Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study

The purpose of this study was to determine the actual diagnostic status of aseptic meningitis and consider the factors that cause difficulties in its diagnosis.

This study retrospectively reviewed the medical records of aseptic meningitis treated at our hospital from 2013 to 2022 and compared biometric data to distinguish between timely diagnose and difficult diagnose cases.

This retrospective observational study included 127 patients aged 18 years or older. 66 (52.0 %) were female, with a median age of 35.9±15.9 years. The main symptoms were headache (122, 96.1 %), general malaise (110, 86.6 %), vomiting (79, 62.2 %). The 127 patients were classified into two groups: A timely diagnosis group diagnosed within 6 days of symptom onset, and a difficult diagnosis group diagnosed within 7 days or longer. There were significant differences between the two groups in the proportion of patients with a history of antimicrobial treatment and fever above 38 °C, and in the positive rates of neck stiffness and jolt accentuation of headache (JAH). The total number of hospitals involved in the process of diagnosis was significantly higher in the difficult diagnosis group and the length of inpatient stay was significantly longer. Multivariate analysis revealed significant differences in neck stiffness, JAH, and prior antibacterial therapy.

Atypical cases, such as neck stiffness and JAH negativity, may make the diagnosis difficult. Clinicians should be aware of this atypical presentation of aseptic meningitis.