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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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