Aseptic meningitis
Classifications and external resources

The image above shows the location and the layers of the meninges surrounding the brain
ICD-10	G03. Nonpyogenic meningitis
ICD-9	322.0 Nonpyogenic menigitis
DiseasesDB	945
eMedicine	NEURO/697

Aseptic meningitis is a condition in which the layers lining of the brain, or meninges, become inflamed and a pyogenic bacterial source is not to blame. Meningitis is diagnosed on a history of characteristic symptoms and certain examination findings (e.g. Kernig's sign). Investigations should show an increase in the number of leukocytes present in the cerebrospinal fluid (CSF), obtained via lumbar puncture, (normal being fewer than five visible per microscopic high power field). Image File history File links Meninges. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... The meninges (singular meninx) are the system of membranes that envelop the central nervous system. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... Pyogenic refers to bacterial infections that make pus. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Meningitis is inflammation of the meninges. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... White Blood Cells is also the name of a White Stripes album. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... A patient undergoes a lumbar puncture at the hands of a neurologist. ...

The term aseptic is frequently a misnomer, implying a lack of infection. On the contrary, many cases of aseptic meningitis represent infection with viruses or mycobacteria that cannot be detected with routine methods. While the advent of polymerase chain reaction has increased the ability of clinicians to detect viruses such as enterovirus, cytomegalovirus, and herpes virus in the CSF, many viruses can still escape detection. Additionally, mycobacteria frequently require special stains and culture methods that make their detection difficult. When CSF findings are consistent with meningitis, and microbiologic testing is unrevealing, clinicians typically assign the diagnosis of aseptic meningitis—making it a relative diagnosis of exclusion. An editor has expressed a concern that the topic of this article may be unencyclopedic. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Species see text Mycobacterium is the a genus of actinobacteria, given its own family, the Mycobacteriaceae. ... Polymerase chain reaction (PCR) is a molecular biology technique [1] for enzymatically replicating DNA without using a living organism, such as E. coli or yeast. ... Species Bovine enterovirus Coxsackie virus Human enterovirus A Human enterovirus B Human enterovirus C Human enterovirus D Human enterovirus E Poliovirus Porcine enterovirus A Porcine enterovirus B Swine vesicular disease virus The enteroviruses are a genus of (+)ssRNA viruses associated with several human and mammalian diseases. ... Species see text Cytomegalovirus (CMV), is a genus of Herpes viruses; in humans the species is known as Human herpesvirus 5 (HHV-5). ... In colloquial use, herpes virus refers to the herpes simplex virus, particularly when transmitted sexually. ... The word culture, from the Latin colo, -ere, with its root meaning to cultivate, generally refers to patterns of human activity and the symbolic structures that give such activity significance. ... An agar plate streaked with microorganisms Microbiology is the study of microorganisms, which are unicellular or cell-cluster microscopic organisms. ... The term diagnosis of exclusion (per exclusionem) refers to a medical condition whose presence cannot be established with complete confidence from examination or testing. ...

Aseptic meningitis can result from non-infectious causes; it is a relatively infrequent side effect of medications, and can be an early finding in autoimmune disease.

Classification

There is no formal classification system. It is usually by the causative organism if identified. A crab is an example of an organism. ...

Symptoms and Signs

These are varied, depending on the causative organism. There are usually non-specific constitutional symptoms lasting for hours or days. These are then followed by meningitis, characterised by headache, stiff neck, fever, photophobia, drowsiness, and myalgia. A rash may be present, which could suggest a particular virus - for example, varicella zoster. However, a non-blanching purpuric rash is not associated with meningitis and suggests systemic bacterial infection. The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ... Meningitis is inflammation of the meninges. ... An analogue medical thermometer showing the temperature of 38. ... Photophobia (also light sensitivity) is a symptom of excessive sensitivity to light and the aversion to sunlight or well-lit places. ... Myalgia means muscle pain and is a symptom of many diseases and disorders. ... A typical rash A rash is a change in the skin which affects its appearance or texture. ... The varicella-zoster virus (VZV), also known as human herpesvirus 3 (HHV-3), is one of the eight herpesviruses known to affect humans (and other vertebrates). ... Purpura is the appearance of purple discolorations on the skin caused by bleeding underneath the skin. ... Systemic Relating to, or affecting a particular body system; especially the nervous system. ...

Complications

Seizures, encephalitis and cognitive problems can develop, although rarely. This article is about the medical condition. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ...

Cause/Etiology

The cause can be infectious or non-infectious.

Infectious

Viruses

• HSV 1 and 2
• HIV
• Enteroviruses
• Varicella zoster
• Epstein-Barr virus
• CMV
• Lymphocytic choriomeningitis virus

HSV is: Herpes simplex virus a human pathogen HSV color space (Hue Saturation Value) HSV-7 the Melbourne station of the Seven television network. ... Human immunodeficiency virus or HIV is a retrovirus that causes Acquired Immunodeficiency Syndrome (AIDS), a condition in which the immune system begins to fail, leading to life-threatening opportunistic infections. ... Species Bovine enterovirus Coxsackie virus Human enterovirus A Human enterovirus B Human enterovirus C Human enterovirus D Human enterovirus E Poliovirus Porcine enterovirus A Porcine enterovirus B Swine vesicular disease virus The enteroviruses are a genus of (+)ssRNA viruses associated with several human and mammalian diseases. ... The varicella-zoster virus (VZV), also known as human herpesvirus 3 (HHV-3), is one of the eight herpesviruses known to affect humans (and other vertebrates). ... The Epstein-Barr virus (EBV), also called Human herpesvirus 4 (HHV-4), is a virus of the herpes family (which includes Herpes simplex virus and Cytomegalovirus), and is one of the most common viruses in humans. ... Species see text Cytomegalovirus (CMV), is a genus of Herpes viruses; in humans the species is known as Human herpesvirus 5 (HHV-5). ... Lymphocytic choriomeningitis (LCM), is a rodent-borne viral infectious disease that presents as aseptic meningitis, encephalitis or meningoencephalitis. ...

Bacteria

• Partially treated meningitis
• Endocarditis
• Mycoplasma
• Mycobacterium tuberculosis
• Borrelia burgdorferi
• Treponema pallidum
• Brucella

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... Species M. genitalium M. hominis M. pneumoniae etc. ... Binomial name Mycobacterium tuberculosis Zopf 1883 Mycobacterium tuberculosis is the bacterium that causes most cases of tuberculosis[1]. It was first described on March 24, 1882 by Robert Koch, who subsequently received the Nobel Prize in physiology or medicine for this discovery in 1905. ... Binomial name Borrelia burgdorferi Johnson RC et al 1984 Borrelia burgdorferi is a spirochete bacteria and the causative agent of Lyme disease. ... Binomial name Treponema pallidum Schaudinn & Hoffmann, 1905 Treponema pallidum is a gram-negative spirochaete bacterium and is considered to be metabolically crippled. ... Species Brucella melitensis Brucella abortus Brucella suis Brucella canis Brucella are a genus of bacteria. ...

Fungi

• Cryptococcus neoformans
• Blastomyces dermatitidis

Cryptococcus neoformans is an encapsulated yeastlike fungus that can live in both plants and animals. ...

Parasites

• Toxoplasma gondii

Binomial name Toxoplasma gondii (Nicolle & Manceaux), 1908 Toxoplasma is a species of parasitic protozoa whose definitive host is cats but which can be carried by the vast majority of warm-blooded animals, including humans. ...

Non-infectious

Drugs

• NSAIDs
• Amoxicillin
• Azathioprine
• Methotrexate
• Intravenous immunoglobulin
• Isoniazid
• Allopurinol

Wikipedia does not yet have an article with this exact name. ... Amoxicillin (INN) or amoxycillin (former BAN) is a moderate-spectrum β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Methotrexate (rINN) (IPA: ), abbreviated MTX and formerly known as amethopterin, is an antimetabolite drug used in treatment of cancer and autoimmune diseases. ... Intravenous immunoglobulin (IVIG) is a blood product used in the treatment of inflammatory or autoimmune diseases, hypogammaglobulinemia and other diseases featuring low antibody levels. ... Isoniazid (also called isonicotinyl hydrazine or isonicotinic acid hydrazide); abbreviated INH or just H. Isoniazid is a first-line antituberculous medication used in the prevention and treatment of tuberculosis. ... Allopurinol is a white, powdery drug used to treat gout. ...

Systemic Diseases

• Sarcoidosis
• Meningioma
• SLE
• Wegener's
• Vasculitis
• Behcet's disease

Meningiomas are tumors arising from the outer part of the arachnoid mater in the meninges of the brain or the spinal cord. ... Lupus erythematosus (also known as systemic lupus erythematosus - SLE) is an autoimmune disorder in which antibodies are created against the patients own DNA. It classically presents with a butterfly-shaped malar rash, causing a wolf-like appearance (Lupus is Latin for wolf). ... In medicine (rheumatology), Wegeners granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels. ... Behçets disease (BD, or Behçets syndrome) is a rare, multisystem disease with chronic inflammation of blood vessels (i. ...

Miscellaneous

• Migraine
• Arachnoiditis

Arachnoiditis describes a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. ...

Diagnosis

Usually the history and examination will arouse suspicion. Confirmation is mainly through CSF findings: Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ...

• Less than 500 mononuclear cells/mm³ (pleocytosis) should develop with 8-48 hours
• Normal glucose
• Elevated pressure
• Elevated protein
• No findings which suggest another diagnosis - e.g. negative bacteria antigen tests, no lactate
• PCR may identify a causative organism

Viruses may be cultured from swabs of other areas, such as the throat. The reticuloendothelial system (RES), part of the immune system, consists of the phagocytic cells located in reticular connective tissue, primarily monocytes and macrophages. ... Glucose (Glc), a monosaccharide (or simple sugar), is one of the most important carbohydrates in biology. ... The use of water pressure - the Captain Cook Memorial Jet in Lake Burley Griffin, Canberra. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... An antigen is a substance that stimulates an immune response, especially the production of antibodies. ... Lactic acid is a chemical compound that plays a role in several biochemical processes. ... Wikipedia does not yet have an article with this exact name. ... Wiktionary has a definition of: Swab In medicine, a swab is a small piece of material, such as gauze or cotton, which is used to clean wounds, apply medications, or retrieve samples of body fluids such as blood or mucus. ...

Blood tests are rarely helpful in establishing the diagnosis (but may be of use to establish baseline chemistry). Imaging is useful in excluding other diagnoses, or identifying other features of infection by an organsim - for example, a chest X-ray may be useful if tuberculosis is suspected. Wikipedia does not yet have an article with this exact name. ... Chemistry (from Greek χημεία khemeia[1] meaning alchemy) is the science of matter at the atomic to molecular scale, dealing primarily with collections of atoms, such as molecules, crystals, and metals. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Frontal chest X-ray. ... Tuberculosis (abbreviated as TB for Tubercle Bacillus) is a common and deadly infectious disease caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system, lymphatic system, circulatory system, genitourinary system, bones and joints. ...

Pathophysiology

Invasion into or past the meninges by a pathogen can set up a local inflammatory response. The clinical signs are due to this meningeal irritation - for example, Kernig's sign is due to pain produced by stretching of the inflamed meninges. An invasion is a military action consisting of armed forces of one geopolitical entity entering territory controlled by another such entity, generally with the objective of conquering territory or altering the established government. ... The meninges (singular meninx) are the system of membranes that envelop the central nervous system. ... This page is a candidate to be moved to Wiktionary. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... See drugs, medication, and pharmacology for substances that treat patients. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ...

Treatment/Management

Anti-pathogenic

If the causative organism has been identified and has a specific therapy, this should be started.

Bacteria

Even though true aseptic meningitis cannot be caused by pyogenic bacteria, broad-spectrum antibiotic cover should be started as the consequences of misdiagnosing a bacterial meningitis are dire, and relatively easily avoided. For non-pyogenic bacteria, local sensitivities should be taken into account, but generally broad-spectrum is best. Some bacteria are normally sensitive to certain drugs - for example, rifampicin is good for Brucella. Pyogenic refers to bacterial infections that make pus. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... The term broad-spectrum antibiotic refers to an antibiotic with activity against a wide range of disease-causing bacteria. ... Staphylococcus aureus - Antibiotics Test plate. ... See: Sensitivity (electronics) Sensitivity (human) Sensitivity (tests) For sensitivity in finance, see beta coefficient This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Rifampicin (INN) (IPA: ) or rifampin (USAN) is a bacteriocidal antibiotic drug of the rifamycin group. ... Species Brucella melitensis Brucella abortus Brucella suis Brucella canis Brucella are a genus of bacteria. ...

Viruses

HSV, varicella and CMV have a specific antiviral therapy; most other viruses do not. For HSV the treatment of choice is acyclovir^[1] HSV is: Herpes simplex virus a human pathogen HSV color space (Hue Saturation Value) HSV-7 the Melbourne station of the Seven television network. ... Varicella is a Latin name for chickenpox. ... Species see text Cytomegalovirus (CMV), is a genus of Herpes viruses; in humans the species is known as Human herpesvirus 5 (HHV-5). ... HSV is: Herpes simplex virus a human pathogen HSV color space (Hue Saturation Value) HSV-7 the Melbourne station of the Seven television network. ... Aciclovir (INN) or aciclovir (USAN), marketed as Zovirax®, is one of the main antiviral drugs. ...

Fungi

Amphotericin B and fluconazole are the best antifungals in most situations. Amphotericin B (Fungilin®, Fungizone®, Abelcet®, AmBisome®, Fungisome®, Amphocil®, Amphotec®) is a polyene antimycotic drug, used intravenously in systemic fungal infections. ... Fluconazole (INN) (IPA: ) is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. ...

Supportive

This will be the majority of the treatment. Fluids, analgesia and antiemetics should cover most cases. Antipyretics should be used judiciously - fever can be a natural response. Steroids are not recommended unless raised intracranial pressure occurs. Phenytoin and other anticonvulsants can be used is seizures occur, but prophylaxis is not recommended. For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... An antiemetic is a drug that is effective against vomiting and nausea. ... Antipyretics are drugs that prevent or reduce fever by lowering the body temperature from a raised state. ... An analogue medical thermometer showing the temperature of 38. ... Steroid skeleton. ... Intracranial pressure, or ICP, is the pressure of the brain, Cerebrospinal fluid (CSF), and the brains blood supply within the intracranial space. ... Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... Prophylaxis refers to any medical or public health procedure whose purpose is to prevent, rather than treat or cure, disease. ...

Prognosis

In immunocompetent individuals, the disease is usually mild and self-limiting. Full recovery 5-14 days afterwards is normal. persons with functioning immune system This page is a candidate to be moved to Wiktionary. ... In biology, a self-limiting organism or colony of organisms limits its own growth by its actions. ...

Prevention/Screening

Vaccines are available for some organisms that cause aseptic menigitis. Good infection control in hospital, as ever, is recommended. If the causative organism is contagious, steps may need to be taken to isolate the individual and protect the community. A bottle and a syringe containing the influenza vaccine. ... A disease is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected or those in contact with the person. ... Isolate may refer to: a language isolate an isolated monkey in the Pit of despair experiment. ...

Epidemiology

Aspetic meningitis is relatively common, with an incidence of around 10/100,000. The male:female ratio is around 1:1. In optics one considers angles of incidence. ... In number and more generally in algebra, a ratio is the linear relationship between two quantities of the same unit. ...

References

1. ^ Tyler Kl. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes. 2004 Jun;11 Suppl 2:57A-64A.