Aseptic meningitis: Difference between revisions
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+ | *Signs and symptoms of meningeal inflammation with negative routine bacterial culture of CSF |
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− | == |
+ | ==Differential Diagnosis== |
+ | *See also causes of [[CSF pleocytosis]] |
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+ | *Infectious |
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+ | **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 |
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+ | ***[[Parechovirus]], especially in very young children and immunocompromised hosts |
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− | ** Drug-induced meningitis |
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+ | **Autoimmune or inflammatory |
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+ | ***[[Behçet disease]] |
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− | *** NSAIDs |
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+ | ***[[Sarcoidosis]] |
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+ | ***[[Vogt-Koyanagi-Harada syndrome]] |
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+ | ***[[Ibuprofen]] and other [[NSAIDs]] |
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+ | **Malignancy |
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+ | ***[[Leukemia]] |
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+ | ***[[Lymphoma]] |
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+ | ***Metastatic [[carcinoma]] or [[adenocarcinoma]] |
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+ | **Other |
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+ | ***[[Epidermoid cyst]] |
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+ | ***Post-vaccination |
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− | == |
+ | ==Investigations== |
− | * |
+ | *[[Enterovirus]] |
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+ | **Usually positive PCR of CSF |
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+ | **Can look for enterovirus in stool, nasopharyngeal, and throat, as well as conjunctiva if there is conjunctivitis |
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+ | **Persists in stool for several weeks, but less specific |
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+ | **NP preferred over throat |
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+ | *[[Parechovirus]] PCR if very young child or immunocompromised |
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+ | *[[West Nile virus]] IgM/IgG/PCR from CSF and blood |
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+ | *[[Syphilis]] screening EIA |
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+ | *[[HIV]] screen |
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+ | [[Category:CNS infections]] |
Latest revision as of 10:08, 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
- Enterovirus EV-B species (includes Group B coxsackieviruses and echoviruses) are the most common cause of aseptic meningitis in both children and adults
- Bacterial
- Leptospirosis
- Lyme disease
- Rickettsia (before onset of fever)
- Other causes of bacterial meningitis after antibiotics
- Mycobacterial
- Fungal
- Viral
- 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