Aseptic Meningitis

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Retrospective studies have suggested that up to 10 percent of patients with HIV-1 infection and AIDS develop clinically apparent aseptic meningitis during the course of their illness. Additionally, HIV has been isolated in blood and CSF of patients with an acute self-limited aseptic meningitis at the time of HIV seroconversion. The clinical features in these cases are similar to those present in patients with aseptic meningitis owing to other viruses, outside of the setting of HIV infection. Patients may have fever, meningeal signs, and headache that can be mild or severe with a dull or throbbing quality. These features may be accompanied by other constitutional signs that are characteristic of a viral syndrome including fatigue, malaise, myalgias, nausea, chills, and minor vomiting. Some individuals may have associated arthralgias, lymphadenopathy, and a maculopapular rash. This rash is erythematous, nonpruritic and typically involves the face or trunk. At times, cranial neuropathies may be a concomitant finding, most often affecting the trigeminal, facial, or vestibulocochlear nerves.

The differential diagnosis of this clinical presentation includes other causes of aseptic meningitis (enteroviruses, varicella zoster), bacterial meningitis, intracranial mass (abscess), subarachnoid hemorrhage, and other causes of headache (migraine). In HIV-related aseptic meningitis, the CSF will reveal a mononuclear pleocytosis ranging from 20 to a few hundred cell/mm3 in the association of an elevated protein. The diagnosis will be made by the demonstration of HIV-1 infection, which may require repeat testing after the resolution of the acute presentation.

The treatment of aseptic meningitis is supportive in nature and includes symptomatic treatment. In association with fluids and bed rest, acetaminophen, aspirin, and nonsteroidal anti-inflammatory agents may be utilized to reduce fever and lessen headache.

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