What should be the focus of the medical history in suspected meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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A history of exposure to a patient with a similar illness is an important diagnostic clue. It may point to the presence of epidemic disease, such as viral or meningococcal meningitis.

Elicit any history of sexual contact or high-risk behavior from the patient. Herpes simplex virus (HSV) meningitis is associated with primary genital HSV infection and HIV infection. A history of recurrent bouts of benign aseptic meningitis suggests Mollaret syndrome, which is caused by HSV.

Animal contacts should be elicited. Patients with rabies could present atypically with aseptic meningitis; rabies should be suspected in a patient with a history of animal bite (eg, from a skunk, raccoon, dog, fox, or bat). Exposure to rodents suggests infection with lymphocytic choriomeningitis virus (LCM) virus and Leptospira infection. Laboratory workers dealing with these animals also are at increased risk of contracting LCM.

Brucellosis may be transmitted through contact with infected farm animals (eg, cows or pigs). The intake of unpasteurized milk and cheese also predisposes to brucellosis, as well as to L monocytogenes infection.

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