Aseptic meningitis in adults
- R Paul Johnson, MD
R Paul Johnson, MD
- Yerkes National Primate Research Center
- Emory University
The term aseptic meningitis refers to patients who have clinical and laboratory evidence for meningeal inflammation with negative routine bacterial cultures. The most common cause is enterovirus . Additional etiologies include other infections, (mycobacteria, fungi, spirochetes), parameningeal infections, medications, and malignancy (table 1) .
Aseptic meningitis often has a similar presentation to bacterial meningitis (eg, fever, headache, altered mental status, stiff neck, photophobia), which can be a life-threatening illness. However, in contrast to bacterial meningitis, the majority of patients with aseptic meningitis have a self-limited course that will resolve without specific therapy.
The assessment of patients with probable aseptic meningitis is complicated by the large number of potential etiologic agents and the relatively limited diagnostic tools for identifying specific pathogens. (See "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Herpes simplex virus type 1 encephalitis".)
The symptoms, signs, and cerebrospinal fluid (CSF) findings for various etiologies of aseptic meningitis will be reviewed here. Each diagnostic entity is discussed in detail separately on the appropriate topic reviews.
MENINGITIS VERSUS ENCEPHALITIS
The presence or absence of normal brain function is the important distinguishing feature between encephalitis and meningitis. Patients with meningitis may be uncomfortable, lethargic, or distracted by headache, but their cerebral function remains normal. In encephalitis, however, abnormalities in brain function are common, including altered mental status, motor or sensory deficits, altered behavior and personality changes, and speech or movement disorders. Seizures and postictal states can be seen with meningitis alone and should not be construed as definitive evidence of encephalitis. Other neurologic manifestations include hemiparesis, flaccid paralysis, and paresthesias.
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- MENINGITIS VERSUS ENCEPHALITIS
- VIRAL MENINGITIS
- HIV infection
- Herpes simplex meningitis
- Recurrent (Mollaret's) meningitis
- Lymphocytic choriomeningitis virus
- Miscellaneous viruses
- OTHER INFECTIONS
- - Syphilis
- - Lyme disease
- Tick-borne diseases
- - Rocky Mountain spotted fever
- - Ehrlichiosis
- Fungal infections
- - Cryptococcal infection
- - Coccidioidal infection
- Tuberculous meningitis
- Bacterial infections
- Angiostrongylus infection
- NEOPLASMS OF THE LEPTOMENINGES
- DRUG-INDUCED MENINGITIS
- APPROACH TO THE PATIENT
- Historical clues
- Clues on physical examination
- SUMMARY AND RECOMMENDATIONS
- - Suspected bacterial meningitis
- - Suspected viral meningitis
- - Unclear etiology