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The acute aseptic meningitis syndrome
1Harvard Medical School, Boston, Massachusetts.
Abstract:
The acute aseptic meningitis syndrome is an entity that presents a diagnostic challenge to the clinician. Although many infectious and noninfectious etiologies exist for this syndrome, viruses, especially nonpolio enteroviruses, are the classic and most important agents encountered. The incidence of polio and mumps meningitis has declined dramatically in the vaccine era, but recently described pathogens, such as human immunodeficiency virus and Borrelia burgdorferi (Lyme disease agent) are now important considerations in the differential diagnosis. Specifically treatable entities (eg, mycobacterial or fungal meningitis, herpes simplex encephalitis, parameningeal infection) that may mimic aseptic meningitis in their initial presentations must not be overlooked. A careful approach to the patient and a rational use of laboratory studies are the basis for establishing a specific diagnosis and assuring a favorable outcome.
Insights
Acute aseptic meningitis presents a diagnostic challenge. While viruses like enteroviruses are common, emerging pathogens and treatable mimics require careful clinical evaluation for favorable outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Medicine
Background:
- Acute aseptic meningitis syndrome poses diagnostic difficulties for clinicians.
- Viruses, particularly nonpolio enteroviruses, are the primary cause, though other infectious and noninfectious etiologies exist.
- Vaccine-preventable diseases like polio and mumps meningitis have decreased, shifting focus to other pathogens.
Purpose of the Study:
- To highlight the diagnostic challenges in acute aseptic meningitis.
- To review the spectrum of etiologies, including classic viral agents and emerging pathogens.
- To emphasize the importance of considering treatable mimics and employing a rational diagnostic approach.
Main Methods:
- Literature review of infectious and noninfectious causes of aseptic meningitis.
- Discussion of classic and emerging pathogens.
- Emphasis on clinical presentation and diagnostic strategies.
Main Results:
- Nonpolio enteroviruses remain the most common viral cause.
- Human immunodeficiency virus and Borna virus burgdorferi are increasingly recognized etiologies.
- Conditions like fungal or mycobacterial meningitis and herpes simplex encephalitis can mimic aseptic meningitis.
Conclusions:
- A systematic clinical approach and judicious laboratory testing are crucial for diagnosing aseptic meningitis.
- Early and accurate diagnosis is essential for effective management and improved patient outcomes.
- Clinicians must remain vigilant for both common viral and less common, treatable causes of aseptic meningitis.