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75 - Aseptic meningitis syndrome
- from Part X - Clinical syndromes: neurologic system
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- By Burt R. Meyers, New York Medical College, Dalilah Restrepo, St. Luke’s – Roosevelt Hospital
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 479-486
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- Chapter
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Summary
Aseptic meningitis syndrome is associated with symptoms, signs, and laboratory evidence of meningeal inflammation with spinal fluid findings that suggest a viral or noninfectious origin. Clinically, patients present with headache, nausea, meningismus, and photophobia, symptoms that are also common in patients with bacterial meningitis. A stiff neck, with or without a Brudzinski or Kernig sign, may be observed. Patients usually appear nontoxic but may have changes in mental status, including irritability. Other signs of possible viral infection may include pharyngitis, adenopathy, morbilliform rash, and evidence of systemic viral infection, including myalgia, fatigue, and anorexia. There are usually no signs of vascular instability, and the course is often self-limiting.
Aseptic meningitis is a syndrome of multiple etiologies, both infectious and noninfectious (Table 75.1). Infections are usually of viral origin but also may be due to mycobacteria, fungi, rickettsiae, and parasites. Group B Coxsackieviruses (mostly serotypes 2 through 5) and echoviruses (mostly serotypes 4, 6, 9, 11, 16, and 30) are responsible for more than 90% of cases of viral meningitis. Herpesvirus, arboviruses, lymphocytic choriomeningitis virus (LCM), Lyme disease, leptospirosis, and acute human immunodeficiency virus (HIV) are the etiologic agents that make up most of the remaining infectious cases. Noninfectious causes include drug reactions, collagen vascular diseases (i.e., lupus erythematosus, granulomatous arteritis), sarcoidosis, cerebral vascular lesions, epidermal cysts, meningeal carcinomatosis, serum sickness, and nonfocal lesions of the central nervous system (CNS). Specific syndromes (i.e., Mollaret's meningitis, Still's disease) may produce a similar clinical picture. The etiologic diagnosis of aseptic meningitis is often complicated by the numerous possible causes and the lack of specific diagnostic tests.
74 - Aseptic Meningitis Syndrome
- from Part X - Clinical Syndromes – Neurologic System
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- By Burt R. Meyers, Mt. Sinai School of Medicine, Mirella Salvatore, Mt. Sinai School of Medicine
- Edited by David Schlossberg
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 513-520
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- Chapter
- Export citation
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Summary
Aseptic meningitis syndrome is associated with symptoms, signs, and laboratory evidence of meningeal inflammation with spinal fluid findings that suggest a viral or noninfectious origin. Clinically, patients present with headache, nausea, meningismus, and photophobia, symptoms that are also common in patients with bacterial meningitis. A stiff neck, with or without a Brudzinski or Kernig sign, may be observed. Patients usually appear nontoxic but may have changes in mental status, including irritability. Other signs of possible viral infection may include pharyngitis, adenopathy, morbilliform rash, and evidence of systemic viral infection, including myalgia, fatigue, and anorexia. There are usually no signs of vascular instability, and the course is often self-limiting.
Aseptic meningitis is a syndrome of multiple etiologies, both infectious and noninfectious (Table 74.1). Infections are usually of viral origin but also may be due to mycobacteria, fungi, rickettsiae, and parasites. Group B coxsackieviruses (mostly serotypes 2 through 5) and echoviruses (mostly serotypes 4, 6, 9, 11, 16, and 30) are responsible for more than 90% of cases of viral meningitis. Herpes virus, arboviruses, lymphocytic choriomeningitis virus (LCM), Lyme disease, leptospirosis, and acute human immunodeficiency virus (HIV) are the etiologic agents that make up most of the remaining infectious cases. Noninfectious causes include drug reactions, collagen-vascular diseases (ie, lupus erythematosus granulomatous arteritis), sarcoidosis, cerebral vascular lesions, epidermal cysts, meningeal carcinomatosis, serum sickness, and nonfocal lesions of the central nervous system (CNS). Specific syndromes (ie, Mollaret's meningitis, Still's disease) may produce a similar clinical picture.
Study of a Needleless Intermittent Intravenous-Access System for Peripheral Infusions: Analysis of Staff, Patient, and Institutional Outcomes
- Meryl H. Mendelson, Louise J. Short, Clyde B. Schechter, Burt R. Meyers, Margarita Rodriguez, Sandra Cohen, John Lozada, Marvalyn DeCambre, Shalom Z. Hirschman
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 19 / Issue 6 / June 1998
- Published online by Cambridge University Press:
- 02 January 2015, pp. 401-406
- Print publication:
- June 1998
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- Article
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OBJECTIVE:
To assess the effect on staff- and patient-related complications of a needleless intermittent intravenous access system with a reflux valve for peripheral infusions.
DESIGN:A 6-month cross-over clinical trial (phase I, 13 weeks; phase II, 12 weeks) of a needleless intermittent intravenous access system (NL; study device) compared to a conventional heparin-lock system (CHL, control device) was performed during 1991 on 16 medical and surgical units. A random selection of patients was assessed for local intravenous-site complications; all patients were assessed for the development of nosocomial bacteremia and device-related complications. Staff were assessed for percutaneous injuries and participated in completion of product evaluations. A cost analysis of the study compared to the control device was performed.
SETTING:A 1,100-bed, teaching, referral medical center.
PATIENTS AND STAFF PARTICIPANTS:594 patients during 602 patient admissions, comprising a random sample of all patients with a study or control device inserted within a previous 24-hour period on study and control units, were assessed for local complications. The 16 units included adult inpatient general medicine, surgical, and subspecialty units. Pediatrics, obstetrics-gynecology, and intensive-care units were excluded. All patients on study and control units were assessed for development of nosocomial bacteremia and device-related complications. All staff who utilized, manipulated, or may have been exposed to sharps on study and control units were assessed for percutaneous injuries. Nursing staff completed product evaluations.
INTERVENTION:The study device, a needleless intermittent intravenous access system with a reflux valve, was compared to the control device, a conventional heparin lock, for peripheral infusions.
RESULTS:During the study, 35 percutaneous injuries were reported. Eight injuries were CHL-related; no NL-related injuries were reported (P=.007). An evaluation of 602 patient admissions, 1,134 intermittent access devices, and 2,268 observed indwelling device days demonstrated more pain at the insertion site for CHL than NL; however, no differences in objective signs of phlebitis were noted. Of 773 episodes of positive blood cultures on study and control units, 6 (0.8%) were device-related (assessed by blinded investigator), with no difference between NL and CHL. Complications, including difficulty with infusion (P<.001) and disconnection of intravenous tubing from device (P<.001), were reported more frequently with CHL than with NL. Of nursing staff responding to a product evaluation survey, 95.2% preferred the study over control device. The projected annual incremental cost to our institution for hospitalwide implementation of NL for intermittent access for peripheral infusions was estimated at $82,845, or $230 per 1,000 patient days.
CONCLUSIONS:A needleless intermittent intravenous access system with a reflux valve for peripheral infusions is effective in reducing percutaneous injuries to staff and is not associated with an increase in either insertion-site complications or nosocomial bacteremia. Institutions should consider these data, available institutional resources, and institution-specific data regarding the frequency and risk of intermittent access-device-related injuries and other types of sharps injuries in their staff when selecting the above or other safety devices.