To The Editors:
We recently observed enteroviral meningitis in 10 children who had attended a summer camp and noted the positive impact of a rapid definitive diagnosis.
In August 2000, 32 children (21 boys and 11 girls, 10 to 15 years of age; median, 12 years) attended a 2-week scout camp in Campra, Switzerland, at an altitude of 1500 meters. The participants prepared their food using a camp kitchen, drank unchlorinated, natural water and used a camp toilet. Two days after returning home 4 boys ages 10, 11, 13 and 15 years, respectively, were hospitalized because of fever, headache and vomiting. None complained of diarrhea, sore throat, cough or chest pain. Clinical examination revealed neck stiffness and positive Kernig and Brudzinski signs. The remaining examination was noncontributory. The cerebrospinal fluid of the 4 patients contained 1427 × l06, 169 × l06, 726 × l06 and 2270 × l06 leukocytes/l, respectively (with 34, 48, 41 and 33% polymorphonuclear cells, respectively). No pathogens were seen on direct cerebrospinal fluid smears. Treatment with ceftriaxone 100 mg/kg once a day was initiated. Enteroviruses were detected within 24 h in the cerebrospinal fluid of the 4 patients by means of a commercially available reverse transcription polymerase chain reaction assay. 1 As a consequence treatment with ceftriaxone was discontinued, and the patients were discharged within 2 days.
During the following 3 days 6 more children, 4 boys and 2 girls 10 to 15 years of age presented with similar findings. They were not investigated by means of a lumbar puncture, were not hospitalized and received symptomatic medical treatment at home. Stool cultures identified coxsackie B5 virus in the 4 index patients as well as in the remaining 6 patients who were treated as outpatients.
Enteroviruses are shed in the feces for up to 8 weeks after infections, and the viruses are transmitted predominantly via ingestion of fecally contaminated material. 2, 3 Nosocomial outbreaks, mostly in special care infant units or in children’s homes, have been reported from many countries. Although the chain of infection was not elucidated in the present outbreak, we speculate that the virus was transmitted horizontally from subject to subject in the camp. Our experience indicates that reverse transcription polymerase chain reaction assay is a rapid diagnostic tool in the context of enteroviral infections of the central nervous system that is able to reduce diagnostic and therapeutic interventions. 4–6
Gian Paolo Ramelli, M.D.
Giacomo D. Simonetti, M.D.
Meri Gorgievski-Hrisoho, Ph.D.
Cristoph Aebi, M.D.
Mario G. Bianchetti, M.D.
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