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Aseptic meningitis Reference – Symptoms, Diagnosis, Treatments
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Aseptic meningitis Reference – Symptoms, Diagnoses, Treatments
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Aseptic meningitis-From Wikipedia, the free encyclopedia
Aseptic meningitis Classification & external resources The image above shows the location and the layers of the meninges surrounding the brain ICD-10 G03. Nonpyogenic meningitis ICD-9 322.0 Nonpyogenic menigitis DiseasesDB 945 eMedicine NEURO/697 Aseptic meningitis is a condition in which the layers lining of the brain, or meninges, become inflamed and a pyogenic bacterial source is not to blame. Meningitis is diagnosed on a history of characteristic symptoms and certain examination findings (e.g. Kernig's sign). Investigations should show an increase in the number of leukocytes present in the cerebrospinal fluid (CSF), obtained via lumbar puncture, (normal being fewer than five visible per microscopic high power field).
The term aseptic is frequently a misnomer, implying a lack of infection. On the contrary, many cases of aseptic meningitis represent infection with viruses or mycobacteria that cannot be detected with routine methods. While the advent of polymerase chain reaction has increased the ability of clinicians to detect viruses such as enterovirus, cytomegalovirus, and herpes virus in the CSF, many viruses can still escape detection. Additionally, mycobacteria frequently require special stains and culture methods that make their detection difficult. When CSF findings are consistent with meningitis, and microbiologic testing is unrevealing, clinicians typically assign the diagnosis of aseptic meningitis—making it a relative diagnosis of exclusion.
Aseptic meningitis can result from non-infectious causes; it is a relatively infrequent side effect of medications, and can be an early finding in autoimmune disease.
Contents 1 Classification 2 Symptoms and Signs 3 Complications 4 Cause/Etiology 4.1 Infectious 4.1.1 Viruses 4.1.2 Bacteria 4.1.3 Fungi 4.1.4 Parasites 4.2 Non-infectious 4.2.1 Drugs 4.2.2 Systemic Diseases 4.3 Miscellaneous 5 Diagnosis 6 Pathophysiology 7 Treatment/Management 7.1 Anti-pathogenic 7.1.1 Bacteria 7.1.2 Viruses 7.1.3 Fungi 7.2 Supportive 8 Prognosis 9 Prevention/Screening 10 Epidemiology 11 References
Classification There is no formal classification system. It is usually by the causative organism if identified.
Symptoms and Signs These are varied, depending on the causative organism. There are usually non-specific constitutional symptoms lasting for hours or days. These are then followed by meningitis, characterised by headache, stiff neck, fever, photophobia, drowsiness, and myalgia. A rash may be present, which could suggest a particular virus - for example, varicella zoster. However, a non-blanching purpuric rash is not associated with meningitis and suggests systemic bacterial infection.
Complications Seizures, encephalitis and cognitive problems can develop, although rarely.
Cause/Etiology The cause can be infectious or non-infectious.
Infectious
Viruses HSV 1 and 2 HIV Enteroviruses Varicella zoster Epstein-Barr virus CMV Lymphocytic choriomeningitis virus
Bacteria Partially treated meningitis Endocarditis Mycoplasma Mycobacterium tuberculosis Borrelia burgdorferi Treponema pallidum Brucella
Fungi Cryptococcus neoformans Blastomyces dermatitidis
Parasites Toxoplasma gondii
Non-infectious
Drugs NSAIDs Amoxicillin Azathioprine Methotrexate Intravenous immunoglobulin Isoniazid Allopurinol
Systemic Diseases Sarcoidosis Meningioma SLE Wegener's Vasculitis Behcet's disease
Miscellaneous Migraine Arachnoiditis
Diagnosis Usually the history and examination will arouse suspicion. Confirmation is mainly through CSF findings:
Less than 500 mononuclear cells/mm³ (pleocytosis) should develop with 8-48 hours Normal glucose Elevated pressure Elevated protein No findings which suggest another diagnosis - e.g. negative bacteria antigen tests, no lactate PCR may identify a causative organism Viruses may be cultured from swabs of other areas, such as the throat.
Blood tests are rarely helpful in establishing the diagnosis (but may be of use to establish baseline chemistry). Imaging is useful in excluding other diagnoses, or identifying other features of infection by an organsim - for example, a chest X-ray may be useful if tuberculosis is suspected.
Pathophysiology Invasion into or past the meninges by a pathogen can set up a local inflammatory response. The clinical signs are due to this meningeal irritation - for example, Kernig's sign is due to pain produced by stretching of the inflamed meninges.
Treatment/Management
Anti-pathogenic If the causative organism has been identified and has a specific therapy, this should be started.
Bacteria Even though true aseptic meningitis cannot be caused by pyogenic bacteria, broad-spectrum antibiotic cover should be started as the consequences of misdiagnosing a bacterial meningitis are dire, and relatively easily avoided. For non-pyogenic bacteria, local sensitivities should be taken into account, but generally broad-spectrum is best. Some bacteria are normally sensitive to certain drugs - for example, rifampicin is good for Brucella.
Viruses HSV, varicella and CMV have a specific antiviral therapy; most other viruses do not. For HSV the treatment of choice is acyclovir[1]
Fungi Amphotericin B and fluconazole are the best antifungals in most situations.
Supportive This will be the majority of the treatment. Fluids, analgesia and antiemetics should cover most cases. Antipyretics should be used judiciously - fever can be a natural response. Steroids are not recommended unless raised intracranial pressure occurs. Phenytoin and other anticonvulsants can be used is seizures occur, but prophylaxis is not recommended.
Prognosis In immunocompetent individuals, the disease is usually mild and self-limiting. Full recovery 5-14 days afterwards is normal.
Prevention/Screening Vaccines are available for some organisms that cause aseptic menigitis. Good infection control in hospital, as ever, is recommended. If the causative organism is contagious, steps may need to be taken to isolate the individual and protect the community.
Epidemiology Aspetic meningitis is relatively common, with an incidence of around 10/100,000. The male:female ratio is around 1:1.
References ^ Tyler Kl. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes. 2004 Jun;11 Suppl 2:57A-64A. v • d • eHealth science > medicine[hide] Advance practice nursing - Audiology - Dentistry - Dietetics - Emergency medical services - Epidemiology - Medical technology - Midwifery - Nursing - Occupational therapy - Optometry - Osteopathic medicine - Pharmacy - Physical therapy (Physiotherapy) - Physician - Physician assistant - Podiatry - Psychology - Public health - Respiratory therapy - Speech and language pathology
Physician specialties: Anesthesiology - Dermatology - Emergency medicine - General practice (Family medicine) - Internal medicine - Neurology - Nuclear medicine - Occupational medicine - Pathology - Pediatrics - Physical medicine and rehabilitation (Physiatry) - Preventive medicine - Psychiatry - Radiation oncology - Radiology - Surgery
Medical subspecialties: Allergy and immunology - Cardiology - Endocrinology - Gastroenterology - Hematology - Infectious disease - Intensive care medicine (Critical care medicine) - Medical genetics - Nephrology - Oncology - Pulmonology - Rheumatology
Surgical subspecialties: Andrology - Cardiac surgery - General surgery - Hand surgery - Interventional neuroradiology - Neurosurgery - Obstetrics and gynecology - Ophthalmology - Oral and maxillofacial surgery - Orthopaedic surgery - Otolaryngology (ENT) - Pediatric surgery - Plastic surgery - Surgical oncology - Thoracic surgery - Transplant surgery - Trauma surgery - Urology - Vascular surgery
Retrieved from "http://en.wikipedia.org/wiki/Aseptic_meningitis"
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