소아기 엔테로바이러스 수막염의 연령별, 바이러스 혈청형별 임상양상

Clinical Characteristics of Childhood Enteroviral Meningitis according to Age and Viral Serotype

Purpose: Enterovirus is the most common cause of aseptic meningitis, and there are many different serotypes of enteroviruses that cause diverse clinical symptoms. This study compared the clinical characteristics of childhood enteroviral meningitis in different age groups and viral serotypes. Methods: Patients younger than 18 years who were diagnosed with aseptic meningitis in the Pediatric Department of Chonnam National University Hospital from January 2008 to December 2014 were enrolled. We retrospectively reviewed their clinical records. Results: Enterovirus was tested in 66.6% of 655 patients with aseptic meningitis, with the testing being more frequent in younger patients (P<0.001). Enterovirus was present in 69.7% of patients, and able to be serotyped in 52.6%. Headache and irritability were more frequent in older children, whereas respiratory and neurologic symptoms were more common in infants and early childhood (P<0.05). Marked pleocytosis in the cerebrospinal fluid (CSF) was more frequent in neonates and infants, whereas marked increases in CSF proteins were more common in adolescents (P<0.05). The most common enterovirus was coxsackievirus B1 (CB1) in neonates and enterovirus 71 (EV71) in infancy and early childhood. Compared with the mean frequencies of symptoms in enteroviral meningitis, less frequent symptoms were fever in echoviruses (Es), headache or irritability in CBs and EV71, and vomiting in CBs. Neurologic symptoms were frequent in EV71 (P<0.05). Marked CSF pleocytosis was more frequent in CBs and Es (P<0.05). Conclusion: The clinical characteristics and laboratory findings of childhood enteroviral meningitis differ with age and viral serotype. In addition, the prevalent enteroviral serotypes differ with age.