Aseptic meningitis: Difference between revisions
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+ | ==Differential Diagnosis== |
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+ | *Infectious |
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+ | **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 |
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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 |
โ | *** |
+ | ***[[Herpes]] (especially HSV-2, as primary infection) |
โ | *** |
+ | ***[[Varicella]] |
โ | *** |
+ | ***[[Mumps]] (encephalitis), measles (acute encephalitis) |
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+ | ***[[Arboviruses]] |
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+ | ***[[Lymphocytic choriomeningitis virus]] (LCMV) |
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+ | ***Acute [[HIV]] |
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+ | ***[[EBV]], [[influenza]], [[Colorado tick virus]], [[rabies]] |
โ | ** |
+ | **Bacterial |
โ | *** |
+ | ***[[Leptospirosis]] |
โ | *** |
+ | ***[[Lyme disease]] |
โ | *** |
+ | ***[[Rickettsia species]] (before onset of fever) |
โ | *** |
+ | ***Other causes of [[bacterial meningitis]] after antibiotics |
โ | ** |
+ | **Mycobacterial |
โ | ** |
+ | **Fungal |
โ | * |
+ | *Non-infectious |
+ | **Autoimmune or inflammatory |
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โ | ** |
+ | ***[[Systemic lupus erythematosus]] |
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+ | ***[[Behรงet disease]] |
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+ | ***[[Sarcoidosis]] |
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+ | ***[[Vogt-Koyanagi-Harada syndrome]] |
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โ | *** [[TMP-SMX]], [[amoxicillin]], [[isoniazid]] |
+ | ***Antimicrobials: [[TMP-SMX]], [[amoxicillin]], [[isoniazid]] |
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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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โ | == |
+ | ==Investigations== |
โ | * |
+ | *[[Enterovirus]] |
โ | ** |
+ | **Usually positive PCR of CSF |
โ | ** |
+ | **Can look for enterovirus in stool, nasopharyngeal, and throat, as well as conjunctiva if there is conjunctivitis |
โ | ** |
+ | **Persists in stool for several weeks, but less specific |
โ | ** |
+ | **NP preferred over throat |
โ | * |
+ | *[[Parechovirus]] PCR if very young child or immunocompromised |
โ | * |
+ | *[[West Nile virus]] IgM/IgG/PCR from CSF and blood |
โ | * |
+ | *[[Syphilis]] screening EIA |
โ | * |
+ | *[[HIV]] screen |
[[Category:CNS infections]] |
[[Category:CNS infections]] |
Revision as of 15:06, 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
- 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 species (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
- 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