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Salmonella paratyphi A enteric fever mimicking viral meningitis.

Enteric fevers are caused by invasive strains of Salmonella. Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C. We present a case of S. paratyphi A enteric fever aseptic meningitis. Headache was so prominent in the case presented that a lumbar puncture was performed to rule out meningitis. Rose spots were not apparent in this dark-skinned patient. Our patient did not have increased serum transaminases and did not have leukopenia, which are common findings in enteric fever. The absence of these findings and the relative bradycardia may be explained by the antimicrobial therapy the patient received before admission. After ruling out malaria, clinicians should suspect enteric fever in patients recently returning from endemic areas, in patients presenting with acute fevers without localizing signs.

Adult↗
PubMed2005

An outbreak of viral meningitis associated with a public swimming pond.

From July to October 2001, 215 cases of aseptic meningitis occurred among the inhabitants of the German city of Kassel and neighbouring counties. A matched case-control study identified bathing in a public, nature-like pond during the beginning of the outbreak as a risk factor for disease [matched odds ratio (mOR) 44.8, 95% confidence interval (CI) 3.9-515.6]. Among bathers, patients with meningitis spent more time in the water (mOR 18.8, 95% CI 2.0-174.1) and swallowed water more frequently (mOR = 7.3, 95% CI 0.7-81.8). Of 30 cerebrospinal fluid samples tested, echovirus 30 was cultured from 16, and echovirus 13 from seven. An echovirus 30 sequence obtained from one pond water sample showed a 99% nucleotide and 100% amino-acid homology with patient isolates. This outbreak demonstrates the potential of nature-like swimming ponds to cause widespread community infection with substantial public health impact.

Adolescent↗
PubMed1983

Hierarchies of T cell responsiveness are reflected in the distribution of effector T cells in viral meningitis.

The vaccinia-virus-immune cytotoxic T lymphocyte (CTL) response, associated with H-2Kk in B10,A(2R) [KkDb] mice, is much more potent than that occurring in the context of H-2Db. This differential reactivity is true for T-cells recovered either from cerebrospinal fluid (CSF) of mice injected intracerebrally (i.c.) with a low dose of virus or from spleen populations primed by intravenous (i.v.) inoculation of a large amount of virus. Further stimulation of CSF inflammatory cells in vitro for 7 days under limiting dilution conditions indicated that the hierarchy of cytotoxic T-cell activity was a function of the relative frequencies of H-2Kk- and H-2Db-restricted lymphocytes. We therefore conclude that the immune response gene effect described previously for cells found in lymphoid tissue is also expressed in a virus-induced inflammatory exudate in the central nervous system.

Animals↗
PubMed1989

Viral meningitis and encephalitis in Saudi Arabia.

The laboratory confirmation of twelve clinically diagnosed cases of aseptic meningitis and encephalitis is described. Among three cases of aseptic meningitis one was due to mumps in a 14-month infant and the other two attributable to Cocksackie B-1. Herpes virus encephalitis due to HSV-1 was conclusively identified by IF monoclonal test from brain biopsy in tissue culture, and a further four cases also of HSV-1 encephalitis by virus isolation from CSF and presence of significant levels of herpes virus antibody in CSF and serum. Measles encephalitis was identified in four pediatric patients with one based on the isolation of measles virus from the CSF and in the other three with significant CSF/serum ratios to measles virus.

Adolescent↗