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Revue Neurologique 2022
Topics: BNT162 Vaccine; COVID-19; COVID-19 Vaccines; Humans; Meningitis, Aseptic; SARS-CoV-2; Steroids
PubMed: 34799078
DOI: 10.1016/j.neurol.2021.10.002 -
Medicine Jan 2023Drug-induced aseptic meningitis (DIAM) is an uncommon meningitis and trimethoprim with or without sulfamethoxazole is the most involved antibiotic. Although DIAM is...
RATIONALE
Drug-induced aseptic meningitis (DIAM) is an uncommon meningitis and trimethoprim with or without sulfamethoxazole is the most involved antibiotic. Although DIAM is easily treated with the discontinuation of the causative drug, the diagnosis is a big challenge for physicians, as it remains a diagnosis of exclusion. Here, we present a case report of trimethoprim-sulfamethoxazole induced aseptic meningitis in a woman with acute osteomyelitis.
PATIENT CONCERNS
A 52-year-old woman was admitted to the hospital for septic shock and acute osteomyelitis of the right homerus. She was started on antibiotic therapy with oxacillin and daptomycin, then oxacillin was replaced with cotrimoxazole, due to its excellent tissue penetration, including bone tissue. During cotrimoxazole therapy, the patient developed a fluent aphasia with ideomotor apraxia and muscle hypertonus.
DIAGNOSIS AND INTERVENTIONS
Having excluded infectious, epileptic and vascular causes of the acute neurologic syndrome of our patient, given the improvement and full recovery after discontinuation of cotrimoxazole, we hypothesized a DIAM.
OUTCOMES
After discontinuation of cotrimoxazole, in 48 hours the patient had a full recovery.
LESSONS
Although DIAM can be easily managed with the withdrawal of the causative drug, it can be difficult to recognize if it is not included in the differential diagnosis. An antimicrobial stewardship program with a strict monitoring of patients by infectious disease specialists is essential, not only to optimize the appropriate use of antimicrobials, but also to improve patient outcomes and reduce the likelihood of adverse events.
Topics: Female; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Meningitis, Aseptic; Anti-Infective Agents; Anti-Bacterial Agents; Oxacillin
PubMed: 36607874
DOI: 10.1097/MD.0000000000032475 -
Journal of Virology May 2022Echovirus 30 (E30), a member of species B enterovirus, is associated with outbreaks of aseptic meningitis and has become a global health emergency. However, the...
Echovirus 30 (E30), a member of species B enterovirus, is associated with outbreaks of aseptic meningitis and has become a global health emergency. However, the pathogenesis of E30 remains poorly understood due to the lack of appropriate animal models. In this study, we established a mouse infection model to explore the pathogenicity of E30. The 2-day-old mice infected with E30 strain WZ16 showed lethargy and paralysis, and some died. Obvious pathological changes were observed in the skeletal muscle, brain tissue, and other tissues, with the highest viral load in the skeletal muscles. Transcriptome analysis of brain and skeletal muscle tissues from infected mice showed that significant differentially expressed genes were enriched in complement response and neuropathy-related pathways. Using immunofluorescence assay, we found that the viral double-stranded RNA (dsRNA) was detected in the mouse brain region and could infect human glioma (U251) cells. These results indicated that E30 affects the nervous system, and they provide a theoretical basis for understanding its pathogenesis. Echovirus 30 (E30) infection causes a wide spectrum of diseases with mild symptoms, such as hand, foot, and mouth disease (HFMD), acute flaccid paralysis, and aseptic meningitis and other diseases, especially one of the most common pathogens causing aseptic meningitis outbreaks. We established a novel mouse model of E30 infection by inoculating neonatal mice with clinical isolates of E30 and observed the pathological changes induced by E30. Using the E30 infection model, we found complement responses and neuropathy-related genes in the mice tissues at the transcriptome level. Moreover, we found that the viral dsRNA localized in the mouse brain and could replicate in human glioma cell line U251 rather than in the neuroblastoma cell line, SK-N-SH.
Topics: Animals; Cell Line, Tumor; Disease Models, Animal; Echovirus Infections; Enterovirus B, Human; Glioma; Humans; Meningitis, Aseptic; Mice; Mice, Knockout; Phylogeny; RNA, Viral; Sequence Analysis, DNA
PubMed: 35420443
DOI: 10.1128/jvi.00129-22 -
Medicine Jan 2016Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency... (Observational Study)
Observational Study
Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine.The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department.A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management.The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine.The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or inflammatory diseases could also be distinguished according to several clinical and biological characteristics highlighted in this retrospective study. As recommendations are now available concerning the prescriptions of antiviral agents in viral meningitis, better therapeutic management is expected in the future.
Topics: Adult; Encephalitis; Enterovirus; Female; Herpesvirus 2, Human; Herpesvirus 3, Human; Hospital Departments; Humans; Internal Medicine; Male; Meningitis, Aseptic; Middle Aged; Retrospective Studies; Young Adult
PubMed: 26765411
DOI: 10.1097/MD.0000000000002372 -
BMC Cancer Jul 2016Cetuximab is a commonly used antibody agent in the treatment of colorectal or head and neck cancer. Although it is generally well tolerated in most patients, cetuximab... (Review)
Review
BACKGROUND
Cetuximab is a commonly used antibody agent in the treatment of colorectal or head and neck cancer. Although it is generally well tolerated in most patients, cetuximab has been associated with some rare but serious adverse events. Aseptic meningitis is one such distinctly uncommon adverse drug reaction.
CASE PRESENTATION
We present the case of a middle-aged Caucasian patient, who presented with fever and headache within a few hours of starting cetuximab therapy and was diagnosed with cetuximab-induced aseptic meningitis after a complete workup.
CONCLUSION
To our knowledge, this is the ninth case of cetuximab-induced aseptic meningitis reported in literature. Because of a nonspecific clinical presentation, this adverse drug reaction can be easily misdiagnosed. It is important to increase awareness of this potentially severe reaction among oncologists.
Topics: Administration, Intravenous; Aged; Anti-Bacterial Agents; Carcinoma, Squamous Cell; Cetuximab; Female; Head and Neck Neoplasms; Humans; Meningitis, Aseptic; Treatment Outcome
PubMed: 27378078
DOI: 10.1186/s12885-016-2434-7 -
JNMA; Journal of the Nepal Medical... Sep 2021Mollaret's meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms...
Mollaret's meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn's criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviral due to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.
Topics: Acyclovir; Aged; Aged, 80 and over; Herpesvirus 2, Human; Humans; Male; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence
PubMed: 35199717
DOI: 10.31729/jnma.6950 -
Biomedical Papers of the Medical... Dec 2019Enteroviruses (EVs) are the most common agents of aseptic meningitis. Some serotypes can cause serious neuroinfection leading to death. The aim of this study was to...
AIMS
Enteroviruses (EVs) are the most common agents of aseptic meningitis. Some serotypes can cause serious neuroinfection leading to death. The aim of this study was to determine the representation of EVs in the etiology of aseptic meningitis in children and to analyze the demographic, clinical, laboratory, and epidemiological characteristics of patients with EV meningitis.
PATIENTS AND METHODS
This was a prospective study including 147 patients in three groups: EV meningitis, tick-borne encephalitis, and aseptic meningitis with unidentified agent.
RESULTS
Boys with EV meningitis predominated over girls. The average patient age was 11 years. Compared to the control group, these patients suffered more from stiff back (P=0.010), vomiting and nausea (P=0.009). They had shorter symptom duration (P<0.001), higher C-reactive protein in blood (P<0.001), higher predominance of polynuclears (P=0.026), and greater lactate (P=0.003) in cerebrospinal fluid (CSF). The serotype seen most frequently (68%) was ECHO virus (ECV) 30.
CONCLUSIONS
Enteroviruses play the most important role in the differential diagnosis of aseptic meningitis. Short symptom duration, slightly higher inflammatory parameters in blood, predominance of polynuclears, and elevated CSF lactate have predictive value in diagnosing this disease. ECV 30 (frequently the agent of epidemics in the Czech Republic) was the aseptic meningitis agent most often seen.
Topics: Adolescent; Child; Child, Preschool; Czech Republic; Enterovirus; Enterovirus Infections; Female; Humans; Male; Meningitis, Aseptic; Meningitis, Viral; Prospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Sequence Analysis
PubMed: 30631207
DOI: 10.5507/bp.2018.082 -
Medicine Jul 2022Viral infection is the most common cause of aseptic meningitis. The purpose of this study was to identify the viruses responsible for aseptic meningitis to better...
BACKGROUND
Viral infection is the most common cause of aseptic meningitis. The purpose of this study was to identify the viruses responsible for aseptic meningitis to better understand the clinical presentations of this disease.
METHOD
Between March 2009 and February 2010, we collected 297 cerebrospinal fluid specimens from children with aseptic meningitis admitted to a pediatric hospital in Yunnan (China). Viruses were detected by using "in house" real-time quantitative polymerase chain reaction or reverse-transcription real-time quantitative polymerase chain reaction from these samples. Phylogenetic analyses were conducted using the Molecular Evolutionary Genetic Analysis version 7.0 software, with the neighbor-joining method.
RESULTS
Viral infection was diagnosed in 35 of the 297 children (11.8%). The causative viruses were identified to be enteroviruses in 25 cases (71.4%), varicella-zoster virus in 5 cases (14.3%), herpes simplex virus 1 in 2 cases (5.7%), and herpes simplex virus 2, Epstein-Barr virus, and human herpesvirus 6 in 1 case each (2.9% each). Of the enteroviruses, coxsackievirus B5 was the most frequently detected serotype (10/25 cases; 40.0%) and all coxsackievirus B5 strains belonged to C group.
CONCLUSIONS
In the study, a causative virus was only found in the minority of cases, of them, enteroviruses were the most frequently detected viruses in patients with viral meningitis, followed by varicella-zoster virus and herpes simplex virus. Our findings underscore the need for enhanced surveillance and etiological study of aseptic meningitis.
Topics: Child; China; Enterovirus; Enterovirus Infections; Epstein-Barr Virus Infections; Herpesvirus 2, Human; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Meningitis, Aseptic; Meningitis, Viral; Phylogeny; Viruses
PubMed: 35777023
DOI: 10.1097/MD.0000000000029772 -
BMJ Case Reports Jul 2017Although the combination of acute urinary retention and aseptic meningitis has not been well recognised, this combination can be referred to as meningitis-retention...
Although the combination of acute urinary retention and aseptic meningitis has not been well recognised, this combination can be referred to as meningitis-retention syndrome (MRS). We report a case of MRS with urodynamic follow-up. A 29-year-old man developed fever and headache, and after 7 days, he developed sudden urinary retention. Neurological examination indicated stiff neck, hyper-reflexes of the lower extremities. Cerebrospinal fluid examination showed mononuclear leucocytosis, increased protein level. Myelin basic protein was absent. MRI of the brain and spinal cord were normal. Cystometrography revealed an atonic bladder. The diagnosis was MRS. After 11 days of hospital day, his symptoms reduced rapidly, and on the 12th day, cystometrography revealed normal pattern. In mild cases, the symptoms reduced and the urodynamic examination improved rapidly. Although MRS is a rare symptom, its urodynamic assessment is important.
Topics: Adult; Humans; Magnetic Resonance Imaging; Male; Meningitis, Aseptic; Neurologic Examination; Syndrome; Urinary Bladder, Neurogenic; Urinary Retention; Urodynamics
PubMed: 28724598
DOI: 10.1136/bcr-2017-220903 -
International Journal of Environmental... Mar 2022Aseptic meningitis (AM) is a potentially severe and life-threatening disease characterized by meningeal inflammation, usually with mononuclear pleocytosis. It represents... (Review)
Review
Aseptic meningitis (AM) is a potentially severe and life-threatening disease characterized by meningeal inflammation, usually with mononuclear pleocytosis. It represents a challenging and controversial issue in medicine for multiple etiologies, classification, and difficult diagnosis in the face of nonspecific sets of signs and symptoms. In the area of interest of oral medicine, in specific clusters of patients, even if rare, the occurrence of aseptic meningitis can pose a diagnostic and management dilemma in the following potential etiologies: (i) systemic diseases with oral and meningeal involvement, which include Behçet's disease and Sjögren syndrome; (ii) drug-induced aseptic meningitis; (iii) aseptic viral meningitis, mostly related to herpes simplex virus infection and hand, foot, and mouth disease, caused by enteroviruses. In this review, clinical manifestations, diagnostic methodologies, incidence, treatment, and prognosis for each of these clinical entities are provided. Furthermore, two illustrative case reports are described: a patient suffering from recurrent oral ulcers, in which a sudden onset of AM allows us to diagnose Neuro Behçet's disease, and a patient affected by pemphigus vulgaris, manifesting a drug-induced AM. Exploring this complex clinical entity scenario, it is clear that an oral medicine specialist has a place on any multidisciplinary team in making such a challenging diagnosis.
Topics: Behcet Syndrome; Herpes Simplex; Humans; Meningitis, Aseptic; Mouth Diseases; Oral Medicine
PubMed: 35409601
DOI: 10.3390/ijerph19073919