Definition

Meningitis occurs when the lining of the brain and spinal cord (meninges) becomes inflamed. Cerebrospinal fluid (CSF), a clear fluid that surrounds and protects the brain and spinal cord, has an increased number of white blood cells. Aseptic meningitis occurs when there are signs of meningitis without an identifiable disease-causing agent.

Causes

The most common causes of aseptic meningitis are:

• Viral infections:
  • Enteroviruses (most common), such as Coxsackie virus, poliomyelitis, or infections that affect the heart valves
  • Arboviruses (transmitted from mosquitoes), such as West Nile virus or variations of encephalitis
  • Sexually transmitted diseases, such as genital herpes or acute HIV infection
• Bacterial infections, such as tuberculosis
• Parasitic infections, such as Lyme disease
• Mycoplasma, an usual bacteria that can cause pneumonia
• Partially treated bacterial meningitis
• Autoimmune disorders, such as systemic lupus erythematosus or sarcoidosis
• Cancer that has spread to the meninges
• Certain medications

Risk Factors

Aseptic meningitis affects children and teens more than adults. Other factors that may increase your chance of developing aseptic meningitis include:

• Being exposed to someone with a viral illness
• The season—mostly occurs in late spring and summer
• Working in a daycare or healthcare setting
• Having a compromised immune system
• Taking certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) or medications injected directly into the CSF

Symptoms

Aseptic meningitis may cause:

• Headache
• Fever and chills
• Stiff neck
• General feeling of illness
• Sore throat
• Fatigue
• Rash
• Muscle or abdominal pain
• Mental confusion
• Sensitivity to light
• Nausea or vomiting

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

You may need to have samples taken of your bodily fluids. This can be done with:

• Blood tests
• Lumbar puncture —to evaluate CSF

Imaging tests can evaluate the brain and surrounding structures. This can be done with:

• MRI scan
• CT scan

Treatment

Talk with your doctor about the best treatment plan for you. Most cases of aseptic meningitis improve with time. Treatment options include:

• Supportive care—Your doctor may recommend that you rest and drink plenty of fluids. You may need to be hospitalized to be monitored and to stay hydrated.
• Medications—If specific causes of meningitis are suspected, your doctor may advise that you take:
  • Antivirals—for viral infection
  • Antibiotics—for bacterial infection
  • Antifungals—for fungal infection
  • Pain relievers—to relieve symptoms
  • Steroids—to reduce inflammation
• In certain cases, your doctor may advise that you stop some medications.

Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.

Prevention

To help reduce your chance of aseptic meningitis:

• Wash your hands often, especially if you:
  • Are in close contact with a person who has an infection
  • Changed the diaper of an infant with an infection
• If you work in a childcare or healthcare setting, clean objects and surfaces
• Be sure all of your vaccinations are up-to-date

National Meningitis Association http://www.nmaus.org

Meningitis Research Foundation of Canada http://www.meningitis.ca

Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8(6):348-361.

Jolles S, Sewell WA, Leighton C. Drug-induced aseptic meningitis: diagnosis and management. Drug Saf. 2000;22(3):215-226.

Meningococcal disease. Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/meningococcal/about/index.html
Updated April 1, 2014. Accessed May 29, 2014.

Norris C, Danis P, Gardner T. Aseptic meningitis in the newborn and young infant. Am Fam Physician. 1999;59(10):2761-2770.