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== |
==Differential Diagnosis== |
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| + | *See also causes of [[CSF pleocytosis]] |
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*Infectious |
*Infectious |
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**Viral |
**Viral |
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***[[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 |
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****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 |
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| − | ***[[ |
+ | ***[[Parechovirus]], especially in very young children and immunocompromised hosts |
| + | ***[[Herpes simplex virus]] (especially HSV-2, as primary infection) |
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***[[Varicella]] |
***[[Varicella]] |
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***[[Mumps]] (encephalitis), measles (acute encephalitis) |
***[[Mumps]] (encephalitis), measles (acute encephalitis) |
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***[[Leptospirosis]] |
***[[Leptospirosis]] |
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***[[Lyme disease]] |
***[[Lyme disease]] |
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| − | ***[[Rickettsia |
+ | ***[[Rickettsia]] (before onset of fever) |
***Other causes of [[bacterial meningitis]] after antibiotics |
***Other causes of [[bacterial meningitis]] after antibiotics |
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**Mycobacterial |
**Mycobacterial |
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***[[IVIg]] |
***[[IVIg]] |
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***[[Azathioprine]] |
***[[Azathioprine]] |
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| − | ***[[NSAIDs]] |
+ | ***[[Ibuprofen]] and other [[NSAIDs]] |
***[[Allopurinol]] |
***[[Allopurinol]] |
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**Malignancy |
**Malignancy |
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***[[Lymphoma]] |
***[[Lymphoma]] |
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***Metastatic [[carcinoma]] or [[adenocarcinoma]] |
***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== |
==Investigations== |
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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
