Routine testing for enterovirus CNS infection a must in febrile infants: study

Infants with human nonpolio enterovirus (EV) central nervous system (CNS) infection often present without cerebrospinal fluid (CSF) pleocytosis, reports a study.

Infection with EV in patients less than 1 year of age can present with a wide range of clinical spectrum, from fever to severe systemic or neurological disease, according to the researchers.

Therefore, “[t]esting for EV should be considered in febrile infants with no source regardless of CSF parameters,” they noted.

This retrospective cohort study analysed 78 infants with EV CNS infection presenting to a tertiary centre between January 2017 and December 2022. Patient demographics, parent-reported symptoms at presentation, and blood and CSF testing at presentation were all recorded.

Of the patients with EV CNS infection included in the final analysis, 41 percent had a normal CSF white blood cell count. Infants with and without CSF pleocytosis showed a similar clinical presentation. However, median C-reactive protein was greater in EV CNS patients without pleocytosis.

“This study demonstrates the utility of EV testing in febrile infants; however, there are some important limitations,” the researchers said.

First, EV testing was not routine practice for febrile infants, so underestimation of the EV CNS infection rates was possible. In addition, only patients with available CSF sample were included. As a result, a selection bias could exist towards younger infants who are more likely to have a lumbar puncture as part of the routine evaluation of a febrile patient.