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Snapshot
  • A 4-year-old girl is brought to the emergency room in July for fevers, headache, and rash. Her symptoms first occurred yesterday with subjective fevers and some photophobia. She developed a diffuse rash throughout her body. Her mother states she has been visiting a neighborhood public pool every week for the entire summer. On physical exam, she has nuchal rigidity and a scattered maculopapular rash on her chest, back, and legs. Her parents are counseled on the need for a lumbar puncture for further evaluation to rule out other causes of meningitis.
Introduction
  • Classification
    • echovirus
      • a non-enveloped, linear, single-stranded, positive-sense RNA virus with an icosahedral capsid
      • a picornavirus and enterovirus
      • transmission via fecal-oral
      • causes aseptic meningitis
  • Epidemiology
    • incidence
      • common cause of aseptic meningitis
      • peaks in summer and fall
    • demographics
      • male > female
      • children > adults
    • location
      • central nervous system
    • risk factors
      • immunosuppressed status
      • exposure to others with echovirus
      • public swimming pool
  • Pathogenesis
    • echovirus binds to decay-accelerating factor, a receptor
    • the virus then replicates in Peyer’s patches
    • it travels to regional lymph nodes and central nervous system
  • Prognosis
    • most infections with echovirus are asymptomatic
    • neonates with aseptic meningitis are at highest risk of death with mortality up to 10%
Presentation
  • Symptoms
    • prodrome with fever, nausea, vomiting, or rash
    • headache
    • stiff neck
    • photophobia
    • irritability
  • Physical exam
    • nuchal rigidity
    • papilledema
    • scattered maculopapular rash
Studies
  • Labs
    • cerebrospinal fluid (CSF) studies
      • ↑ white blood cells
      • normal protein
      • normal glucose
      • detection of RNA on reverse transcriptase-polymerase chain reaction (RT-PCR)
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
Differential
  • Bacterial meningitis
    • distinguishing factor
      • CSF with decreased glucose and increased protein
Treatment
  • Management approach
    • mainstay of treatment is supportive care
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • hemodynamic support
Complications
  • Seizures
  • Myocarditis
  • Guillain-Barre syndrome
 

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