Epidemiology and diagnostic methodology for enterovirus infection, including cerebrospinal fluid analysis: a 5-year review.

BACKGROUND AND PURPOSE Enterovirus is the most common pathogen of human illness, but data on epidemiology and laboratory diagnosis of enterovirus from Taiwan are rare. We reviewed hospital records to determine the types of enterovirus isolated and the adequacy of the laboratory diagnostic methods. METHODS This retrospective study reviewed hospital records, laboratory results, and medical records of patients infected with enterovirus visiting Taipei Veterans General Hospital, Taipei, Taiwan, during a 5-year period from January 2001 through December 2005. The review included analysis of cell counts and biochemistry of cerebrospinal fluid (CSF). RESULTS 290 strains were isolated. After rhinoviruses were excluded, 288 strains of enteroviruses were included for evaluation. Coxsackievirus A accounted for 18.8% of isolates. Among coxsackievirus B serotypes B2, B3 and B5, 79/94 isolates (84.0%) replicated in human larynx carcinoma (HEP2) cells, while 42/74 serotype B4 isolates (56.8%) grew in rhabdomyosarcoma (RD) cells. Growth of echovirus in RD and Madin-Darby canine kidney (MRC-5) cells occurred for 23/34 positive isolates (68.0%). Twenty four patients had well-documented cell count and biochemistry of CSF. A predominance of polymorphonuclear cells and increasing protein level of the central nervous system, together with empiric antibiotic therapy, was noted in 15/24 of patients (62.5%). CONCLUSION Use of multiple cell media and sampling of multiple sites remain the best methods for recovery of enterovirus. To improve the effectiveness of enterovirus isolation and avoid unnecessary use of antibiotics, increased use of rapid, sensitive laboratory diagnostic methods, such as polymerase chain reaction, may be appropriate.