![]() ![]() As most of the viral infections start affecting the mucosa of the respiratory or gastrointestinal tracts, symptoms involving these organs may be present 4,5. ![]() Other nonspecific symptoms such as vomiting, headache, anorexia, exanthems, and myalgia may be also associated. Clinical presentationĬlassically, patients present with fevers and clinical signs of meningeal irritation (e.g. ![]() Viral meningitis is more common in young children, particularly in those with less than one year or between 5 to 10 years.Īfter a long term period since the implementation of highly effective conjugate vaccines, there has been a significant change in the etiology and the incidence and hospital admissions for viral meningitis have dropped 1,3. leptomeningeal carcinomatosis, sarcoidosis, vasculitis, and connective tissue diseases). To avoid misleading interpretations, we prefer to save this term only for those noninfective inflammatory processes involving the meninges (e.g. Ped ID Journal 2004 23: 511-517.Aseptic meningitis is a term frequently used as a synonym for viral meningitis (as distinct from bacterial meningitis). Pediatrics 2002 110: 712-719.įourth years: Differentiating Acute Bacterial Meningitis from Acute Viral Meningitis Among Children with Cerebrospinal Fluid Pleocytosis: A Multivariable Regression Model. Third years: Development and Validation of a Multivariable Predictive Model to Distinguish Bacterial from Aseptic Meningitis in Children in the Post-Haemophilus influenza Era. Second years: Accuracy and Test Characteristics of Ancillary Tests of Cerebrospinal Fluid for Predicting Acute Bacterial Meningitis in Children with Low White Blood Cell Counts in Cerebrospinal Fluid. Given her non-toxic clinical appearance, you feel comfortable that these constellation of symptoms represent aseptic meningitis, but you are uncertain as to the clinical utility of the CSF in clearly distinguishing viral (and other forms of aseptic meningitis) from bacterial meningitis and what the most appropriate management is for this well-appearing patient, so you turn to the medical literature.įirst years: Cerebrospinal Fluid Findings in Aseptic Versus Bacterial Meningitis. The CSF gram stain shows many PMN’s without any appreciable organisms. ![]() She reluctantly consents to the procedure and her cerebral spinal fluid (CSF) appears clear and colorless.Ĭhalking this case up to another case of “viral syndrome”, you are surprised when the lab results subsequently indicate a pleocytosis and protein elevation on the CSF with 450 white blood cells (60% neutrophils) and protein 120 mg/dL. Recognizing the necessity of excluding meningitis, you once again explain to the concerned patient and her family of the need to exclude a CNS infection as the source of today’s symptoms. Your hopes of finding an obvious source for the fever were dashed with an unremarkable chest x-ray and urinalysis. She has no focal neurological deficits and you do not appreciate any “jolt accentuation” of her headache. Her temperature is 39.7° Celsius and she has a heart rate of 110, but no appreciable photophobia or neck stiffness and no other clinically apparent source for her fever. She has no past medical history, no HIV-risk factors, and has not traveled outside of the St. Working overnights (again) you face the dilemma of performing yet another lumbar puncture on a febrile 37-year old female with a non-specific, severe headache and fever of 18-hours duration. Note that all of these articles deal with children because you are unable to locate any recent study in adults to answer your PICO question. You next do a search on OVID, but yield an incomprehensibly long list of over 2000 references so you decide to search the term meningitis through the various EM journals and obtain the Academic EM reference below.įinally, you scour the bibliography of this Academic EM selection to find the Nigrovic article and perform a Web of Science review of the Nigrovic article to obtain the Bonsu article. Recognizing that CJEM is not MEDLINE accessible and therefore does not show up on Web of Science reviews, you turn to the bibliography of Graham’s narrative review and locate one of the following articles. Asking around, one of your colleagues provides you with an interesting narrative review from the Canadian Journal of Emergency Medicine (Graham TP, Myth: CSF Analysis Can Differentiate Bacterial Meningitis from Aseptic meningitis, CJEM 2003 5: 348-349) on this very topic. Search Strategy: You search the bibliography of Rosen’s and Roberts & Hedges, only to find numerous dated references circa the 1980’s. CSF Analysis in Bacterial versus a Septic Meningitis ![]()
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