How are the different types of viral aseptic meningitis differentiated?

Updated: Jul 17, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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The diagnosis of viral meningitis is based on the clinical presentation and cerebrospinal fluid (CSF) findings that include lymphocyte-predominant pleocytosis of fewer than 500 cells/µL, normal glucose concentration, normal or slightly elevated protein, and negative bacterial antigen tests. The CSF profile in drug-induced aseptic meningitis, which includes neutrophilic pleocytosis, does not distinguish this disorder from infectious meningitis.

Properly implemented nucleic acid tests of CSF are more sensitive than cultures in diagnosing enteroviral infections and have the potential to reduce cost and unnecessary treatment. Other findings, including low concentrations of tumor necrosis factor (TNF) and lactic acid, add further validity for diagnosing aseptic rather than bacterial meningitis.

Diagnosis of HIV encephalitis

HIV encephalitis is characterized by progressive intellectual impairment, behavior disturbances, and sensorimotor deficits. DNA analysis helps to detect HIV in the brains of these patients, and HIV-specific immunoglobulin is produced intrathecally. Congenital HIV encephalitis is more severe than the adult forms and may result in microcephaly and basal ganglia calcification.

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