Outcome of routine cerebrospinal fluid screening for enterovirus and human parechovirus infection among infants with sepsis-like illness or meningitis in Cornwall, UK

Enteroviruses (EV) and human parechoviruses (HPeV) are known and emerging cause of sepsis-like illnesses in infants; however, testing is not yet routine. We retrospectively evaluated the number of diagnosed EV/HPeV infections in children under the age of 5 years who presented with sepsis-like illness or meningitis in Cornwall, UK, before and after routine implementation of viral screening of cerebrospinal fluid samples. During the 4-year period prior to routine testing, we identified 20 cases of EV meningitis and no cases of HPeV. In the year after introduction of routine screening, 27 cases of EV and 14 cases of HPeV were identified in 1 year. The majority of EV/HPeV infections occurred among children under 3 months old between May and August. Clinical and laboratory characteristics of EV and HPeV infections were mostly indistinguishable. We found that CSF pleocytosis and biochemistry-based testing strategy could miss 48.1 and 78.5% of EV and HPeV cases, respectively. With routine viral screening, the mean length of hospital stay (3.8 vs 5.9 days, P < 0.001) and antibiotic days (2.8 vs 4.7 days, P < 0.001) were significantly reduced in EV/HPeV-positive cases compared to a similar cohort without any detectable microbial aetiology. Conclusion: Routine EV and HPeV testing of CSF samples in children has the potential to reduce length of stay and antibiotic use.What is Known:• EV and HPeV are frequent cause of meningitis and sepsis-like illness among young children.• There is increasing evidence supporting routine EV and HPeV testing of paediatric CSF.What is New:• Outcome of routine EV and HPeV testing in Cornwall, UK.• The value of testing all paediatric CSF without any screening criteria.• A rapid diagnosis of EV/HPeV can significantly reduce length of hospital stay and unnecessary antibiotics.