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Ponka and Pettersson) Most are due to viral infections Of these, the most common are the enteroviral infections echovirus and Coxsackie virus These make up 80 percent of cases of aseptic meningitis in which a speci c viral cause can be established Mumps is perhaps next in frequency, followed by HSV-2, lymphocytic choriomeningitis (LCM), and adenovirus infections EBV (infectious mononucleosis), CMV, leptospirosis, HSV-1, and the bacterium Mycoplasma pneumoniae (see Chap 32) In uenza virus, adenoviruses, and numerous sporadic and otherwise innocuous agents have at times been isolated from the spinal uid in cases of aseptic meningitis The California and West Nile viruses, which are arthropod-borne viruses ( arboviruses ), are responsible for a small number of cases (usually the arboviruses cause an encephalitis or meningoencephalitis, as discussed further on) Rarely, the icteric stage of infectious hepatitis is preceded by mild meningitis, the nature of which becomes evident when the jaundice appears All these viral infections, particularly those due to the enteroviruses together with mycoplasmal infection, leptospirosis, and Lyme borreliosis account for the largest proportion of infectious cases of aseptic meningitis in which the etiology can be established, the remainder being due to tuberculosis, fungal infections and rarer organisms Chronic and recurrent meningitis constitutes a special problem, discussed below It is now well recognized that infection with HIV may present as an acute, self-limited aseptic meningitis with an infectious mononucleosis-like clinical picture While HIV has been obtained from the CSF in the acute phase of the illness, seroconversion occurs only later, during convalescence from the meningitis (see further on in this chapter) HSV-1 has been isolated from the CSF of patients with recurrent bouts of benign aseptic meningitis (so-called Mollaret meningitis), but this nding has not been consistent (Steel et al) As discussed in Chap 47, it is now believed that this virus also underlies many if not most cases of what has been traditionally considered idiopathic Bell s palsy Finally, two other aspects of the virology of aseptic meningitis should be noted; rst, in every published series of cases from virus isolation centers, a speci c cause cannot be established in one-third or more of cases of presumed viral origin; second, most agents capable of producing aseptic meningitis also sometimes cause encephalitis. birt pdf 417 Eclipse BIRT PDF417 Barcode Maker add-in makes PDF417 ...
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