Viral Meningitis Differential Diagnoses

  • Author: Cordia Wan, MD; Chief Editor: Karen L Roos, MD   more...
 
Updated: Mar 29, 2011
 
 

Diagnostic Considerations

In very young patients, the signs and symptoms of viral meningitis are not "textbook," and a high index of suspicion is required for accurate diagnosis and management. The elderly may also present with atypical signs and symptoms.

For the clinician, as previously mentioned, consideration of other pathogens, such as bacteria, mycoplasma, and fungi, is crucial. Partially untreated bacterial meningitis in particular can manifest similarly to viral meningitis. These are treatable pathogens that can have devastating outcomes if misdiagnosed.

The clinician should also realize that the picture of aseptic meningitis is created not only by infectious agents, but also by chemical irritation (chemical meningitis), neoplasm (meningitis carcinomatous), granulomatous disorders, and other inflammatory conditions.

In addition to the differentials listed in the next section, mimics of viral meningitis include the following:

  • Partially treated bacterial meningitis
  • Parameningeal infection
  • Coccidioides immitis infection
  • Cryptococcus neoformans infection
  • Histoplasma capsulatum infection
  • Candida species infection
  • Blastomyces dermatitidis infection
  • Mycoplasma infection
  • Listeria infection
  • Leptospira infection
  • Drugs
  • Heavy metals
  • Surgically implanted materials
  • Sjögren syndrome
  • Behçet disease
  • Electroencephalogram in neurologic infections
  • Cytomegalovirus encephalitis
  • Abnormal neonatal electroencephalogram
  • Low-grade astrocytoma
  • Lumbar puncture (CSF Examination)
  • Electroencephalogram in status epilepticus
  • Leptomeningeal carcinomatosis
  • Migraine variants
  • Neurocysticercosis
  • Neurosarcoidosis
  • Subdural empyema
  • Varicella zoster
  • Hydrocephalus
  • Brucellosis
  • Lyme disease
  • Neurosyphilis
  • Brucellosis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Cordia Wan, MD  Adult Neurologist, Kaiser Permanente Hawaii, Kaiser Permanente Southern California

Cordia Wan, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Amir Vokshoor, MD  Staff Neurosurgeon, Department of Neurosurgery, Spine Surgeon, Diagnostic and Interventional Spinal Care, St John's Health Center

Amir Vokshoor, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, and North American Spine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

J Stephen Huff, MD  Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Florian P Thomas, MD, MA, PhD, Drmed  Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, and National Multiple Sclerosis Society

Disclosure: Nothing to disclose.

Chief Editor

Karen L Roos, MD  John and Nancy Nelson Professor of Neurology, Professor of Neurological Surgery, Department of Neurology, Indiana University School of Medicine

Karen L Roos, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

References

  1. Desmond RA, Accortt NA, Talley L, Villano SA, Soong SJ, Whitley RJ. Enteroviral meningitis: natural history and outcome of pleconaril therapy. Antimicrob Agents Chemother. Jul 2006;50(7):2409-14. [Medline]. [Full Text].

  2. CDC. Final 2008 West Nile Virus Activity in the United States. Centers for Disease Control and Prevention. Available at http://bit.ly/fATcE1. Accessed September 1, 2009.

  3. Hviid A, Rubin S, Mühlemann K. Mumps. Lancet. Mar 15 2008;371(9616):932-44. [Medline].

  4. Canada Communicable Disease Report. International Note: Global Advisory Committee on Vaccine Safety, 11-12 June, 2003. April 1, 2004. [Full Text].

  5. Weekly Epidemiological Record. World Health Organization. January 19, 2007;No. 3, 2007, 82:18-22. [Full Text].

  6. Landry ML, Greenwold J, Vikram HR. Herpes simplex type-2 meningitis: presentation and lack of standardized therapy. Am J Med. Jul 2009;122(7):688-91. [Medline].

  7. US Food and Drug Administration. FDA Clears Rapid Test for Meningitis. FDA. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108870.htm. Accessed September 1, 2009.

  8. King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics. Sep 2007;120(3):489-96. [Medline].

  9. Kanegaye JT, Nigrovic LE, Malley R, Cannavino CR, Schwab SH, Bennett JE, et al. Diagnostic value of immature neutrophils (bands) in the cerebrospinal fluid of children with cerebrospinal fluid pleocytosis. Pediatrics. Jun 2009;123(6):e967-71. [Medline].

  10. Nigrovic, Kuppermann, Macias et al. Clinical Prediction Rule for Identifying Children With Cerebrospinal Fluid Pleocytosis at Very Low Risk of Bacterial Meningitis. JAMA. Jan 3, 2007;297:52-60. [Full Text].

 
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T1-weighted MRI of brain demonstrates diffuse enhancement of the meninges in viral meningoencephalitis.
This rash consists of an enlarging annular plaque. Image courtesy of Lyme Disease Network (http://www.lymenet.org/).
 
 
 
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