International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Diagnostic utility of non-CSF samples and neuroimaging in pediatric enterovirus CNS infections: a prospective study from North India.
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Sharma Deepanjli, Shori Shivangi, Ghosh Arnab, Sethi Aakash, Bansal Arun, Goyal Kapil, Vyas Sameer, Sankhyan Naveen, Singh Mini P
Аннотация
OBJECTIVES: The current study aims to evaluate the diagnostic utility of enterovirus (EV) polymerase chain reaction (PCR) testing on throat and rectal swab/stool samples, along with neuroimaging, in the diagnosis of pediatric EV central nervous system (CNS) infections.
METHODS: This prospective observational study recruited 380 children aged <12 years with suspected CNS infection and 50 age-matched controls with non-infectious neurological disorders. All patients underwent EV real-time PCR testing on cerebrospinal fluid (CSF), throat, and rectal swab/stool samples, alongside brain magnetic resonance imaging (MRI). The diagnostic accuracy was assessed using EV-positive participants as true positives and patients with confirmed non-enteroviral or non-infectious etiologies as true negatives. MRI patterns were classified as typical or atypical based on brainstem involvement.
RESULTS: Infectious agents could be detected in 123/380 (32.3%) participants; of these, 33 (8.7%) had infections attributed to EV, while 90 (23.7%) were labeled as non- EV CNS infections. For 257 (67.6%) participants, no infectious agent could be identified; hence, they were excluded from further analysis. Among the samples used for EV testing, rectal swab/stool samples showed the highest sensitivity (90.32%), followed by throat swab samples (32.3%). CSF PCR showed the lowest sensitivity (11.1%). MRI data were available for 26/33 patients, with characteristic brainstem involvement observed across probable and possible diagnostic categories.
CONCLUSIONS: Rectal swab/stool PCR, together with neuroimaging, may improve the diagnosis of pediatric EV CNS infections and identify infections missed by CSF PCR alone.
METHODS: This prospective observational study recruited 380 children aged <12 years with suspected CNS infection and 50 age-matched controls with non-infectious neurological disorders. All patients underwent EV real-time PCR testing on cerebrospinal fluid (CSF), throat, and rectal swab/stool samples, alongside brain magnetic resonance imaging (MRI). The diagnostic accuracy was assessed using EV-positive participants as true positives and patients with confirmed non-enteroviral or non-infectious etiologies as true negatives. MRI patterns were classified as typical or atypical based on brainstem involvement.
RESULTS: Infectious agents could be detected in 123/380 (32.3%) participants; of these, 33 (8.7%) had infections attributed to EV, while 90 (23.7%) were labeled as non- EV CNS infections. For 257 (67.6%) participants, no infectious agent could be identified; hence, they were excluded from further analysis. Among the samples used for EV testing, rectal swab/stool samples showed the highest sensitivity (90.32%), followed by throat swab samples (32.3%). CSF PCR showed the lowest sensitivity (11.1%). MRI data were available for 26/33 patients, with characteristic brainstem involvement observed across probable and possible diagnostic categories.
CONCLUSIONS: Rectal swab/stool PCR, together with neuroimaging, may improve the diagnosis of pediatric EV CNS infections and identify infections missed by CSF PCR alone.