983. Diagnostic Practices for Suspected Acute Central Nervous System (CNS) Infection in Children in the Post Conjugate Vaccine Era, 2004-2014
Session: Poster Abstract Session: CNS Infection
Friday, October 9, 2015
Room: Poster Hall
Background: Since the introduction of the H. influenzae b conjugate vaccine in 1990 and the pneumococcal conjugate vaccine in 2000, the incidence of meningitis due to these organisms in children in the US has decreased markedly. However, diagnostic procedures used by many physicians in evaluating suspected meningoencephalitis in children have not adapted to the changing epidemiology. 

Methods: We conducted a retrospective review of CSF studies in children 1 m - 21 y presenting at SUNY Downstate Medical Center, Brooklyn, NY with suspected CNS infection from 2004-2014. Patients in the NICU and PICU were excluded. The frequency of N-methyl-D-aspartate Receptor (NMDAR) antibody studies was analyzed from 2010-2014. 

Results: A total of 1,130 unique visits were identified. The results of CSF studies are given in Table 1.

Table 1.

CSF study

Number sent

Number positive (%)

Bacterial Cx

Suspected  contaminants

1130

4 (0.35)*

18 (1.59)†

Viral Cx

256

6 (2.34)§

HSV PCR

10

0

NMDAR ab

6

5 (83.3)

* S. pneumoniae in 9 yo unvaccinated child, 3 GBS in infants 1-3 m

† CoNS (10), Enterococcus (3), GNR(2), S. aureus (1), Viridans Strep (1), Aspergillus (1)

§ Enterovirus

Conclusion: As the initial reflexive reaction of many physicians is to rule out treatable bacterial infections, bacterial studies were performed more frequently than viral and other studies, although there were only 4 pts with bacterial meningitis. CSF Cx was 4.5x more likely to yield a contaminant than a pathogen. The frequency of viral infection was underestimated. This approach is inconsistent with the current epidemiology and may lead to unnecessary testing of limited CSF samples. Since 2010, 5 cases with positive NMDAR antibody encephalitis were identified at our institution. This entity exceeded other identified causes of encephalitis. These data suggest diagnostic practices for the evaluation of suspected acute CNS infections in children need to be modified to reflect current epidemiology and also highlight the need for greater accessibility to PCR for viral diagnostics.

Natalie Banniettis, MD1, Shubhi Kaushik, MD1, Saumya Joshi, MD1, Stephan Kohlhoff, MD2 and Margaret Hammerschlag, MD, FIDSA1, (1)Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, (2)Pediatric Infectious Disease, SUNY Downstate Medical Center, Brooklyn, NY

Disclosures:

N. Banniettis, None

S. Kaushik, None

S. Joshi, None

S. Kohlhoff, None

M. Hammerschlag, None

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