Aseptic Meningitis

Definition

• Negative bacterial microbiologic data. CSF pleocytosis wich appropriate blood and CSF cultures (aseptic meningitis can be neutrophilic, though less common)

• Misnomer, as "aseptic" only in sense that less likely to be acute bacterial meningitis, but can be due to both infectious and noninfectious etiologies

Etiologies (Nw/roiojy 2006:66:75)

• Viral: enteroviruses (most common). HIV, HSV (type 2 > 1).VZV. mumps, lymphocytic choriomeningitis virus, encephalitis viruses, adenovirus, polio. CMV. EBV

• Parameningeal focus of infection (eg, brain abscess, epidural abscess, septic thrombophlebitis of dural venous sinuses, or subdural empyema)

• Tuberculosis, fungal, spirochetal (Lyme disease, syphilis, leptospirosis). rickettsial.

Coxiella, Ehrlichia

• Partially treated bacterial meningitis

• Medications: TMP/SMX. NSAIDs. penicillin, isoniazid

• Systemic illness: SLE. sarcoidosis. Behcet's. Sjogren's syndrome, rheumatoid arthritis

• Neoplasms: intracranial tumors (or cysts), lymphomatous or carcinomatous meningitis

Empiric treatment

• No abx if suspect viral (cell count - 500 w/ 50% lymphs.TP - 80-100 mg/dl. normal glc.

© Gram stain, not elderly/immunocompromised); o/w start empiric abx. wait for cx data

• MTb: antimyobacterial Rx + dexamethasone (NEJM 2004:351:1741)

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