Aseptic meningitis: Difference between revisions

Latest revision as of 14:08, 25 July 2023

Signs and symptoms of meningeal inflammation with negative routine bacterial culture of CSF

Differential Diagnosis

See also causes of CSF pleocytosis
Infectious
- Viral
  - Enterovirus EV-B species (includes Group B coxsackieviruses and echoviruses) are the most common cause of aseptic meningitis in both children and adults
    - CV-B2 to CV-B5, E-6, E-6, E-9, E-11, E-13, E-16, E-18, E-30, and E-33
  - Parechovirus, especially in very young children and immunocompromised hosts
  - Herpes simplex virus (especially HSV-2, as primary infection)
  - Varicella
  - Mumps (encephalitis), measles (acute encephalitis)
  - Arboviruses
  - Lymphocytic choriomeningitis virus (LCMV)
  - Acute HIV
  - EBV, influenza, Colorado tick virus, rabies
- Bacterial
  - Leptospirosis
  - Lyme disease
  - Rickettsia (before onset of fever)
  - Other causes of bacterial meningitis after antibiotics
- Mycobacterial
- Fungal
Non-infectious
- Autoimmune or inflammatory
- Drug-induced meningitis
  - Antimicrobials: TMP-SMX, amoxicillin, isoniazid
  - IVIg
  - Azathioprine
  - Ibuprofen and other NSAIDs
  - Allopurinol
- Malignancy
  - Leukemia
  - Lymphoma
  - Metastatic carcinoma or adenocarcinoma
- Other
  - Epidermoid cyst
  - Post-vaccination

Investigations

Enterovirus
- Usually positive PCR of CSF
- Can look for enterovirus in stool, nasopharyngeal, and throat, as well as conjunctiva if there is conjunctivitis
- Persists in stool for several weeks, but less specific
- NP preferred over throat
Parechovirus PCR if very young child or immunocompromised
West Nile virus IgM/IgG/PCR from CSF and blood
Syphilis screening EIA
HIV screen

@@ Line 1: / Line 1: @@
+*Signs and symptoms of meningeal inflammation with negative routine bacterial culture of CSF
-= Aseptic meningitis =
-== Differential Diagnosis ==
+==Differential Diagnosis==
+*See also causes of [[CSF pleocytosis]]
-* Infectious
+*Infectious
-** Viral
+**Viral
-*** EV-B species (includes Group B coxsackieviruses and echoviruses) are the most common cause of aseptic meningitis in both children and adults
+***[[Enterovirus]] EV-B species (includes Group B coxsackieviruses and echoviruses) are the most common cause of aseptic meningitis in both children and adults
-**** CV-B2 to CV-B5, E-6, E-6, E-9, E-11, E-13, E-16, E-18, E-30, and E-33
+****CV-B2 to CV-B5, E-6, E-6, E-9, E-11, E-13, E-16, E-18, E-30, and E-33
-*** Herpes (especially HSV-2, as primary infection)
+***[[Parechovirus]], especially in very young children and immunocompromised hosts
-*** Varicella
+***[[Herpes simplex virus]] (especially HSV-2, as primary infection)
-*** Mumps (encephalitis), measles (acute encephalitis)
+***[[Varicella]]
-*** Arboviruses
+***[[Mumps]] (encephalitis), measles (acute encephalitis)
-*** Lymphocytic choriomeningitis virus (LCMV)
+***[[Arboviruses]]
-*** Acute HIV
+***[[Lymphocytic choriomeningitis virus]] (LCMV)
-*** EBV, influenza, Colorado tick virus, rabies
+***Acute [[HIV]]
-** Bacterial
+***[[EBV]], [[influenza]], [[Colorado tick virus]], [[rabies]]
-*** Leptospirosis
+**Bacterial
-*** Lyme disease
+***[[Leptospirosis]]
-*** Rickettsioses (before onset of fever)
+***[[Lyme disease]]
-*** Other causes of bacterial meningitis after antibiotics
+***[[Rickettsia]] (before onset of fever)
-** Mycobacterial
+***Other causes of [[bacterial meningitis]] after antibiotics
-** Fungal
+**Mycobacterial
-* Non-infectious
+**Fungal
-** Systemic lupus erythematosus
+*Non-infectious
-** Drug-induced meningitis
+**Autoimmune or inflammatory
-*** IVIg
+***[[Systemic lupus erythematosus]]
-*** Azathioprine
+***[[Behçet disease]]
-*** NSAIDs
+***[[Sarcoidosis]]
-*** Septra, amoxicillin, isoniazid
+***[[Vogt-Koyanagi-Harada syndrome]]
-*** Allopurinol
+**Drug-induced meningitis
+***Antimicrobials: [[TMP-SMX]], [[amoxicillin]], [[isoniazid]]
+***[[IVIg]]
+***[[Azathioprine]]
+***[[Ibuprofen]] and other [[NSAIDs]]
+***[[Allopurinol]]
+**Malignancy
+***[[Leukemia]]
+***[[Lymphoma]]
+***Metastatic [[carcinoma]] or [[adenocarcinoma]]
+**Other
+***[[Epidermoid cyst]]
+***Post-vaccination
-== Investigations ==
+==Investigations==
-* Enterovirus
+*[[Enterovirus]]
-** Usually positive PCR of CSF
+**Usually positive PCR of CSF
-** Can look for enterovirus in stool, nasopharyngeal, and throat, as well as conjunctiva if there is conjunctivitis
+**Can look for enterovirus in stool, nasopharyngeal, and throat, as well as conjunctiva if there is conjunctivitis
-** Persists in stool for several weeks, but less specific
+**Persists in stool for several weeks, but less specific
-** NP preferred over throat
+**NP preferred over throat
-* Parechovirus PCR if very young child or immunocompromised
+*[[Parechovirus]] PCR if very young child or immunocompromised
-* West Nile IgM/IgG/PCR from CSF and blood
+*[[West Nile virus]] IgM/IgG/PCR from CSF and blood
-* Syphilis screening EIA
+*[[Syphilis]] screening EIA
-* HIV screen
+*[[HIV]] screen
+[[Category:CNS infections]]