II. Definition

  1. Clinical findings consistent with Meningitis, but with negative CSF Culture

IV. Epidemiology

  1. Aseptic Meningitis accounts for 96% of pediatric cases with Leukocytosis on CSF
  2. Incidence
    1. Infants (<1 year): 70 per 100,000
    2. Children (age 1 to 14): 5.2 per 100,000
    3. Adults: 7.6 per 100,000
    4. Martin (2016) Lancet Infect Dis 16(11): 1279-87 [PubMed]
    5. Kupila (2006) Neurology 66(10: 75-80 [PubMed]

V. Causes

  1. Most common in children
    1. Enterovirus or Arbovirus (summer, fall)
    2. Herpes Simplex Virus (HSV)
    3. Borrelia Burgdorferi (Lyme Disease)
  2. Most common in adults
    1. Enterovirus
    2. Herpes Simplex Virus (HSV)
    3. Varicella-Zoster Virus (VZV)
  3. Common viral infections causing Aseptic Meningitis
    1. Enterovirus (85% of Viral Meningitis)
      1. Echovirus (esp. children)
      2. Coxsackievirus (type A which causes hand, foot and mouth, and Type B)
      3. Polio Virus
    2. Arbovirus (Arthopod-borne viruses such as St. Louis Encephalitis virus, West Nile Virus)
    3. Herpes Viruses (esp. HSV 2, but also HSV 1, EBV, CMV, VZV)
    4. Acute Retroviral Syndrome (HIV Infection)
    5. Lymphocytic choriomeningitis virus (rodent-borne arena virus)
    6. Mumps
    7. Less common causes include Adenovirus, Measles, Rubella
  4. Bacteria causing Aseptic Meningitis (culture negative)
    1. Epidural or subdural Brain Abscess
    2. Partially treated Meningitis
    3. Leptospira
    4. Borrelia Burgdorferi (Lyme Disease)
    5. Mycobacterium tuberculosis (Tuberculous Meningitis)
    6. Less common: Syphilis, Chlamydia, Ehrlichiosis, Rocky Mountain Spotted Fever, Mycoplasma, Brucella
  5. Other causes of Aseptic Meningitis
    1. Cryptococcal Meningitis (Advanced HIV Infection or AIDS)
    2. Fungal Meningitis (Coccidioides, Histoplasma)
    3. Medications (esp. Ibuprofen, but also other NSAIDs, TMP-SMZ, pyridium, Azathioprine)
    4. Malignancy (e.g. Leukemia, Lymphoma, metastatic cancer)
    5. Autoimmune Conditions (Sarcoidosis, Behcet's Disease)

VI. Symptoms

  1. Fever
  2. Headache
  3. Stiff neck
  4. Photophobia

VII. Differential Diagnosis

  1. Bacterial Meningitis
    1. Often indistinguishable without Lumbar Puncture and CSF Culture
    2. Additional findings (e.g. Parotitis in mumps) may suggest cause
  2. Encephalitis (e.g. HSV Encephalitis, West Nile Virus, St. Louis Encephalitis)
    1. Abnormal brain function distinguishes Encephalitis from Meningitis
    2. Altered behavior, personality, Level of Consciousness, speech, movement or weakness
    3. Seizures may occur with either Meningitis or Encephalitis

VIII. Management

  1. See Meningitis
  2. See Bacterial Meningitis Management
    1. Empiric antibiotics for Meningitis if diagnosis unclear

IX. References

  1. Johnson in Hirsch (2012) Aseptic Meningitis, UpToDate, Wolters-Kluwer, accessed 4/9/2016
  2. Wan in Roos (2015) Viral Meningitis, EMedicine, Medscape, accessed 4/9/2016
  3. Bamberger (2010) Am Fam Physician 82(12): 1491-8 [PubMed]
  4. Mount (2017) Am Fam Physician 96(5): 314-22 [PubMed]

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Ontology: Aseptic Meningitis (C0025290)

Definition (MSHFRE) Syndrome caractérisé par des céphalées, une rigidité de la nuque, un fébricule, une pléïocytose lymphocytaire du LCR sans multiplication bactérienne aiguë. La méningite virale en est la cause la plus fréquente mais on peut retrouver des infections à mycoplasmes, à rickettsies. Il peut être secondaire à des investigations cliniques ou thérapeutiques, à des processus néoplasiques ou à des foyers periméningés septiques. D'autres étiologies peuvent être responsables de ce syndrome. (From Adams et al., Principles of Neurology, 6th ed, p745)
Definition (MSH) A syndrome characterized by headache, neck stiffness, low grade fever, and CSF lymphocytic pleocytosis in the absence of an acute bacterial pathogen. Viral meningitis is the most frequent cause although MYCOPLASMA INFECTIONS; RICKETTSIA INFECTIONS; diagnostic or therapeutic procedures; NEOPLASTIC PROCESSES; septic perimeningeal foci; and other conditions may result in this syndrome. (From Adams et al., Principles of Neurology, 6th ed, p745)
Concepts Disease or Syndrome (T047)
MSH D008582
ICD10 G03.0
SnomedCT 186490006, 301770000, 58170007
English Meningitis, Aseptic, ASEPTIC MENINGITIS, MENINGITIS ASEPTIC, aseptic meningitis, aseptic meningitis (diagnosis), Meningitis aseptic, Meningitis, Aseptic [Disease/Finding], meningitis aseptic, Aseptic meningitis, Aseptic meningitis (disorder), aseptic; meningitis, meningitis; aseptic, Aseptic Meningitis
French MENINGITE ASEPTIQUE, Méningite aseptique, Méningite à liquide clair
Portuguese MENINGITE ASSEPTICA, Meningite asséptica, Meningite Asséptica
Dutch aseptische meningitis, aseptisch; meningitis, meningitis; aseptisch, meningitis aseptisch, Aseptische meningitis, Meningitis, aseptische
German aspetische Meningitis, MENINGITIS ASEPTISCH, Meningitis aseptisch, Meningitis, aseptische, Aseptische Meningitis
Italian Meningite senza infezione, Meningite asettica
Swedish Hjärnhinneinflammation, aseptisk
Japanese ムキンセイズイマクエン, 髄膜炎-無菌性, 無菌性髄膜炎, 無菌髄膜炎, 非細菌性髄膜炎
Czech meningitida aseptická, Aseptická meningitida
Finnish Aseptinen aivokalvotulehdus
Russian MENINGIT ASEPTICHESKII, МЕНИНГИТ АСЕПТИЧЕСКИЙ
Polish Zapalenie opon mózgowo-rdzeniowych limfocytarne, Zapalenie opon limfocytowe, Zapalenie opon aseptyczne
Croatian MENINGITIS, ASEPTIČNI, ASEPTIČNI MENINGITIS, ASEPTIČKI MENINGITIS
Hungarian aseptikus meningitis, asepticus meningitis
Norwegian Aseptisk meningitt
Spanish meningitis aséptica (trastorno), meningitis aséptica, Meningitis aséptica, Meningitis Aséptica