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Terminology. Subarachnoid inflammation from any cause other than pyogenic bacteria or fungi. The differential includes viruses, other microorganisms, and non-infectious causes viral meningitis. Since most cases are caused by viruses, the terms "aseptic" and "viral" are often used synonymously.
Causes of Aseptic Meningitis other than Enterovirus.
Viral Diseases with Systemic Manifestations
mumps
herpes simplex
varicella-zoster
adenoviruses
Epstein-Barr virus
parvovirus (erythema infectiosum)
lymphocytic choriomeningitis virus
Non-Viral Infections
partially treated bacterial
parameningeal infection
mastoiditis
sinusitis
brain abscess
spirochetal infections
syphilis
leptospirosis
Lyme disease
fungal
cryptococcal
coccidioidomycosis
histoplasmosis
tuberculous
toxoplasmosis
Rocky Mountain Spotted Fever
Mycoplasma pneumoniae
Bartonella henselae (cat scratch disease)
amebic meningoencephalitis
Non-Infectious Etiology
brain tumor
carcinomatous
chemical
intrathecal drugs and radiographic dyes
lead poisoning
benign intracranial hypertension
Unknown Etiology
Kawasaki disease
Etiology
may occur as part of a broader range of clinical manifestations caused by some viruses
The differential diagnosis where is the sole or dominant manifestation is more limited
Prior to the discovery of the non-polio enteroviruses (circa 1950), most cases were considered to be "non-paralytic" poliomyelitis.
Large studies conducted from 1955 to 1962 among patients of all ages (1-3), found multiple agents caused. Mumps virus and poliovirus infections are now controlled by immunization in the U.S.
Etiology Presenting with Predominately CNS
Symptoms and Signs.
Diseases Limited to Central Nervous System
enteroviruses
mumps
arboviruses
lymphocytic choriomeningitis virus (LCM)
Unknown Etiology
Mollaret's syndrome
A prospective study conducted at three Baltimore hospitals from 1986 to 1990 showed > 90% of viruses isolated from children under 2 y/o are coxsackie B viruses and echoviruses; coxsackie A viruses appear to cause < 3% of cases (4).
Seasonality. disease activity corresponds to the seasonal pattern observed with all enterovirus infections, i.e., a marked summer-fall predominance. Disease occurs at a lower incidence at other times of the year.
Rates of Disease
Based on continuous surveillance in Olmsted County, MN the overall population-based rate of physician-diagnosed was
The age-specific incidence has varied somewhat among different reported outbreaks (7-14), but most data indicate that is predominantly a disease of infants less than a year of age. A declining number of cases are
Clinical and Laboratory Features
Clinical Presentation
In the older child and adult presents with fever to 400 C, headache, meningismus, nausea and vomiting (10). Other signs of enterovirus infection, i.e., rash, are present in a minority