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Cited by 135Infectious Encephalopathies and EncephalitisViral Infections and Immunology ResearchBacterial Infections and Vaccines

Aseptic meningitis in adults and children: diagnostic and management challenges

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Shukla, Bhavarth, Aguilera, Elizabeth A., Salazar, Lucrecia, Wootton, Susan H., Kaewpoowat, Quanhathai, Hasbun, Rodrigo·2017·Journal of Clinical Virology
DOI 10.1016/j.jcv.2017.07.016PMC PMC5581214
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Abstract

Background Aseptic meningitis represents a common diagnostic and management dilemma to clinicians.Objectives To compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis.Study design We conducted a retrospective study from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX. Patients age≥2months who presented with community-acquired aseptic meningitis with a CSF white blood cell count >5cells/mm 3 and a negative Gram stain and cultures were enrolled. Patients with a positive cryptococcal antigen, positive blood cultures, intracranial masses, brain abscesses, or encephalitis were excluded.Results A total of 509 patients were included; 404 were adults and 105 were children. Adults were most likely to be female, Caucasian, immunosuppressed, have meningeal symptoms (headache, nausea, stiff neck, photophobia) and have a higher CSF protein (P <0.05). In contrast, children were more likely to have respiratory symptoms, fever, and leukocytosis (P <0.05). In 410 (81%) patients, the etiologies remained unknown. Adults were more likely to be tested for and to have Herpes simplex virus and West Nile virus while children were more likely to be tested for and to have Enterovirus (P <0.001). The majority of patients were admitted (96.5%) with children receiving antibiotic therapy more frequently (P <0.001) and adults receiving more antiviral therapy (P=0.001). A total of 384 patients (75%) underwent head CT scans and 125 (25%) MRI scans; all were normal except for meningeal enhancement. All patients had a good clinical outcome at discharge.Discussion Aseptic meningitis in adults and children represent a management challenge as etiologies remained unknown for the majority of patients due to underutilization of currently available diagnostic techniques.

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  • Children are usually less likely to present with meningeal complications and often present with nonspecific illness, making meningitis more likely to be misdiagnosed in children.

    “Children are usually less likely to present with meningeal complications and usually present with nonspecific illness, which makes meningitis more likely to be misdiagnosed in children [31].”

    From Viral meningitis: an overview (2021) · cites this paper as [31]

    The Discussion (page unavailable) says children in this aseptic-meningitis cohort were less likely than adults to present with meningeal complaints and notes that children often present with nonspecific febrile illness. Neither the Discussion nor the Results (page unavailable) establishes that meningitis is more likely to be misdiagnosed in children; the paper's diagnostic-challenge conclusion concerns unknown etiologies, not a higher pediatric misdiagnosis rate. (LLM, conf=0.87)

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  • In many suspected CNS infections, large volumes of cerebrospinal fluid are required for diagnostic testing, with long turnaround times for results, which can be affected by prior antimicrobial treatment, timing of LP, and volume of CSF analyzed.

    “In many suspected CNS infections, large volumes of cerebrospinal fluid (CSF) are required for diagnostic testing, with long turnaround times for results, which themselves can be affected by prior antimicrobial treatment, timing of LP, and volume of CSF analyzed (3–6).”

    From Clinical Utilization of the FilmArray Meningitis/Encephalitis (ME) Multiplex Polymerase Chain Reaction (PCR) Assay (2019) · cites this paper as [6]

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  • Enteroviruses are responsible for many cases of viral meningitis in both pediatric and adult populations.

    “Viral meningitis is frequently reported in pediatric populations; however, enteroviruses are responsible for many cases in both pediatric and adult populations (11, 12, 18–23).”

    From Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay (2020) · cites this paper as [11]

    The Discussion (page unavailable) reports a significant number of enterovirus cases in children, and the Results report 49 enterovirus cases overall. It does not establish that enteroviruses accounted for many adult cases; the Discussion instead identifies HSV as the most common etiology found in adults. (LLM, conf=0.83)

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  • The viral etiology of the majority of aseptic meningitis cases is unknown.

    “Importantly, the viral etiology of the majority of aseptic meningitis cases is unknown (9–11).”

    From Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay (2020) · cites this paper as [11]

  • Meningitis of unknown cause was reported to be 62% in Qatar, 81.5% in the USA, and 42% in the UK.

    “Meningitis of unknown cause was reported to be 62% in Qatar, 81.5% in the USA, and 42% in the UK (11, 19, 21).”

    From Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay (2020) · cites this paper as [11]

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Authors
Shukla, B., Aguilera, E. A., Salazar, L., Wootton, S. H., Kaewpoowat, Q., & Hasbun, R.
Affiliations
The University of Texas Health Science Center at Houston (US)
Corresponding author
Hasbun, Rodrigo
ORCID
Venue
Journal of Clinical Virology
Publisher
Elsevier BV
Published
2017-09
Volume
94
Pages
110-114
ISSN
1386-6532 (ISSN-L)
DOI
10.1016/j.jcv.2017.07.016
PMC
PMC5581214
OpenAlex
W2743370247
Cited by
135
References
17
Citations by year
2026: 11 · 2025: 17 · 2024: 11 · 2023: 14 · 2022: 19 · 2021: 21 · 2020: 23 · 2019: 9 · 2018: 10
FWCI
8.84
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Clinical Virology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Starr Foundation
  • National Center for Research Resources (K23RR018929)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
aseptic meningitis, children versus adults, clinical epidemiology, diagnostic assessment, management, unknown etiology, herpes simplex virus, West Nile virus, enterovirus, cerebrospinal fluid protein, meningeal enhancement, head CT, magnetic resonance imaging, immunosuppression, clinical outcomes
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Hospitalization, Humans, Infant, Infant, Newborn, Male, Meningitis, Aseptic, Middle Aged, Retrospective Studies, Texas, Young Adult

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