Aseptic Meningitis Face Sheet

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Aseptic Meningitis Face Sheet 1. What is aseptic meningitis (AM)? - AM refers to a viral infection of the meninges (a system of membranes surrounding the brain and spinal cord). It is a fairly common disease, however, almost all cases occur as an isolated event, and outbreaks are rare. 2. Who gets AM? - Anyone can get AM but it occurs most often in children. 3. What viruses cause this form of meningitis? - Approximately half of the cases of AM in the United States are caused by common intestinal viruses (enteroviruses). Occasionally, children develop AM associated with either mumps or herpes virus infection. Mosquito-borne viruses: e.g. WNV also account for a few cases each year in Pennsylvania. In most cases, the specific virus is never identified. 4. How are viruses that cause AM spread? - In the absence of a specific laboratory diagnosis of the causative AM virus, it is difficult to implement targeted prevention measures as some are spread person-to-person while others are spread by insects. 5. What are the symptoms? - They include fever, headache, stiff neck and fatigue. Rash, sore throat and intestinal symptoms may also occur. 6. How soon do symptoms appear? - Generally appear within one week of exposure. 7. How is AM diagnosed? – The only way to diagnose AM is to collect a sample of spinal fluid through a lumbar puncture (also known as a spinal tap). 8. Is a person with AM contagious? – While some of the enteroviruses that may cause AM are potentially contagious person to person, others, such as mosquito- borne viruses, cannot be spread person to person. 9. Should a person with AM be isolated? - Since most cases of AM are due to enterovirus infection that may be passed in the stool, people with AM should be instructed to thoroughly wash their hands after using the toilet. Isolation is not necessary. 10. How is AM treated? - There are no specific medicines used to treat AM. 11. For more information about Aseptic Meningitis: http://www.cdc.gov/meningitis/viral.html 1 This fact sheet provides general information. Please contact your physician for specific clinical information. 2 .

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Lesson of the Month (2)
CMJ0906-Pande_LoM.qxd 11/17/09 9:58 AM Page 626 7 Nelson RL, Persky V, Davis F, Becker E. Risk of disease in siblings Address for correspondence: Dr SD Pande, Changi of patients with hereditary haemochromatosis. Digestion General Hospital, 2 Simei Street 3, Singapore 529889. 2001;64:120–4. Email: [email protected] 8 Reyes M, Dunet DO, Isenberg KB, Trisoloni M, Wagener DK. Family based detection for hereditary haemochromatosis. J Genet Couns 2008;17:92–100. Clinical Medicine 2009, Vol 9, No 6: 626–7 lesson of the month (2) negative. He was treated empirically with intravenous acyclovir and ceftriaxone for three days before all these culture results were Considering syphilis in aseptic meningitis available. He subsequently made a very good recovery. As part of a screen for other causes of aseptic meningitis, syphilis serology was Clinicians need to consider syphilis in the differential requested which was positive for immunoglobulin M (IgM) anti- diagnosis of macular or papular rashes with body and venereal disease research laboratory (VDRL) was posi- neurological conditions, particularly aseptic meningitis, tive with a titre of 1:64. This was confirmed with a repeat sample. as early diagnosis and treatment lead to a better The patient therefore continued treatment with ceftriaxone for prognosis. two weeks. As part of contact tracing his wife, who was asympto- matic, was screened for syphilis and was found to have positive serology. She was treated with a standard regime of benzathine penicillin. On follow-up, both showed good responses serologi- cally and both patients tested negative for HIV. Lesson In March 2007 a 45-year-old heterosexual male presented to the Discussion medical assessment unit with a three-week history of headaches, occasional vomiting and more recent confusion.
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Tuberculous Meningitis
J Neurol Neurosurg Psychiatry 2000;68:289–299 289 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.68.3.289 on 1 March 2000. Downloaded from NEUROLOGICAL ASPECTS OF TROPICAL DISEASE Tuberculous meningitis G Thwaites, T T H Chau, N T H Mai, F Drobniewski, K McAdam, J Farrar Uncertainty and doubt dominate all aspects of infection is under debate.11 Certain ethnic tuberculous meningitis (TBM). The variable groups seem to be more susceptible to M natural history and accompanying clinical fea- tuberculosis than others. Studies using tubercu- tures of TBM hinders the diagnosis. Ziehl- lin conversion as a surrogate marker suggest Neelsen staining lacks sensitivity and culture that black skinned people are more susceptible results are often insuYciently timely to aid to infection than white people.12 Recently it has clinical judgement. New rapid diagnostic been proposed that certain polymorphisms in methods are incompletely evaluated, and many the human NRAMP1 gene may aVect suscep- are not suitable for laboratories in low income tibility to pulmonary tuberculosis in West countries. The duration of chemotherapy for Africans.13 Whether genetic factors inﬂuence TBM is unclear and the beneﬁts of adjuvant prevalence of TBM within a population is corticosteroids remain in doubt. The only unknown. uncomfortable certainties lie in the fatal conse- The extent to which BCG vaccination Department of Microbiology, St quences of missed diagnoses and delayed treat- aVords protection against TBM is still debated. Thomas’s Hospital, ment. A meta-analysis of the published trials on the London UK This review will discuss the current uncer- eYcacy of BCG vaccination suggested a G Thwaites tainties surrounding TBM.
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