THE JOURNAL OF INFECTIOUS DISEASES • VOL. 131, NO.1· © 1975 by the University of Chicago. All rights reserved.
JANUARY 1975
An Epidemic of Echovims 18 Meningitis Catherine M. Wilfert, Brian A. Lauer, Mitchell Cohen, M. Lyndle Costenbader, and Eugene Myers
From the Departments of Pediatrics, Microbiology, and Medicine, Duke University Medical Center, Durham, North Carolina; and the Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia
Echovirus 18 has been isolated sporadically in the United States from normal subjects, from patients with viral meningitis [1], acute exanthematous disease [2, 3], and on one occasion from newborns in a nursery during an epidemic of diarrheal disease [4]. The only recorded epidemic of echovirus 18 meningitis occurred in Australia in 1968-1969 [5]. In the summer of 1972, a major outbreak of viral meningitis occurred in Durham, North Carolina. Cases of nonbacterial meningitis were first recognized during the last week of June in the outpatient departments at Duke University Medical Center (DUMC). Echovirus 18 was cultured from specimens of cerebrospinal fluid (CSF), and this finding prompted an investigation of the outbreak.
DUMC between June 1, 1972 and September 30, 1972. For the purposes of the study, a case of aseptic meningitis was defined as a patient of any age with an acute illness clinically compatible with viral meningitis in addition to a CSF pleocytosis of ~ 10 white blood cells/mm" and/or a viral isolate from the CSF. A lumbar puncture was performed on all patients, all of whom had negative bacterial cultures of CSF. We identified patients meeting the criteria by screening the hospital admission records coded for aseptic meningitis, the charts of all patients who had specimens of CSF submitted to the Central Bacteriology Laboratory or the Virology Laboratories of the DUMC, and the log of patients seen in the Medical Outpatient Department of the DUMC. The data were abstracted onto standardized data collection forms. Information about patterns of isolation of enterovirus elsewhere in the state and the nation was obtained from the Epidemiology Section, Division of Health Services, North Carolina Department of Human Resources, and the Center for Disease Control (CDC).
Materials and Methods
Patients. We reviewed the medical records of all patients with aseptic meningitis seen at the Received for publication May 16, 1974, and in revised form August 30, 1974. This study was supported by Public Health Services training grant no. HD 00132 from the National Institute of Child Health and Human Development. Please address requests for reprints to Dr. Catherine M. Wilfert, Department of Pediatrics, Duke University Medical School, Durham, North Carolina 27710.
Viral isolation and identification procedures. CSF, throat swabs, and stool swabs were taken by the pediatric and internal medicine house staff from patients suspected of having viral meningitis. CSF was inoculated directly into duplicate cell 75
Downloaded from http://jid.oxfordjournals.org/ at University of Sussex on August 19, 2015
The first reported outbreak of echovirus 18 meningitis in the United States occurred during the summer of 1972 in Durham, North Carolina. One hundred three cases of aseptic meningitis were seen at Duke University Medical Center over a period of four months. Most of the patients were less than 25 years old, black, and residents of Durham County or nearby counties. Symptoms included headache (92%), fever (76%), nuchal rigidity (67%), and nausea and/or vomiting (51 % ). In contrast to previously published reports of echovirus 18 infection, diarrhea and rash were infrequent (6 % and 5 %, respectively). There were no deaths. Counts of white blood cells in the cerebrospinal fluid ranged from 0 to 1,540 cells/rnm'', but 90% of the patients had < 500 cells/nun". Echovirus 18 was recovered from the cerebrospinal fluid of 55 of 78 patients, and echovirus 11 was isolated from two patients. Virus was recovered from the cerebrospinal fluid of 12 patients despite white blood cell counts in cerebrospinal fluid of < 10 cells/rnm".
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JANUARY 1975
An Epidemic of Echovims 18 Meningitis Catherine M. Wilfert, Brian A. Lauer, Mitchell Cohen, M. Lyndle Costenbader, and Eugene Myers
From the Departments of Pediatrics, Microbiology, and Medicine, Duke University Medical Center, Durham, North Carolina; and the Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia
Echovirus 18 has been isolated sporadically in the United States from normal subjects, from patients with viral meningitis [1], acute exanthematous disease [2, 3], and on one occasion from newborns in a nursery during an epidemic of diarrheal disease [4]. The only recorded epidemic of echovirus 18 meningitis occurred in Australia in 1968-1969 [5]. In the summer of 1972, a major outbreak of viral meningitis occurred in Durham, North Carolina. Cases of nonbacterial meningitis were first recognized during the last week of June in the outpatient departments at Duke University Medical Center (DUMC). Echovirus 18 was cultured from specimens of cerebrospinal fluid (CSF), and this finding prompted an investigation of the outbreak.
DUMC between June 1, 1972 and September 30, 1972. For the purposes of the study, a case of aseptic meningitis was defined as a patient of any age with an acute illness clinically compatible with viral meningitis in addition to a CSF pleocytosis of ~ 10 white blood cells/mm" and/or a viral isolate from the CSF. A lumbar puncture was performed on all patients, all of whom had negative bacterial cultures of CSF. We identified patients meeting the criteria by screening the hospital admission records coded for aseptic meningitis, the charts of all patients who had specimens of CSF submitted to the Central Bacteriology Laboratory or the Virology Laboratories of the DUMC, and the log of patients seen in the Medical Outpatient Department of the DUMC. The data were abstracted onto standardized data collection forms. Information about patterns of isolation of enterovirus elsewhere in the state and the nation was obtained from the Epidemiology Section, Division of Health Services, North Carolina Department of Human Resources, and the Center for Disease Control (CDC).
Materials and Methods
Patients. We reviewed the medical records of all patients with aseptic meningitis seen at the Received for publication May 16, 1974, and in revised form August 30, 1974. This study was supported by Public Health Services training grant no. HD 00132 from the National Institute of Child Health and Human Development. Please address requests for reprints to Dr. Catherine M. Wilfert, Department of Pediatrics, Duke University Medical School, Durham, North Carolina 27710.
Viral isolation and identification procedures. CSF, throat swabs, and stool swabs were taken by the pediatric and internal medicine house staff from patients suspected of having viral meningitis. CSF was inoculated directly into duplicate cell 75
Downloaded from http://jid.oxfordjournals.org/ at University of Sussex on August 19, 2015
The first reported outbreak of echovirus 18 meningitis in the United States occurred during the summer of 1972 in Durham, North Carolina. One hundred three cases of aseptic meningitis were seen at Duke University Medical Center over a period of four months. Most of the patients were less than 25 years old, black, and residents of Durham County or nearby counties. Symptoms included headache (92%), fever (76%), nuchal rigidity (67%), and nausea and/or vomiting (51 % ). In contrast to previously published reports of echovirus 18 infection, diarrhea and rash were infrequent (6 % and 5 %, respectively). There were no deaths. Counts of white blood cells in the cerebrospinal fluid ranged from 0 to 1,540 cells/rnm'', but 90% of the patients had < 500 cells/nun". Echovirus 18 was recovered from the cerebrospinal fluid of 55 of 78 patients, and echovirus 11 was isolated from two patients. Virus was recovered from the cerebrospinal fluid of 12 patients despite white blood cell counts in cerebrospinal fluid of < 10 cells/rnm".
76
14 13
12 11
10
If)
Q) If)
