Shukla B, et al. – This work was performed to compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis. Researchers noticed underutilization of currently available virological tools. Majority of these patients seemed to undergo unnecessary cranial imaging and antibiotic therapy. All patients had a good clinical outcome.

Methods

• A retrospective study was performed from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX.
• This study enrolled patients age ≥ 2 months who presented with community–acquired aseptic meningitis with a CSF white blood cell count >5 cells/mm³ and a negative Gram stain and cultures.
• Authors excluded patients with a positive cryptococcal antigen, positive blood cultures, intracranial masses, brain abscesses, or encephalitis.

Results

• This study included 509 patients; 404 were adults and 105 were children.
• Adults comprised, in majority, female, Caucasian, immunosuppressed, had meningeal symptoms (headache, nausea, stiff neck, photophobia) and had a higher CSF protein (P < 0.05).
• In contrast, children more frequently indicated respiratory symptoms, fever, and leukocytosis (P < 0.05).
• The etiologies remained unknown in 410 (81%) patients.
• Adults were more frequently assessed for and to have Herpes simplex virus and West Nile virus while children were more frequently assessed for and to have Enterovirus (P < 0.001).
• The majority of patients were admitted (96.5%); children received antibiotic therapy more frequently (P < 0.001) and adults received more antiviral therapy (P = 0.001).
• Head CT scans were performed on a total of 384 patients (75%) and MRI scans were performed on 125 (25%) patients; all were normal except for meningeal enhancement.
• At discharge, all patients had a good clinical outcome.