Illness with symptoms like bacterial meningitis, but bacteria can't be detected.
Coxsackie and Echoviruses = 50% of cases.
Other 50% = virus, fungi, cancer, bacteria not grown on routine culture.
Sx = stiff neck, N/V, light sensitivity, chills, HA, confusion, sore throat, enanthem (rash on mucosal surface).
PE = stiff neck, fever, tachycardia.
Prognosis = excellent with recovery in 5-14 days. Less than 1% with lasting sequelae.
No specific tx.
Caused by measles virus.
Rare, progressive, demyelinating, neurologic disease of children.
Begins 2-10 years after measles infection.
Insidious onset of personality changes, poor school performance, intellectual deterioration, myoclonic jerks, autonomic and motor dysfunction, blindness.
Over 6-12 months, become bedridden and unconscious.
Eventually, metabolic imbalances 2/2 autonomic dysfunction --> superinfection and death.
Bacterial: Increased OP, very high WBC (PMNs), high protein, low glucose.
Viral: Nrl OP, high WBC with lymphocytes, protein <100 (normal = <45), normal glucose.
Fungal: Increased OP, lymphocytes, Nrl/increased protein, nrl/decreased glucose.
TB: Increased OP, 50% PMN infiltrate, increased protein, low glucose.
HSV: Variable OP, lymphocytes, increased protein, normal glucose.
Very high opening pressure.
Normal glucose, elevated protein, lymphocytes.
Can occur in anyone who is immunocompromised (ie, HIV or otherwise).
Lives in soil, bird guano.
Presentation = HA, personality changes, fever, CN palsies (CN 6), deafness, blindness.
Dx: Latex ag on serum, CSF.
Rx: Amphotericin B + flucytosine, fluconazole
Mechanical lowering of CSF pressure may alleviate CN palsies.