Enterovirus meningitis in adults in 1999-2000 and evaluation of clinical management.

Enterovirus meningitis is well documented in children. However, there is a paucity of reports in adults, despite the availability of genome detection (RT-PCR) in cerebrospinal fluid (CSF), which provides a rapid and reliable diagnosis. The clinical course and management of 30 cases of entero-virus proven meningitis prospectively diagnosed between August 1999 and November 2000 in immunocompetent adults were analysed, and laboratory and clinical strategies evaluated. Patient age ranged between 17 and 43 (median 29). The analysis of clinical, biological, and epidemiological data showed the difficulty of recognising enterovirus meningitis in adults. Characteristic symptoms were either inconstant (the association of fever/headache/stiff neck) or misleading (the presence of vesicular lesions). CSF data showed moderate pleocytosis but a predominance of lymphocytes in only 12/27 (44%) patients. An epidemiological background was present in 10/30 (33%) patients, but 10/30 (33%) patients were admitted during cold months. Consequently, although the detection of enterovirus genome in CSF was positive in all cases, the results were communicated within a median of 6 days [2-9] after admission, mainly because the aetiology was not considered early enough. Management of patients varied between departments and between individual physicians, with measures ranging from computed tomography (33%) to the prescription of aciclovir (20%) or antibiotics (53%). Enterovirus meningitis should not be underestimated in adults. Management could be improved and standardised, and costs reduced by more systematic year-round use of enterovirus RT-PCR in meningitis, provided results are rapid.