Neonatal viral meningitis. The importance of the polymerase chain reaction in their diagnosis
*Correspondencia: Dr. Carlos Marcilla Vázquez. Sección de Neonatología. Complejo Hospitalario Universitario de Albacete. Hermanos Falcó, 37. E-02006 Albacete.
E-mail: carlos.marcilla11@gmail.com
Introduction: The different types of viral meningitis constitute a condition that is relatively frequent in newborn infants, although in many cases they are underdiagnosed due to the absence of pleocytosis in the cerebrospinal fluid (CSF).
Aims: To describe the clinical features and laboratory findings of newborn infants with viral meningitis and to highlight the importance of the polymerase chain reaction (PCR) in the CSF to diagnose this condition.
Patients and methods: A retrospective review of the medical records of newborn infants hospitalised in the neonatology section who had been diagnosed with viral meningitis between May 2014 and May 2017.
Results: Altogether 17 cases of viral meningitis were registered (15 caused by enterovirus and two due to parechovirus), which accounts for 14.8% of all newborns hospitalised owing to febrile symptoms. All of them had fever (100%), and other notable symptoms were irritability (76%) and rejection of feeding (65%). Normal cellularity was found in the CSF without high protein levels in 88% of them, and without hypoglycorrhachia in all of them (100%), which meant that many of these children had previously been left with a diagnosis of a febrile syndrome with no focus. These data stress the need to perform the PCR in the CSF of newborn infants who have a fever without a focus, due to the normal status of the results of the complementary tests in most cases. Subsequent neurological follow-up was performed in 64.7% of the children in the neurology service, without any neurological sequelae being found, except in one case.
Conclusions: Multiple PCR in the CSF has become an essential diagnostic technique in cases of newborn infants with a suspected infection, and replaces viral culture as the reference test due its being quicker and more sensitive.
Objetivos Describir las características clínicas y los hallazgos de laboratorio de neonatos con meningitis víricas y destacar la importancia de la reacción en cadena de la polimerasa (PCR) en el LCR para diagnosticar esta patología.
Pacientes y métodos Revisión retrospectiva de historias clínicas de neonatos ingresados en la sección de neonatología diagnosticados de meningitis vírica entre mayo de 2014 y mayo de 2017.
Resultados Se registraron 17 casos de meningitis vírica (15 causadas por enterovirus y dos por parechovirus), que constituyen el 14,8% de los neonatos ingresados por síndrome febril. Todos manifestaron fiebre (100%), y otros síntomas destacados fueron irritabilidad (76%) y rechazo de la ingesta (65%). El 88% cursó con celularidad normal en el LCR y sin hiperproteinorraquia, y el 100%, sin hipoglucorraquia, por lo que previamente muchos de estos niños quedaban con el diagnóstico de síndrome febril sin foco. Estos datos resaltan la necesidad de realizar la PCR en el LCR a neonatos con fiebre sin foco, debido a la normalidad de las pruebas complementarias en la mayoría de los casos. El 64,7% de los niños recibió seguimiento neurológico posterior en consulta de neurología, sin objetivarse secuelas neurológicas, salvo en uno de ellos.
Conclusiones La PCR múltiple en el LCR se ha convertido en una técnica diagnóstica imprescindible en el recién nacido con sospecha de infección y sustituye al cultivo viral como prueba de referencia por su mayor rapidez y sensibilidad.
