institutions with slower lab turnaround times.



1) King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days or younger. Pediatrics. 2007 Sep;120(3):489-96.

2) Dewan M, Zorc JJ, Hodinka RL, Shah SS. Cerebrospinal fluid enterovirus testing in infants 56 days or younger. Arch Pediatr Adolesc Med. 2010 Sep;164(9):824-30.