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Aseptic Meningitis

Introduction

Aseptic meningitis is the inflammation of the meninges, a membrane covering the brain and spinal cord, caused by something else rather than bacteria. The testing for both meningitis and aseptic meningitis is mostly the same. A cerebrospinal fluid sample is taken by lumbar puncture and is tested for leukocyte levels and to determine if the infection is bacterial, viral, or something else. The symptoms are the same for both meningitis and aseptic meningitis but the severity of the symptoms can depend on the certain cause.

The most common cause of aseptic meningitis is by viral infection. Other causes may include side-effects from drugs and connective tissue disorders. Mumps and herpes seem to be another leading cause of aseptic meningitis. Getting vaccinations for and taking precautions from these two viruses can decrease the likelihood of getting aseptic meningitis from these two viruses. If someone does get aseptic meningitis, they can be hospitalized and treated for the inflammation and anti-viral medication.

Cause of Aseptic Meningitis

The most common cause of aseptic meningitis is a viral infection, specifically by enteroviruses. In fact, 90% of all meningitis cases that are viral are caused by enteroviruses. Other viruses that may cause aspetic meningitis are varicella-voster virus, herpes, and mumps. Other causes can be from mycobacteria and complications from HIV. Aseptic meningitis can also be a side-effect of certain drugs such as Cetuximab, which is used to fight certain types of cancers. Other drugs such as antibiotics, anti-inflammatories, and others have shown to cause rare cases of aseptic meningitis, but are hard to link to specific drugs.

Symptoms

Aseptic meningitis is a disease that is can depend on the patient’s age, however research has shown some distinct symptoms that indicate the possibility of aseptic meningitis. A variety of patients notice a change in body temperatures (higher than normal temperatures 38-40*C), marked with the possibility of vomiting, headaches, firm neck pain, and even anorexia (Irani, Aseptic Meningitis and Viral Myelitis). In younger patients, like babies, a meningeal inflammation can be noticed along with the possibility of hepatic necrosis and myocarditis (Irani, Aseptic Meningitis and Viral Myelitis). In serious cases, a multiple organ failure can also signal aseptic meningitis and oftentimes, in babies, seizures and focal neurological deficits can be early symptoms of aseptic meningitis (Irani, Aseptic Meningitis and Viral Myelitis). In fact, in newborns, the mortality rate is 70% (Irani, Aseptic Meningitis and Viral Myelitis). The next set of age group, like children, have similar but varying symptoms of sore throat, rashes, and diarrhea (Irani, Aseptic Meningitis and Viral Myelitis). In adults, symptoms and the harshness of them tend to be less in duration. Additionally, the probability of developing aseptic meningitis increases when patients have a case of mumps or herpes (Irani, Aseptic Meningitis and Viral Myelitis).

Types of aseptic meningitis

There are multiple types of Aseptic meningitis which are differentiated based on the cause of the aseptic meningitis infection. The types are divided further into subtypes based on the specific virus or infection cause.

a. Drug Induced Aseptic Meningitis (DIAM)

1. Irritation of the meninges from drugs administered directly to the spinal canal or subarachnoid space.
2. Hypersensitivity to the drug that results in an immune response.

b. Viral Meningitis

1. Enterovirus (EV) caused meningitis.  This is the most common cause of viral meningitis, with 90% of viral meningitis cases being caused by EVs.
2. Mumps
3. Mosquito carried viruses of the flavivirus family.  Saint Louis encephalitis (SLE) and West Nile virus (WNV) are the most typical.
4. Specific types of Herpes can result in aseptic meningitis.  These are (HSV)-1, (HSV)-2, varicella-zoster virus, and (HHV6).

c. Autoimmune diseases such as systemic lupus erythematosus.

d. Cancer-caused aseptic meningitis.  This affects about 5% of all cancer cases, with a predominance in leukemias.

Prevention

One of the leading reasons for why patients develop aseptic meningitis is because of mumps and herpes (Irani, Aseptic Meningitis and Viral Myelitis). As a result, prevention is key in making sure that smaller issues don’t lead larger problems, like aseptic meningitis. For example, one way to prevent this disease is for patients to get vaccinated for mumps and herpes. This can prevent not only the ultimate possibility of developing meningitis, but also limits patients from developing mumps or a case of the herpes. In addition to vaccinations, it is important to follow other common rules like washing hands often, covering your mouth when sneezing or coughing or even, making sure to not share drinks or personal items. Furthermore, practicing safe sex and avoiding oral sex when a person is sick or has blisters around the mouth, which all inevitably lead to herpes. Following these guidelines along with a good diet and getting exercise can help prevent aseptic meningitis.

Treatment

If CSF levels are irregular among individuals than they will undergo hospitalization where they receive antiviral therapy. If aseptic meningitis was caused by herpes simplex virus (HSV), than the individual will receive, acyclovir, an antiviral drug. If infants are diagnosed than medical professionals will order regular check-ins for hearing and learning disabilities.

Diagnosis

Medical professionals will take into consideration the season of the year, the medical history of the individual and family, physical examination, and laboratory results when diagnosing aseptic meningitis.

One common medical test used when diagnosing aseptic meningitis is lumbar puncture. A medical professional inserts a needle between two vertebrae to remove cerebrospinal fluid (CSF) from the spinal cord. The cerebrospinal fluid collected from the lumbar puncture is analyzed to distinguish between bacterial and aseptic meningitis. Samples of CSF undergo cell count, Gram stains, and viral cultures, and polymerase chain reaction test (PCR).Other laboratory tests include blood, urine, and stool collection. Medical professionals also have the option of performing a computed tomographic (CT) scan or magnetic resonance imaging (MRI), these tests help observe calcifications or abscesses.

Prognosis

Aseptic Meningitis is an acute viral infection where symptoms last between one to two weeks. When aseptic meningitis is caused by cytomegalovirus 20 percent of individuals face mortality or morbidity. If left untreated it can affect an individuals hearing and learning abilities.

History

Aseptic meningitis cases have varied historically.  Aseptic meningitis caused by mumps has declined in the United States due to the increased use of vaccination which prevents mumps cases from occurring.