3 Historically the diagnosis was made by culturing CSF in cell lines, but this has been replaced by rapid, more sensitive and highly specific PCR-based molecular assays. 2 It cannot be distinguished from other causes of central nervous system (CNS) infection and therefore a rapid diagnosis is important for appropriate management and infection control. 2 Enteroviral meningitis is typically characterised by headache, fever, nausea, vomiting, photophobia, neck stiffness and occasionally rash. 1 Children are more commonly affected by enteroviral infections than adults, although enterovirus remains a leading cause of viral meningitis in adults along with HSV-2 and VZV. 1 Enteroviral disease follows a seasonal pattern, the peak incidence being between late summer and autumn. She had no rash, and on full examination no other external signs of disease.Īlthough she described ‘feverishness’ before admission, lack of temperature above 38☌ likely reflects the fact that this was not documented, but her symptoms were consistent with a febrile illness.Įnteroviruses are the most common cause of viral meningitis, accounting for the majority of cases of aseptic meningitis where a cause is determined. She had marked photophobia and moderate neck stiffness, but Kernig's sign was negative. Her vital signs showed a temperature of 37.4☌, blood pressure of 105/70 mm Hg, pulse 100 bpm and oxygen saturation of 100% on air. She had not received any antimicrobial therapy prior to her admission. She had no significant medical history, did not take any regular medications and had not taken any new medication recently, and did not smoke or drink. Her travelling companions and her family were all well. She was well while abroad, other than a brief episode of diarrhoea. She was bitten relentlessly by flying insects, but not ticks and had no history of animal bites or freshwater contact. She was up-to-date with pretravel vaccinations including typhoid, hepatitis A and yellow fever and in keeping with current recommendations for her itinerary, she did not take malaria prophylaxis. She had travelled to Lima and a small rural area near Puna. Three weeks earlier she had returned from Peru, where she had undertaken voluntary work in an orphanage. She had vomited once, and had some mild neck pain and photophobia. She gave a history of gradually increasing frontal headaches that over the past 4 days had become unbearable and associated with fevers and chills. An 18-year-old student presented to accident and emergency department for the third time in 3 days.
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