Aseptic meningitis in adults and children: Diagnostic and management challenges

Background: Aseptic meningitis represents a common diagnostic and management dilemma to clinicians. Objectives: To compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis. Study design: We conducted a retrospective study from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX. Patients age >= 2 months who presented with community-acquired aseptic meningitis with a CSF white blood cell count > 5 cells/mm(3) and a negative Gram stain and cultures were enrolled. Patients with a positive cryptococcal antigen, positive blood cultures, intracranial masses, brain abscesses, or encephalitis were excluded. Results: A total of 509 patients were included; 404 were adults and 105 were children. Adults were most likely to be female, Caucasian, immunosuppressed, have meningeal symptoms (headache, nausea, stiff neck, photophobia) and have a higher CSF protein (P<0.05). In contrast, children were more likely to have respiratory symptoms, fever, and leukocytosis (P<0.05). In 410 (81%) patients, the etiologies remained unknown. Adults were more likely to be tested for and to have Herpes simplex virus and West Nile virus while children were more likely to be tested for and to have Enterovirus (P<0.001). The majority of patients were admitted (96.5%) with children receiving antibiotic therapy more frequently (P<0.001) and adults receiving more antiviral therapy (P = 0.001). A total of 384 patients (75%) underwent head CT scans and 125 (25%) MRI scans; all were normal except for meningeal enhancement. All patients had a good clinical outcome at discharge. Discussion: Aseptic meningitis in adults and children represent a management challenge as etiologies remained unknown for the majority of patients due to underutilization of currently available diagnostic techniques.