16 Feb

Prior to the introduction of mumps vaccine in 1967, mumps virus, a paramyxovirus, was an important cause of aseptic meningitis. It remains an important cause worldwide and in unimmunized populations. Mumps is transmitted via a respiratory route, with most infections occurring in winter and spring months. Symptomatic meningitis is estimated to occur in 10% to 30% of mumps patients. When mumps meningitis is associated with parotitis, diagnosis is relatively straightforward. However, meningitis may precede parotitis or occur without it in 40% to 50% of cases.
Examination of the CSF typically shows higher leukocyte counts, which occasionally have a neutrophilic predominance. The diagnosis is usually made serologically.
There is no specific treatment for mumps illness. Most often, meningitis due to mumps is a benign illness, and patients recover fully. Uncommonly, patients may develop more severe neurologic sequelae.

Although encephalitis is the most commonly recognized and clinically significant neurologic manifestation of most arthropod-borne illnesses, some arboviruses may cause aseptic meningitis. In the United States, the most common arboviral cause of meningitis is the St. Louis encephalitis virus, a flavivirus. Aseptic meningitis accounts for about 15% of symptomatic cases of St. Louis encephalitis and is more common in patients younger than 60 years. Other arboviral causes include the California encephalitis group (most importantly the La Crosse virus), and Colorado Tick fever virus. These agents may be difficult to distinguish from enteroviruses clinically. Treatment is supportive. Recently, the West Nile virus has emerged as a major arbovirus causing encephalitis, but it may rarely cause an aseptic meningitis.

Miscellaneous Viruses
Measles and adenoviruses are causes of encephalitis and meningoencephalitis but may cause aseptic meningitis as well. Measles may e associated with a pleocytosis in about one third of cases, although most patients are asymptomatic. Adenovirus is commonly associated with a respiratory illness. Parainfluenza virus as well as influenza A and B has also been associated with aseptic meningitis.

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