Aseptic meningitis: Difference between revisions

Revision as of 19:06, 14 September 2020

Differential Diagnosis

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
  - Herpes (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 species (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
  - NSAIDs
  - Allopurinol
- Malignancy
  - Leukemia
  - Lymphoma
  - Metastatic carcinoma or adenocarcinoma

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: @@
-== Differential Diagnosis ==
+==Differential Diagnosis==
-* Infectious
+*Infectious
-** Viral
+**Viral
-*** [[Enterovirus]] 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)
+***[[Herpes]] (especially HSV-2, as primary infection)
-*** [[Varicella]]
+***[[Varicella]]
-*** [[Mumps]] (encephalitis), measles (acute encephalitis)
+***[[Mumps]] (encephalitis), measles (acute encephalitis)
-*** [[Arboviruses]]
+***[[Arboviruses]]
-*** [[Lymphocytic choriomeningitis virus]] (LCMV)
+***[[Lymphocytic choriomeningitis virus]] (LCMV)
-*** Acute [[HIV]]
+***Acute [[HIV]]
-*** [[EBV]], [[influenza]], [[Colorado tick virus]], [[rabies]]
+***[[EBV]], [[influenza]], [[Colorado tick virus]], [[rabies]]
-** Bacterial
+**Bacterial
-*** [[Leptospirosis]]
+***[[Leptospirosis]]
-*** [[Lyme disease]]
+***[[Lyme disease]]
-*** [[Rickettsia species]] (before onset of fever)
+***[[Rickettsia species]] (before onset of fever)
-*** Other causes of [[bacterial meningitis]] after antibiotics
+***Other causes of [[bacterial meningitis]] after antibiotics
-** Mycobacterial
+**Mycobacterial
-** Fungal
+**Fungal
-* Non-infectious
+*Non-infectious
+**Autoimmune or inflammatory
-** Systemic lupus erythematosus
+***[[Systemic lupus erythematosus]]
-** Drug-induced meningitis
+***[[Behçet disease]]
-*** IVIg
+***[[Sarcoidosis]]
-*** Azathioprine
+***[[Vogt-Koyanagi-Harada syndrome]]
-*** NSAIDs
+**Drug-induced meningitis
-*** [[TMP-SMX]], [[amoxicillin]], [[isoniazid]]
+***Antimicrobials: [[TMP-SMX]], [[amoxicillin]], [[isoniazid]]
-*** Allopurinol
+***[[IVIg]]
+***[[Azathioprine]]
+***[[NSAIDs]]
+***[[Allopurinol]]
+**Malignancy
+***[[Leukemia]]
+***[[Lymphoma]]
+***Metastatic [[carcinoma]] or [[adenocarcinoma]]
-== 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]]