Access free multiple choice questions on this topic. Aseptic meningitis is a term used to define inflammation of the brain linings, called meninges, due to various etiologies with negative cerebrospinal fluid CSF bacterial cultures. Viruses are the most common etiology for aseptic meningitis, but other causes can be divided into two main categories: infectious and non-infectious. Manifestations may differ based on the underlying cause and the host's immune status, placing patients with deficient humoral immunity at a higher risk of negative outcomes, including neonates and patients with agammaglobulinemia.
The etiology of aseptic meningitis can be categorized into infectious and non-infectious. In terms of infectious causes, these include viruses, bacteria, fungi, and parasites, the most common agent being viral. Bacterial, fungal, and parasitic infectious are less common than viral. Bacterial causes of aseptic meningitis may include partially treated meningitis, parameningeal infection such as epidural abscess and mastoiditis , Mycoplasma pneumoniae , endocarditis, Mycobacterium tuberculosis , Treponema pallidum, and leptospirosis.
Fungal causes may include Candida , Cryptococcus neoformans , Histoplasma capsulatum , Coccidioides immitis , and Blastomyces dermatitides. Parasites causing aseptic meningitis include Toxoplasma gondii , naegleria, neurocysticercosis, trichinosis, and Hartmannella. For the non-infectious causes of aseptic meningitis, etiologies can be classified into three main groups: [1]. Aseptic meningitis secondary to certain vaccines has also been described, such as measles, mumps, rubella vaccine primarily, [8] but also varicella vaccine, yellow fever vaccine, rabies vaccine, pertussis vaccine, and the influenza vaccine.
In general, the annual incidence is unknown due to underreporting. In a study done on children in South Korea, the age distribution was relatively uniform, with a higher incidence in children less than one year old and aged 4 to 7. The male-to-female ratio was 2 to 1. No single aspect of clinical history has high enough sensitivity or specificity to lead us to a definitive diagnosis. A comprehensive and thorough history should always be taken in these patients since the differential is so broad.
History taking should include sick contacts, recent travels, substance abuse, sexual history, preceding or concurrent infections, and recent use of medications keeping in mind drug-induced aseptic meningitis.
There may be other associated findings depending on the underlying cause. Over the years, even though up to two-thirds of the aseptic meningitis cases are of unknown etiology, new diagnostic tools have appeared that have aided in identifying pathogens, such as polymerase chain reaction PCR and next-generation sequencing.
In the same way, significant advancements have been made in determining and diagnosing autoimmune or paraneoplastic neurological syndromes. Primary evaluation should include laboratory testing to look for alternative causes of the presenting symptoms. A lumbar puncture LP should be performed to collect cerebrospinal fluid CSF to make a definitive diagnosis. Other tests to consider include syphilis serology, tuberculosis testing, serum human immunodeficiency virus HIV testing.
Numerous differences have been found between adults and children concerning their presentation and their laboratory findings. Fever, concurrent respiratory illness, and rash are symptoms more common to children. Children also had more CSF neutrophilic pleocytosis than adults, as well as higher leukocyte counts than adults.
It is critical to use age-adjusted values for leukocyte counts when interpreting CSF results in neonates and young infants. Drug-induced aseptic meningitis, in particular, may have few lab abnormalities, so clinicians have to maintain a high level of suspicion and perform a comprehensive history regarding all medications a patient might be taking and how much.
Although differentiation between aseptic and bacterial meningitis can be difficult, some tools have been developed to ease the choice. Other laboratory findings such as procalcitonin, serum C-reactive protein, and CSF lactate levels can help discern between aseptic and bacterial meningitis. Of note: when the time comes for an LP, and there is any suspicion for elevated intracranial pressure due to a space-occupying lesion or inflammation, obtaining a computed tomography CT scan of the head before the LP is recommended.
CT scan is not usually necessary in neonates and infants with open fontanelles. The imaging of choice in this age group is head ultrasound. Early recognition of the most plausible cause of meningitis is crucial to begin treatment as soon as possible. Initial stabilization of the patient is necessary, and intravenous fluids for 48 hours have been proven beneficial.
Still, if this will delay treatment or if the patient is critically ill, antimicrobials should come first. The patient should also be placed on droplet isolation precautions until the etiology is identified. If the CSF results are more consistent with aseptic meningitis, antibiotics should then be discontinued keeping in mind the initial presentation of the patient and his clinical status. Steroids are used as adjunctive therapy to reduce the inflammatory response.
Evidence supports the use of dexamethasone 10 to 20 minutes prior to antibiotics or concomitant with their administration, even though the etiology is initially unknown while awaiting culture results. Repeat LP is unnecessary but should be considered in patients whose clinical status does not improve after 48 hours.
Once the diagnosis of aseptic meningitis has been established, the patient can often be discharged home except for the elderly, immunocompromised, and children with pleocytosis.
When discharging the patient, home care needs should be based on etiology. For instance, patients with diagnosed enterovirus should be advised to practice excellent hand hygiene and avoid sharing food as it is primarily transmitted via the fecal-oral route. Also, if the meningitis is drug-induced, the drug should be stopped or, if essential, be replaced with a drug not associated with meningeal irritation.
The signs and symptoms of aseptic meningitis are often vague and nonspecific; therefore, the differential is quite broad. The headache and fever, being some of the most common symptoms, drive the differential. Bacterial meningitis is the most concerning and common alternative cause and should be the default diagnosis until ruled out.
Intracranial hemorrhage, especially subarachnoid hemorrhage, should be considered in patients with the appropriate clinical presentation. Neoplastic disorders leukemia, tumors of the brain , other types of headaches migraine , inflammation of brain structures brain abscess, epidural abscess should also be considered.
Fever from almost any source can present with headache and neck stiffness as associated symptoms. Urinary tract infections and pneumonia can present with headaches, body aches, and fever. Thus, an exhaustive search for infectious sources is part of every workup. Many of the causes of aseptic meningitis may give most or all of the symptoms but have no meningeal involvement.
Viral syndromes, in particular, often give headaches, muscle aches, weakness, and fever. Anyone can get aseptic meningitis, but the highest rates occur among children under age 5. Children who attend school or day care are at an increased risk of catching a virus that can cause aseptic meningitis. Adults who work in these facilities are also at risk. People are more likely to develop meningitis if they have a condition that weakens their immune system, such as AIDS or diabetes.
The symptoms of aseptic meningitis can vary due to the virus or medical condition that caused it. Aseptic meningitis is often a mild condition, and you may recover without medication or treatment. Many of the symptoms are similar to those of the common cold or flu so you may never know you had aseptic meningitis. This makes aseptic meningitis different from bacterial meningitis, which causes severe symptoms and may be life-threatening. However, you should still seek medical treatment if you suspect you or your child has aseptic meningitis.
Without a medical exam, it can be difficult to tell in the early states what type of meningitis you. Aseptic meningitis can also cause dangerous complications. You should call your doctor as soon as possible if you or your child has any of the following symptoms:.
In most cases, your doctor will perform a spinal tap. During a spinal tap your doctor will extract cerebrospinal fluid from your spine. This is the only definitive way to diagnosis meningitis. Spinal fluid is made by the brain and surrounds the brain and spinal cord to protect it. Your spinal fluid will have high protein levels and an increased white blood cell count if you have meningitis. This fluid can also help your doctor determine whether bacteria, viruses, or other infectious agents are causing the meningitis.
Your doctor may also order other tests to determine the virus that caused the aseptic meningitis. The tests can include blood tests or imaging tests, such as X-rays and CT scans. Treatment options may vary depending on the specific cause of the meningitis. Most people with aseptic meningitis recover in one to two weeks without medical treatment. Analgesics and anti-inflammatory medications may be recommended for pain and fever control.
Your doctor might also prescribe medications if the aseptic meningitis was caused by a fungal infection or by a treatable virus, such as herpes. We will not share your information with third parties unless you give your consent or unless permitted by applicable law. Try our AI assistant here. Informed by current CDC guidelines. Skip to main content Skip to accessibility services Buoy Logo.
Nav Close Icon. Nav Open Icon. Health articles Chevron Icon. Featured topics. Symptom checker. Editorial standards. Who we serve Chevron Icon. Brokers and Consultants. Solutions Chevron Icon. Sections Icon. What is aseptic meningitis? When to see a doctor. Buoy Chat Icon. Symptom Checker. Verified By Experts Icon. Verified by experts 7 min read. No Ads. Emily Martin, MD. Resident in Emergency Medicine at the University of Washington.
Jeffrey M. Last updated January 5, Heart Icon. Speech Bubble Icon. Share Icon. Share Facebook Icon. LinkedIn Icon. Pinterest Icon. Pocket Icon. Share Link Icon. Copied to clipboard. Table of Contents. Aseptic meningitis questionnaire Use our free symptom checker to find out if you have aseptic meningitis.
Symptoms of aseptic meningitis Main symptoms The following are the main symptoms of aseptic meningitis. Lethargy Confusion Headache Fever Nausea Vomiting Altered mental status Stiff neck meningismus Photophobia light sensitivity Seizures Double vision Facial Droop Skin rash Arthritis pain in joints Related conditions Encephalitis is a similar condition and refers to inflammation of the meningeal lining as well as the actual brain tissue.
Causes of aseptic meningitis Many people think of bacterial meningitis when they hear the term meningitis, which refers to a serious bacterial infection of the meninges requiring intravenous antibiotics for treatment. Enterovirus meningitis Enteroviruses are a group of viruses that are transmitted through the gastrointestinal system and can cause a variety of viral illnesses in children and adults.
Herpes meningitis Herpes virus type 2 HSV-2 is another common cause of aseptic meningitis. Fungal meningitis Fungal spores can be inhaled leading to a variety of infectious symptoms including pneumonia and meningitis. Cryptococcus: This can cause meningitis and commonly infects immunocompromised patients.
Parameningeal infection Sometimes, an infection that is close to the meninges can lead to inflammation and meningitis symptoms. Other infectious causes Other less common infections that can cause aseptic meningitis include Lyme disease, syphilis, and tuberculosis TB. Neoplastic cancerous meningitis Cancer of the blood, including lymphoma and leukemia, can spread to the meninges causing meningitis symptoms.
Drug-induced meningitis Drug-induced meningitis is uncommon and infectious and neoplastic cancerous causes must be ruled out before this diagnosis can be made. Treatment options and prevention for aseptic meningitis The diagnostic process for meningitis has been detailed in this section, as well as methods of treatment, prevention, and the prognosis.
Diagnosis The mainstay of diagnosing meningitis is by examining cerebral spinal fluid CSF for signs of inflammation, viruses, fungus, or cancer cells. This involves you lying on your side or bending over a table. Your physician will place a small needle through your back into the spinal canal to obtain a sample of CSF. Once the fluid sample is obtained, various tests including white blood cell counts, and tests for viruses, bacteria, or fungus can be done to determine the cause of meningitis.
Typically, this is used to rule out other causes of the symptoms including masses, bleeding, or fluid collections in the brain. An MRI may help with the diagnosis for neoplastic cancerous causes of aseptic meningitis. Medical treatments The best course of medical treatment will be determined by your healthcare team and will likely include the following. Antibiotics: When people have symptoms of meningitis, they are typically started on empiric antibiotics in case the cause of meningitis is bacterial.
Bacterial meningitis can be life-threatening and a rapid initiation of antibiotic treatment improves outcomes.
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