Clinical and epidemiological peculiarities of enterovirus meningitis in the period of seasonal outbreak in 2015

The aim. To analyse the morbidity of the enterovirus infection (EI) in Novokuznetsk – the major industrial city of Western Siberia and to determine the clinical peculiarities of enterovirus meningitis (EM) in the outbreak period in 2015.

The materials and methods. There have been analysed the official statistical data in the period of 2006–2015 and the enterovirus meningitis, clinical manifestations in 148 patients, hospitalized in 2015. Liquor was tested by the method of the polymerase chain reaction (PCR) for presence RNA of the enteroviruses. The C-reactive protein value was tested by the method of the latex test and the procalcitonin value was tested by the method of the immunoenzymatic analysis. The statistical material treatment has been done using InStat programme.

The results. There has been registered 3,2 times growth of the enterovirus infection morbidity in 2015, compared to 2014, which 6,2 times exceeds Russia, s average rate. The enteroviruses ECHO 30 have been identified in patients, biological material and in wastewater. In the structure of the clinical forms the share of the enterovirus meningitis makes 92, 91%. The children, s morbidity 4,57 times exceeds the total burden of disease. The age structure accompanying the enterovirus meningitis: children 2–6 years of age – 47,3%, 7–14 years of age – 27,7%, 15–17 years of age – 7,43%, 18–53 years of age – 17,57%. Vomiting and headache in children (under the age of 7) are registered rarely, and the full meningeal syndrome and the neutrophil pleocytosis in liquor in children (under the age of 7) are registered more frequently. The rate of children and adults has increased in 2015, compared to 2005. The alteration in clinical picture relates to degree of meningeal syndrome intensity and catarrhal manifestations. The C-reactive protein value (in 67,21%) and the procalcitonin value (in 100%) don, t exceed the threshold values in patients with leucocytosis and pleocytosis of liquor with neutrophil/mixed character, which enables to differentiate enterovirus meningitis from bacterial meningitis and to exclude antibiotic treatment.

The conclusion. The dynamics of the rate of the enterovirus infection morbidity on the territory under investigation differs from Russia, s average rate. The enterovirus meningitis has got clinical and age peculiarities in different epidemic seasons.

1. Kanaeva O.I. Enterovirusnaya infektsiya: mnogoobrazie vozbuditeley i klinicheskikh form // Infektsiya i immunitet. – 2014. – T.4, №1. – S. 27-36.

2. Lukashev A.N. Sotsial’no-ekonomicheskaya znachimost’ enterovirusnoy infektsii i ee rol’ v strukture infektsionnoy patologii v mire / Lukashev A.N., Ivanova O.E., Khudyakova L.V. // Zhurnal mikrobiologii, epidemiologii i immunobiologii. – 2010. – № 5. – S. 113-120.

3. Lityaeva L.A. Kliniko-epidemiologicheskie osobennosti enterovirusnykh meningitov u detey v Orenburgskoy oblasti / Lityaeva L.A., Kovaleva O.V., Yakubovich I.S. // Epidemiologiya i infektsionnye bolezni. Aktual’nye voprosy. 2013. – №2. – S. 56-60.

4. Al’misheva A.Sh. Epidemiologicheskie i ekologicheskie aspekty seroznykh meningitov enterovirusnoy prirody: avtoref. diss… kand. med. nauk / Al’misheva A.Sh. – M., 2008. – 23 s.

5. Berger A. Enterovirus meningitis in Germani: Compareitive Evolution of Different laboratory Diagnostic Methods. Infection 2001; 29: 138-42.

6. Papa A. Enterovirus meningitis in Greece from 2003-2005: diagnosis, CSF laboratory findings, and clinical manifestations. J of Clinical Laboratory Analysis 2006; 20(5): 177-83.

7. VOZ. Enterovirus D68 v Soedinennykh Shtatakh Ameriki: http://www.who.int/csr/don/17-september-2014-enterovirus/ru

8. Golitsyna L.N. Zabolevaemost’, etiologicheskaya struktura i voprosy profilaktiki enterovirusnoy (nepoli) infektsii / Golitsyna L.N., Novikova N.A. // Informatsionnyy byulleten’ – 2015. – №2: http://www.epidemiolog.ru

9. Golitsyna L.N. Enterovirusy v Rossiyskoy Federatsii v 2013 godu (po dannym Referens-tsentra po monitoringu EVI) / Golitsyna L.N., Novikova N.A. // Informatsionnyy byulleten’ «Zabolevaemost’, etiologicheskaya struktura i voprosy profilaktiki enterovirusnoy (nepolio) infektsii». – 2014:: http://www.epidemiolog.ru

10. Demina A.V. Enterovirusy. Chast’ 2. Enterovirusnye infektsii: mnogoobrazie klinicheskikh proyavleniy / Demina A.V., Netesov S.V. // Byul. SO RAMN. — 2009. — № 6. — S. 116–125.

11. Eshmolov S.N. Kliniko-laboratornye osobennosti enterovirusnykh meningitov u detey v sovremennykh usloviyakh (po dannym Yaroslavskoy oblasti) / Eshmolov S.N., Sitnikov I.G., Mel’nikova I.M. // Detskie infektsii. – 2012. – tom 11. Spetsvypusk. – S. 48-52.

12. Sorokina M.N. Virusnye entsefality i meningity u detey: rukovodstvo dlya vrachey / Sorokina M.N., Skripchenko N.V. – M.: OAO «Izdatel’stvo «Meditsina», 2004. – S. 332, 337-343.

13. Uchaykin G.F. Enterovirusnyy meningit u detey Khabarovska v kontse KhKh stoletiya / Uchaykin G.F., Protasenya I.I., Reznik V.I., Shchibrik E.V., Kochetkov A.V.. Pereskokova M.A., Isaeva N.V. // Epidemilogiya i infektsionnye bolezni. – 2003. – №2. – S. 42-46.

14. Mikhaylova E.V. Meningity enterovirusnoy etiologii u detey: sovremennye podkhody k diagnostike i osobennosti klinicheskogo techeniya / Mikhaylova E.V., Shteynberg A.V., Erem›yeva I.G. // Infektsionnye bolezni. – 2008. – T.6, №1. – S. 31-34.

15. Gel›fand B.R. Prokal›tsitonin: novyy laboratornyy diagnosticheskiy marker sepsisa i gnoyno-ssepticheskikh oslozhneniy v khirurgii / Gel›fand B.R., Filimonov M.I., Brazhnik T.B., Sergeeva N.A., Burnevich S.Z. // Vestnik intensivnoy terapii. — 2003. — T. 1, № 2.

16. Pääkkönen, M., Kallio, M. J., Kallio, P. E. and Peltola, H. (2013). C-reactive protein versus erythrocyte sedimentation rate, white blood cell count and alkaline phosphatase in diagnosing bacteraemia in bone and joint infections. Journal of Paediatrics and Child Health, 49: E189–E192. doi: 10.1111/jpc.12122.

17. Gendrel D, Raymond J, Assicot M, Moulin F, Iniguez JL, Lebon P, and Bohuon C (1997) Measurement of procalcitonin levels in children with bacterial or viral meningitis. Clin Infect Dis 24:1240-1242.