How is enteroviral aseptic meningitis differentiated from West Nile virus (WNV) infection and encephalitis (WNE)?

Updated: Apr 05, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The most common cause of aseptic meningitis encountered during the summer months, particularly in late August or early September, is enteroviral meningitis. Enteroviral aseptic meningitis is most commonly due to coxsackieviruses but may also be due to enterocytopathogenic human orphan virus or nonparalytic strains of poliovirus. Enteroviral meningitis may occur after water exposure in swimming pools, lakes, streams, or oceans, as well as after contact with infected individuals.

Acute enteroviral CNS infections usually manifest as aseptic meningitis, uncommonly as meningoencephalitis, or, rarely, as encephalitis. Nonexudative pharyngitis, maculopapular extremity rash, loose stools, and even diarrhea often accompany enteroviral aseptic meningitis, which provides clues to its presence.

Excluding enterovirus 71, enteroviral meningitis is not accompanied by paralysis or prolonged and/or profound relative lymphopenia. Enterovirus D68 may also be associated with the above symptoms with a transverse myelitis syndrome and may present similarly to acute flaccid paralysis.


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