acyclovir and Meningitis--Aseptic

Leptospirosis is a zoonotic illness caused by pathogenic spirochetes of the genus Leptospira. The disease spectrum ranges from a mild influenza-like presentation to a more serious Weil's syndrome. Leptospirosis rarely presents as a primary neurological syndrome. We report two cases of Leptospira borgpetersenii serovar Tarasssovi presenting as aseptic meningitis in Sri Lanka.. We describe case reports of two patients presenting as symptomatic aseptic meningitis due to neuroleptospirosis. Both patients had significant neurological involvement at presentation in the absence of common clinical features of leptospirosis. These patients were initially managed as bacterial or viral meningitis and leptospirosis was suspected due to a history of exposure to contaminated water. Subsequently, they were diagnosed to have neuroleptospirosis by positive Leptospira serology and both patients gained full recovery.. Our report highlights the importance of considering leptospirosis as a differential diagnosis in patients with aseptic meningitis in endemic settings. Obtaining a detailed occupational and recreational history is helpful in diagnosing neuroleptospirosis promptly. We report the association of Leptospira borgpetersenii serovar (sv.) Tarassovi (strain bakeri) in causing aseptic meningitis, which has not been reported to the best of our knowledge.

Topics: Acyclovir; Adult; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Drinking Water; Humans; Leptospira; Leptospirosis; Male; Meningitis, Aseptic; Serogroup; Sri Lanka; Treatment Outcome

Recurrent meningitis is a rare clinical scenario that can be self-limiting or life threatening depending on the underlying etiology. This review describes the causes, risk factors, treatment, and prognosis for recurrent meningitis. As a general overview of a broad topic, the aim of this review is to provide clinicians with a comprehensive differential diagnosis to aide in the evaluation and management of a patient with recurrent meningitis.. New developments related to understanding the pathophysiology of recurrent meningitis are as scarce as studies evaluating the treatment and prevention of this rare disorder. A trial evaluating oral valacyclovir suppression after HSV-2 meningitis did not demonstrate a benefit in preventing recurrences. The data on prophylactic antibiotics after basilar skull fractures do not support their use. Intrathecal trastuzumab has shown promise in treating leptomeningeal carcinomatosis from HER-2 positive breast cancer. Monoclonal antibodies used to treat cancer and autoimmune diseases are new potential causes of drug-induced aseptic meningitis. Despite their potential for causing recurrent meningitis, the clinical entities reviewed herein are not frequently discussed together given that they are a heterogeneous collection of unrelated, rare diseases. Epidemiologic data on recurrent meningitis are lacking. The syndrome of recurrent benign lymphocytic meningitis described by Mollaret in 1944 was later found to be closely related to HSV-2 reactivation, but HSV-2 is by no means the only etiology of recurrent aseptic meningitis. While the mainstay of treatment for recurrent meningitis is supportive care, it is paramount to ensure that reversible and treatable causes have been addressed for further prevention.

Topics: Acyclovir; Antibodies, Monoclonal; Antiviral Agents; Diagnosis, Differential; Herpes Simplex; Herpesvirus 2, Human; Humans; Meningitis; Meningitis, Aseptic; Prognosis; Recurrence; Secondary Prevention; Valacyclovir; Valine

Mollaret's meningitis is a rare form of benign recurrent aseptic meningitis first described in 1944. We report a case of Mollaret's meningitis due to Herpes Simplex Virus type 2 (HSV2), diagnosed with Polymerase Chain Reaction (PCR) implementation in the Cerebrospinal fluid (CSF) of the patient and treated successfully with acyclovir. To our knowledge, this is the first case of Mollaret's meningitis reported in Greece. We reviewed the literature since PCR has become widely available. Herpes Simplex Virus type 2 has been the most commonly identified causative agent of Mollaret's meningitis.

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Greece; Herpesvirus 2, Human; Humans; Meningitis; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Meningitis, Aseptic; Meningitis, Viral; Polymerase Chain Reaction

Presented here is a new case of benign recurrent aseptic meningitis, or Mollaret's meningitis, in which cerebrospinal fluid was positive for herpes simplex virus type 2 using the polymerase chain reaction test. A search of the existing medical literature revealed 58 previously reported cases of Mollaret's meningitis in which samples of cerebrospinal fluid were tested for herpes simplex virus. Discussed here are the history, clinical and laboratory findings, differential diagnoses and therapeutic options for this illness.

Topics: Acyclovir; Adult; DNA, Viral; Follow-Up Studies; Herpes Simplex; Herpesvirus 2, Human; Humans; Infusions, Intravenous; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Acyclovir; Antibodies, Viral; Autonomic Nervous System Diseases; Diagnosis, Differential; Female; Herpes Genitalis; Herpesviridae Infections; Humans; Male; Meningitis, Aseptic; Recurrence; Sex Factors; Simplexvirus

No standardized therapy has been established for viral encephalitis except for herpes simplex encephalitis. Not a few neurologists, however, have had an impression that administration of corticosteroids ameliorated neurological impairment and induced better prognosis in some patients with viral encephalitis. Five patients with aseptic meningitis and 9 patients with viral encephalitis, who were moderately to severely ill, were examined for cerebrospinal fluid (CSF) parameters before and after short-term intravenous administration of corticosteroids. In all of the patients with aseptic meningitis, severe headache and nausea disappeared rapidly with this treatment, which was accomplished via anti-inflammatory effects of corticosteroids. By contrast, 5 of the patients with viral encephalitis responded well to intravenous corticosteroids, whereas the remaining 4 patients did not, three of whom showed poor prognosis. The CSF containing more than 15% of CD4+CD26+ memory helper T cells guaranteed good response to corticosteroid therapy. It appeared that viral encephalitis with severe inflammation had poor prognosis irrespective of attempted therapy including intravenous corticosteroids. The CSF of patients who responded well to corticosteroid treatment showed a significant reduction in CD4+CD29+ helper-inducer T cells in the course of the illness. This finding indicates that autoimmune mechanisms may be involved in the pathogenesis of neurological impairment in a part of patients with viral encephalitis.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Autoimmunity; Betamethasone; Dexamethasone; Drug Therapy, Combination; Encephalitis, Viral; Humans; Meningitis, Aseptic; T-Lymphocytes, Helper-Inducer

The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management. All cerebrospinal fluid samples collected in 1 year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS), and treatment were analyzed. Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs = 0.3822, p = 0.0003). Forty-one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56% vs. 24%; p = 0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as human immunodeficiency virus and syphilis if the viral PCR panel was negative. The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes require further assessment.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Cerebrospinal Fluid; Enterovirus; Enterovirus Infections; Humans; Infant; Meningitis, Aseptic; Meningitis, Viral; Polymerase Chain Reaction; Retrospective Studies

Meningitis retention syndrome (MRS) is a rare condition that presents with acute urinary retention as a complication of aseptic meningitis. Cases of MRS due to varicella zoster virus (VZV) infection without a rash are rare. We report the case of a patient who had no signs of meningitis or VZV infection, including a rash.. A 58-year-old man presented with dysesthesia of the lower limbs and acute urinary retention. He had fever but no rash and no signs of meningitis. He was diagnosed to have VZV infection based on the detection of VZV DNA in the cerebrospinal fluid. He responded satisfactorily to a course of intravenous acyclovir and experienced no sequelae during a 2-year follow-up period.. MRS due to aseptic meningitis of viral origin should be considered in the differential diagnosis of acute urinary retention even in the absence of specific signs and symptoms of meningitis or a suggestive rash.

Topics: Acyclovir; Antiviral Agents; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Aseptic; Middle Aged

Mollaret's meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn's criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviral due to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.

Topics: Acyclovir; Aged; Aged, 80 and over; Herpesvirus 2, Human; Humans; Male; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence

The aseptic meningitis caused by varicella zoster virus (VZV) reactivation was less described in the literature, most of which were detected by means of polymerase chain reaction. The authors presented 4 adult immunocompetent patients with acute aseptic meningitis with VZV infection diagnosed by next-generation sequencing (NGS).. VZV is an infectious agent that causes aseptic meningitis in immunocompetent adults and could not be accompanied by skin manifestations. The NGS of CSF is a rapid detection for the identification and differentiation of meningitis in patients, which is of great importance for providing the rapid and accurate diagnosis and the targeted antimicrobial therapy for central nervous system infection.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebrospinal Fluid; Exanthema; Herpesvirus 3, Human; High-Throughput Nucleotide Sequencing; Humans; Magnetic Resonance Imaging; Male; Meningitis, Aseptic; Meningitis, Viral; Middle Aged; Varicella Zoster Virus Infection; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; Bradycardia; Drug-Related Side Effects and Adverse Reactions; Humans; Male; Meningitis, Aseptic

A 55-year-old woman was diagnosed with aseptic meningitis at the age of 43 and 44. She developed sudden fever and headache, and she showed nuchal rigidity. Cerebrospinal fluid examination revealed pleocytosis (cell count 208/mm

Topics: Acyclovir; Antiviral Agents; Biomarkers; DNA, Viral; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Meningitis, Aseptic; Middle Aged; Polymerase Chain Reaction; Recurrence; Time Factors

Topics: Acyclovir; Anti-Inflammatory Agents; Antirheumatic Agents; Antiviral Agents; Drug Substitution; Drug Therapy, Combination; Edema; Face; Female; Glucocorticoids; Humans; Hydrocortisone; Injections, Intravenous; Meningitis, Aseptic; Middle Aged; Neck; Prednisolone; Spondylitis, Ankylosing; Sulfasalazine; Treatment Outcome

Benign recurrent aseptic meningitis is a rare disorder described by Mollaret in 1944. When initially described, this form of aseptic meningitis had no identifiable infecting agent. New sophisticated diagnostic tools have now identified herpes simplex type 2 virus as the most commonly isolated agent. Antiviral treatment has been used successfully for prophylaxis and treatment.

Topics: Acyclovir; Antiviral Agents; Chemoprevention; Herpes Simplex; Herpesvirus 2, Human; Humans; Meningitis, Aseptic; Secondary Prevention

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Female; Humans; Meningitis, Aseptic; Stuttering; West Nile Fever; West Nile virus

Topics: Acyclovir; Anti-Bacterial Agents; Antibodies, Viral; Antiviral Agents; Cefotaxime; Chickenpox; Child; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence; Spinal Puncture; Vancomycin

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Meningitis, Aseptic; Meningitis, Viral; Middle Aged

Topics: Acyclovir; Adult; Antiviral Agents; Cerebrospinal Fluid; Diagnosis, Differential; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Meningitis, Aseptic

While HSV-2 meningitis has been described in prepubertal children in the context of sexual abuse, to the best of our knowledge recurrent episodes have not been described in this population. We report a 9-y-old girl with recurrent HSV-2 meningitis presenting as aseptic meningitis without any evidence of genital herpes. A high index of suspicion for this condition would be needed to make a diagnosis in this age group, which in turn would guide further therapeutic decisions.

Topics: Acyclovir; Antiviral Agents; Child; Child Abuse, Sexual; Female; Herpesvirus 2, Human; Humans; Meningitis, Aseptic; Polymerase Chain Reaction; Secondary Prevention

We report a 44-year-old Japanese woman with herpes simplex virus (HSV) type 2 recurrent meningitis (Mollaret's meningitis). The diagnosis was confirmed by nested polymerase chain reaction in her cerebrospinal fluid, but the patient's conventional HSV antibodies by complement fixation, neutralizing test or enzyme immunoassay showed low titres with low lymphoproliferative response. Several similar cases are discussed. Although the reason for the recurrent pathogenesis is uncertain, our report suggests that the low immune response including immune evasion may be involved in the pathogenesis of HSV type 2 recurrent meningitis. For this patient, long-term suppressive and patient-initiated therapies were conducted to prevent the recurrence of meningitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; DNA, Viral; Female; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; Humans; Meningitis, Aseptic; Polymerase Chain Reaction; Secondary Prevention; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Male; Meningitis, Aseptic; Polymerase Chain Reaction

To report a case of neurotoxicity and aseptic meningitis in a patient receiving valacyclovir.. An 86-year-old white man had started valacyclovir 1 g 3 times a day for a herpetic rash along the left side of his face. He subsequently presented with balance difficulties, constant frontal headaches, and a seizure 1 day prior to admission. Cerebral spinal fluid (CSF) analysis revealed 162 white cells/mm(3), 1 red blood cell/mm(3), glucose 56 mg/dL, and protein 144 mg/dL, with a negative Gram stain. Further laboratory examination failed to demonstrate other causes for the patient's clinical picture. After discontinuation of valacyclovir and supportive care, the patient symptomatically improved.. As of the third week of September 2003, only 1 other case of valacyclovir-related aseptic meningitis was published describing a patient with characteristics similar to those of our patient. Our patient's neurologic symptoms may have been due to acyclovir toxicity, but acyclovir-toxic patients present with normal CSF findings. Several drug classes, including nonsteroidal antiinflammatory drugs, antibiotics, and intravenous immunoglobulins, can induce aseptic meningitis. Other reasons for the patient's symptoms or causes of meningitis were excluded, although viral meningitis remains a possibility. Valacyclovir-induced aseptic meningitis was considered to be possible according to the Naranjo probability scale.. Healthcare providers should be aware of valacyclovir as a possible cause of drug-induced aseptic meningitis.

Topics: Acyclovir; Aged; Aged, 80 and over; Humans; Male; Meningitis, Aseptic; Nervous System Diseases; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Injections, Intravenous; Male; Meningitis, Aseptic; Time Factors

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Fatal Outcome; Humans; Male; Meningitis, Aseptic; Neuritis; Valacyclovir; Valine

Topics: Acyclovir; Adult; Cerebrospinal Fluid; Diagnosis, Differential; Follow-Up Studies; Humans; Leukocytes, Mononuclear; Leukocytosis; Male; Meningitis, Aseptic; Recurrence; Spinal Puncture; Syndrome; Time Factors

Herpes simplex viruses (HSV) are responsible for neurological disorders that require rapid diagnostic methods and specific antiviral therapy. During 1997, 1431 cerebrospinal fluid samples (CSF) collected from 1339 patients with neurological disorder presentations were processed for HSV detection. Eleven patients were positive for HSV, seven presenting with encephalitis (6/7 due to HSV1) and 4 with aseptic meningitis (4/4 due to HSV2). The incidence of HSV encephalitis was 2.33 cases / 10(6) inhabitants/year. Among encephalitis (HSV encephalitis) cases, 1 patient died due to the late implementation of antiviral therapy, and sequelae were observed in 4 cases. No sequelae were observed in aseptic meningitis cases. Four HSV encephalitis cases were monitored by PCR detection in CSF. Despite acyclovir therapy, PCR remained positive in CSF up to 20 days in 2 cases. This result suggest that the antiviral treatment for HSV encephalitis should be monitored by PCR detection of HSV in CSF.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Central Nervous System Infections; Cerebrospinal Fluid; Child; Child, Preschool; DNA, Viral; Encephalitis; Female; Follow-Up Studies; France; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Incidence; Infant; Male; Meningitis, Aseptic; Middle Aged; Polymerase Chain Reaction

A 46-year-old male was admitted to our hospital with headache, high fever and subsequent consciousness disturbance. Spinal fluid examination intimated aseptic meningitis. Not only these symptoms but bladder dysfunction was presented. The patient was treated with conservative therapy and bladder dysfunction was resolved a month and a half later. We report a case of urinary retention secondary to aseptic meningitis and review the clinical presentation and treatment.

Topics: Acyclovir; Consciousness Disorders; Globins; Humans; Male; Meningitis, Aseptic; Middle Aged; Treatment Outcome; Urinary Retention

A previously healthy, 37-year-old immunocompetent man presented with disseminated cutaneous zoster and aseptic meningitis. Varicella zoster virus DNA was recovered from the cerebrospinal fluid (CSF) by the polymerase chain reaction. Cytological evaluation of the CSF revealed 'reactive, highly atypical lymphocytosis'. The patient fully recovered after treatment with aciclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Blotting, Southern; DNA, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Aseptic

An otherwise healthy 3-year-old girl developed severe varicella complicated by aseptic meningitis and received intravenous acyclovir (ACV) therapy. Her two siblings who were susceptible to varicella-zoster virus (VZV) and closely exposed to VZV in the family received oral ACV (45 or 54 mg/kg per day in four divided doses for 7 days) starting 8 days after onset of the index case for post-exposure prophylaxis of varicella. They showed only five or seven papules over the body without fever 12 days after onset of the index case, while they had one-third or half the level of antibody titer and equal sized skin reactions to VZV antigen of the index case 2.5 months later.

Topics: Acyclovir; Administration, Oral; Antibodies, Viral; Antibody Formation; Antiviral Agents; Chickenpox; Child; Child, Preschool; Family Health; Female; Herpesvirus 3, Human; Humans; Immunity, Cellular; Male; Meningitis, Aseptic

Three men who had worked at the same animal research facility and had had contact with macaque monkeys were infected with B virus (Herpesvirus simiae). Their clinical presentations varied from self-limited aseptic meningitis syndrome to fulminant encephalomyelitis and death. Patient 1 was treated only after a respiratory arrest and other signs of advanced brain stem dysfunction had occurred. He died 8 days after hospital admission, despite treatment with acyclovir. Patient 2 presented with subtle signs and symptoms of brain stem encephalitis. He received antiviral therapy with intravenous ganciclovir. Patient 3 had a headache without meningismus and was also treated with acyclovir. Both patients 2 and 3 survived and did not have objective sequelae. Viral culturing, ELISA and western blot antibody testing, and magnetic resonance imaging all proved useful in the diagnosis of these patients' conditions.

Topics: Acyclovir; Adult; Animals; Brain Stem; Encephalomyelitis; Ganciclovir; Herpesviridae Infections; Herpesvirus 1, Cercopithecine; Humans; Laboratory Infection; Macaca; Male; Meningitis, Aseptic; Michigan; Radiography

Topics: Acyclovir; Adult; Female; Herpes Genitalis; Humans; Meningitis, Aseptic; Middle Aged; Simplexvirus

A case of aseptic meningoencephalitis with recurrent abnormal behavior, status epilepticus and aphthous stomatitis was described. A 39-year-old man, who had a history of low grade fever and abnormal behavior over 2 years without mucocutaneo-ocular symptoms, was admitted to Shinshu University Hospital because of status epilepticus. On admission, neurological examination revealed comatose state with neck stiffness, anisocoria (right greater than left), conjugate deviation to right and bilateral pyramidal tract signs. His cerebrospinal fluid examination revealed a total protein content of 206 mg/dl with 22 lymphocytes and 134 polymorphonuclear leukocytes/mm3. EEG recorded on the 3rd hospital day showed periodic sharp waves and polyspikes, occurring every 1 seconds, predominantly arise from the right hemisphere, which corresponds to periodic lateralized epileptiform discharges (PLEDs). Herpes simplex encephalitis was suspected and acyclovir was administered. Neck stiffness and cerebrospinal fluid findings were improved and PLEDs disappeared. But aphthous stomatitis appeared and meningoencephalitis was relapsed. Laboratory examination revealed erythrocyte sedimentation rate 40 mm/hr, positive C-reactive protein, elevated CH50 and sialic acid, enhanced migration of neutrophils and HLA-B 51. Neuro-Behçet's syndrome was strongly suspected with laboratory data but the clinical course was atypical. His clinical signs were markedly improved after administration of prednisolone. The present case suggests that neuro-Behçet's syndrome with only a part of major symptoms could be diagnosed as viral encephalitis and acyclovir may be effective for the treatment of neuro-Behçet's syndrome.

Topics: Acyclovir; Adult; Diagnosis, Differential; Electroencephalography; Humans; Male; Meningitis; Meningitis, Aseptic; Recurrence; Status Epilepticus; Stomatitis, Aphthous