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Understanding Aseptic Meningitis: Causes, Symptoms, and Diagnosis

Aseptic meningitis is a syndrome characterized by meningial inflammation without identifiable bacterial pathogens. Commonly caused by viruses, particularly enteroviruses, it can affect individuals of all ages, though it’s most frequent in young children during summer months. Symptoms include fever, lethargy, irritability, and signs of meningeal irritation like Kernig and Brudzinski signs. Diagnosis relies on CSF analysis, specifically enterovirus PCR, while imaging (CT) is recommended in certain cases. Supportive care is vital, especially in managing symptoms.

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Understanding Aseptic Meningitis: Causes, Symptoms, and Diagnosis

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  1. Good Morning! Thursday July 26th, 2012

  2. Semantic Qualifiers

  3. Illness Script • Predisposing Conditions • Age, gender, preceding events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc) • Pathophysiological Insult • What is physically happening in the body, organisms involved, etc. • Clinical Manifestations • Signs and symptoms • Labs and imaging

  4. Kernig sign • Thigh is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful • Brudzinski sign • Involuntary lifting of the legs in meningeal irritation when lifting a patient's head

  5. Aseptic Meningitis • Definition: syndrome of meningeal inflammation in which common bacterial pathogens have not been identified • Caused by a variety of infectious and noninfectious agents • A definitive agent is found in 1 out of 4 patients • Most common: viral • Enteroviruses are most frequent cause in children

  6. Causes of Aseptic Meningitis**

  7. Causes of Aseptic Meningitis**

  8. Predisposing conditions: Enterovirus** • Summer months • Swimming pools • Meningitis caused by enterovirus most common in children < 1 year old; but can be seen at any age • Risk factor for neonatal infection: Mother with enteroviral infection • Intrauterine transmission also possible • Think about in young neonate with signs of sepsis

  9. Pathophysiology: Enterovirus • Enteroviruses (over 66 serotypes) • Echovirus • Coxsackievirus A and B • Poliovirus • Most commonly associated with meningitis outbreaks: • Coxsackieviruses A9, B2, B4 • Echoviruses 6, 9, 11, and 30 • Spread by fecal-oral route** • Vertical transmission (perinatal)**

  10. Clinical Manifestations** • Generally similar to those of bacterial meningitis, but often are less severe • 1-2 days prodromal symptoms • Younger child: fever, hypothermia, lethargy, irritability, poor feeding, vomiting, apnea, seizures, altered mental status • Older child: fever, headache, malaise, myalgia, nausea, vomiting, stiff neck, photophobia

  11. Clinical Manifestations** • Signs of meningeal irritation • Infants: irritability with exam; prefer to be motionless • Older children: Kernig, Brudinski • Absence does not exclude meningitis • Exanthem, pharyngitis, myocarditis, pericardial effusion

  12. Diagnosis: CSF analysis**

  13. Dignosis** • Enterovirus PCR from CSF fluid • More sensitive than viral culture • Enterovirus culture from pharynx or stool can support the diagnosis of enterovirus aseptic meningitis; but results takes longer than PCR

  14. Imaging? ** • CT of the head is necessary before LP in patients with signs or symptoms of increased ICP • Indications for head CT may include • Altered mental status (GCS <12 or drop in GCS of ≥2) • Immune deficiency • Papilledema • Focal neurologic deficit [excluding isolated CN VI or VII palsy] • CSF shunt • Hydrocephalus • CNS trauma • History of neurosurgery or a space-occupying lesions • Signs or symptoms of parameningeal infection or tumor

  15. Management • Supportive Care!! • Fluids, pain control, anti-emetics • Empiric therapy if suspect/cannot rule out bacterial meningitis

  16. Noon Conference! Renal Emergencies, Dr. Straatman

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