Diagnostic Utility of Non-CSF Samples and Neuroimaging in Pediatric Enterovirus CNS Infections: A Prospective Study from North India.

OBJECTIVE: The current study aims to evaluate the diagnostic utility of enterovirus PCR testing on throat and rectal swab /stool samples, along with neuroimaging, in the diagnosis of pediatric enterovirus (EV) Central Nervous System (CNS) infections. METHODS: This prospective observational study recruited 380 children aged <12 years with suspected CNS infection and 50 age-matched controls with non-infectious neurological disorders. All the patients underwent enterovirus real-time PCR testing on CSF, throat, and rectal swab samples, alongside brain MRIs. The diagnostic accuracy was assessed using EV-positive cases as true positives and patients with confirmed non-enteroviral or non-infectious aetiologies as true negatives. MRI patterns were classified as typical or atypical based on brainstem involvement. RESULTS: Infectious agents could be detected in 123/380 (32.3%) cases, out of these 33 (8.7%) had infections attributed to enterovirus while 90 (23.7%) were labelled as non-enterovirus CNS infections. In 257 (67.6%), no infectious agent could be identified, hence they were excluded from further analysis. Among the samples used for enterovirus testing, rectal swab/stool samples showed highest sensitivity (90.32%) followed by throat swab samples (32.3%). CSF PCR showed the lowest sensitivity (11.1%). MRIs were available for 26/33 patients, with characteristic brainstem involvement observed across probable and possible cases. CONCLUSION: Rectal swab/stool PCR, together with neuroimaging, may improve the diagnosis of pediatric EV CNS infections and identify cases missed by CSF PCR alone.