COVID-19-associated meningitis: Difference between revisions

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__NOTOC__
__NOTOC__
{{COVID-19}}
{{SI}}
 
{{CMG}}; {{AE}} {{Wd}}, {{MAH}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{Fs}}, {{sali}}


{{CMG}}; {{AE}} {{Wd}}, {{MAH}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}


{{COVID-19}}


==Overview==
==Overview==
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* Exosomal cellular transport is also a pathway for [[SARS-CoV-2]] systemic dissemination and spread to [[CNS]].<ref name="pmid26393640">{{cite journal| author=Alenquer M, Amorim MJ| title=Exosome Biogenesis, Regulation, and Function in Viral Infection. | journal=Viruses | year= 2015 | volume= 7 | issue= 9 | pages= 5066-83 | pmid=26393640 | doi=10.3390/v7092862 | pmc=4584306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26393640  }}</ref>
* Exosomal cellular transport is also a pathway for [[SARS-CoV-2]] systemic dissemination and spread to [[CNS]].<ref name="pmid26393640">{{cite journal| author=Alenquer M, Amorim MJ| title=Exosome Biogenesis, Regulation, and Function in Viral Infection. | journal=Viruses | year= 2015 | volume= 7 | issue= 9 | pages= 5066-83 | pmid=26393640 | doi=10.3390/v7092862 | pmc=4584306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26393640  }}</ref>


[[File:COVID-Meningitis.jpg|700px|center]]
[[File:Meningitis Pathophysiology.png|center|600x600px]]
 
<br />
<br />


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==Differentiating COVID-19-associated meningitis from other Diseases==
==Differentiating COVID-19-associated meningitis from other Diseases==


* COVID-19-associated meningitis must be differentiated from other [[diseases]] that cause [[fever]], [[headache]], and [[altered mental status]] with or without [[cough]], such as [[Encephalitis MRI|encephalitis]], [[stroke]], [[tumor]], [[Brain hemorrhages|brain hemorrhage]], [[neurosyphilis]], [[migraine]], [[hypertensive encephalopathy]], [[Wernicke's encephalopathy|wernicke’s encephalopathy]], [[Brain abscess|abscess]], [[drug toxicity]], and [[seizure]].<br />
* For further information about the differential diagnosis, [[COVID-19-associated meningitis differential diagnosis|click here]].
 
* To view the differential diagnosis of COVID-19, [[COVID-19 differential diagnosis|click here]].
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="4" |<small>Symptoms
! colspan="5" |<small>Physical Examination</small>
! rowspan="2" |<small>Past medical history</small>
! colspan="3" |<small>Diagnostic tests</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Headache</small>
!↓<small>LOC</small>
!<small>Motor weakness</small>
!<small>Abnormal sensory</small>
!<small>Motor Deficit</small>
!<small>Sensory deficit</small>
!<small>Speech difficulty</small>
!<small>Gait abnormality</small>
!<small>Cranial nerves</small>
!<small>CT /MRI</small>
!<small>CSF Findings</small>
!<small>Gold standard test</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]]
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' [[Leukocytes]],
 
'''↑''' Protein
 
↓ Glucose
| style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Fever]], [[Neck rigidity|neck]]  
[[Neck rigidity|rigidity]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Encephalitis]]
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]]
| style="background: #F5F5F5; padding: 5px text-align:center" | +
| style="background: #F5F5F5; padding: 5px text-align:center" |'''↑''' [[Leukocytes]], ↓ Glucose
| style="background: #F5F5F5; padding: 5px text-align:center" |CSF [[PCR]]
| style="background: #F5F5F5; padding: 5px text-align:center" |[[Fever]], [[Seizure|seizures]], [[Focal neurologic signs|focal neurologic abnormalities]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }} </ref>
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]]
|style="background: #F5F5F5; padding: 5px; text-align:center"| +
|style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |MRI
|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |[[Neck stiffness]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subdural hematoma|Subdural hemorrhage]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Sexually transmitted disease|STI]]<nowiki/>s
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]],
 
Abnormal [[gait]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
|style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
|style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
|style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" |History of alcohal abuse
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
|style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
|style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
|style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Drug screen test
|style="background: #F5F5F5; padding: 5px;" |[[Lithium]], [[Sedatives]], [[phenytoin]], [[carbamazepine]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" |
|style="background: #F5F5F5; padding: 5px text-align:center" |History of [[emotional stress]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" |History of relapses and remissions
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''  CSF IgG levels
(monoclonal bands)
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" | +
|style="background: #F5F5F5; padding: 5px text-align:center" |Previous history of [[seizures]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Mass lesion
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[apathy]], [[irritability]],
|}
 
 
==Epidemiology and Demographics==
==Epidemiology and Demographics==


Line 393: Line 118:
===History and Symptoms===
===History and Symptoms===


'''History:'''
'''History'''


* Five cases of meningitis in COVID-19 patients have been reported. The disease course of these patients is given in the table.
* The disease course of 5 cases of COVID-19 associated meningitis include:


{| class="wikitable"
{| class="wikitable"
Line 516: Line 241:
|}
|}


'''Symtoms:'''
'''Common Symptoms'''
 
*[[Fever]]
*[[Fever]]
*[[Headache]]
*[[Headache]]
*[[Nausea]]/ [[vomiting]]
*[[Irritability]]
*[[Malaise]]
*[[Neck stiffness]]
*[[Neck stiffness]]
* Light sensitivity/ [[photophobia]]
* Light sensitivity/ [[photophobia]]
* [[Nausea]]/ [[vomiting]]
 
* [[Malaise]]
'''Less Common Symptoms'''
* [[Myalgias]]
 
*[[Myalgias]]
*[[Confusion]]
*[[Confusion]]
*[[Irritability]]
*[[Seizures]] (with concomitant [[encephalitis]])
* [[Seizures]] (with concomitant [[encephalitis]])


===Physical Examination===
===Physical Examination===
Line 535: Line 264:
* Increased [[respiratory rate]]
* Increased [[respiratory rate]]


'''Physical Exam:'''
'''Neuromuscular:'''
* [[Altered mental status]]
* [[Altered mental status]]
* [[Photophobia]]
* [[Photophobia]]
Line 615: Line 344:


===Electrocardiogram===
===Electrocardiogram===
* There are no [[ECG]] findings associated with COVID-19-associated meningitis.
 
* To view the [[electrocardiogram]] findings on COVID-19, [[COVID-19 electrocardiogram|click here]].<br />
* To view the [[electrocardiogram]] findings on COVID-19, [[COVID-19 electrocardiogram|click here]].
*There are no [[ECG]] findings associated with COVID-19-associated meningitis


===X-ray===
===X-ray===
* There are no [[X-rays|x-ray]] findings associated with COVID-19-associated meningitis.
* There are no [[X-rays|x-ray]] findings associated with COVID-19-associated meningitis.
* To view the [[x-ray]] finidings on COVID-19, [[COVID-19 x ray|click here]].<br />
* To view the [[x-ray]] finidings on COVID-19, [[COVID-19 x ray|click here]].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
*There are no [[Echocardiography and ultrasound|echocardiography]]/[[ultrasound]]  findings associated with COVID-19-associated meningitis.
*There are no [[Echocardiography and ultrasound|echocardiography]]/[[ultrasound]]  findings associated with COVID-19-associated meningitis.
* To view the [[Echocardiography|echocardiographic]] findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]].<br />
* To view the [[Echocardiography|echocardiographic]] findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]].


===CT scan===
===CT scan===
*[[CT scan]] of brain may detect brain inflammation.
*[[CT scan]] of the [[brain]] may detect brain [[inflammation]].
* To view the [[CT scan]] findings on COVID-19, [[COVID-19 CT scan|click here]].
* To view the [[CT scan]] findings on COVID-19, [[COVID-19 CT scan|click here]].


Line 644: Line 374:
==Treatment==
==Treatment==
=== Medical Therapy===
=== Medical Therapy===
The mainstays of [[medical]] [[therapy]] for viral meningitis are:
The mainstays of [[medical]] [[therapy]] for viral meningitis are:<ref name="pmid322517913">{{cite journal| author=Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J | display-authors=etal| title=A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. | journal=Int J Infect Dis | year= 2020 | volume= 94 | issue=  | pages= 55-58 | pmid=32251791 | doi=10.1016/j.ijid.2020.03.062 | pmc=7195378 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32251791  }}</ref><ref name="pmid32043983">{{cite journal |vauthors=Russell CD, Millar JE, Baillie JK |title=Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury |journal=Lancet |volume=395 |issue=10223 |pages=473–475 |date=February 2020 |pmid=32043983 |pmc=7134694 |doi=10.1016/S0140-6736(20)30317-2 |url=}}</ref><ref name="pmid32256705">{{cite journal| author=Russell B, Moss C, George G, Santaolalla A, Cope A, Papa S | display-authors=etal| title=Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence. | journal=Ecancermedicalscience | year= 2020 | volume= 14 | issue=  | pages= 1022 | pmid=32256705 | doi=10.3332/ecancer.2020.1022 | pmc=7105343 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32256705  }}</ref><ref name="pmid25174548">{{cite journal |vauthors=Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y |title=Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase |journal=Brain Dev. |volume=37 |issue=5 |pages=471–7 |date=May 2015 |pmid=25174548 |doi=10.1016/j.braindev.2014.08.003 |url=}}</ref><ref name="pmid32479911">{{cite journal| author=Efe IE, Aydin OU, Alabulut A, Celik O, Aydin K| title=COVID-19-Associated Encephalitis Mimicking Glial Tumor. | journal=World Neurosurg | year= 2020 | volume= 140 | issue=  | pages= 46-48 | pmid=32479911 | doi=10.1016/j.wneu.2020.05.194 | pmc=7256557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32479911  }}</ref><ref name="urlA Study to Evaluate the Efficacy and Safety of Tocilizumab in Hospitalized Participants With COVID-19 Pneumonia - Full Text View - ClinicalTrials.gov">{{cite web |url=+https://clinicaltrials.gov/ct2/show/NCT04372186 |title=A Study to Evaluate the Efficacy and Safety of Tocilizumab in Hospitalized Participants With COVID-19 Pneumonia - Full Text View - ClinicalTrials.gov |format= |work= |accessdate=}}</ref><ref name="pmid32234467">{{cite journal| author=Zhang C, Wu Z, Li JW, Zhao H, Wang GQ| title=Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. | journal=Int J Antimicrob Agents | year= 2020 | volume= 55 | issue= 5 | pages= 105954 | pmid=32234467 | doi=10.1016/j.ijantimicag.2020.105954 | pmc=7118634 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32234467  }}</ref>
=====Symptomatic treatments:=====
=====Symptomatic treatments:=====


*[[Anti-inflammatory]] drugs like [[steroids]] are helpful to decrease brain [[inflammation]] in COVID-19 associated meningitis'''<ref name="pmid322517913" />'''.
*[[Anti-inflammatory]] drugs like [[steroids]] are helpful to decrease brain [[inflammation]] in COVID-19 associated meningitis.
*[[Corticosteroids]] ([[methylprednisolone]] 300 mg/day)<ref name="pmid32043983">{{cite journal |vauthors=Russell CD, Millar JE, Baillie JK |title=Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury |journal=Lancet |volume=395 |issue=10223 |pages=473–475 |date=February 2020 |pmid=32043983 |pmc=7134694 |doi=10.1016/S0140-6736(20)30317-2 |url=}}</ref> in severe [[COVID-19]] patients are shown to reduce [[mortality]]. <ref name="pmid32256705">{{cite journal| author=Russell B, Moss C, George G, Santaolalla A, Cope A, Papa S | display-authors=etal| title=Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence. | journal=Ecancermedicalscience | year= 2020 | volume= 14 | issue=  | pages= 1022 | pmid=32256705 | doi=10.3332/ecancer.2020.1022 | pmc=7105343 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32256705  }}</ref>
*[[Corticosteroids]] ([[methylprednisolone]] 300 mg/day) in severe [[COVID-19]] patients are shown to reduce [[mortality]].  
* If a [[COVID-19]] patient with [[meningitis]] develops [[seizures]] [[anti-epileptic drugs]] like [[levetiracetam]] (50-60 mg/kg/day)<ref name="pmid25174548">{{cite journal |vauthors=Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y |title=Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase |journal=Brain Dev. |volume=37 |issue=5 |pages=471–7 |date=May 2015 |pmid=25174548 |doi=10.1016/j.braindev.2014.08.003 |url=}}</ref> may be necessary.'''<ref name="pmid322517913">{{cite journal| author=Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J | display-authors=etal| title=A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. | journal=Int J Infect Dis | year= 2020 | volume= 94 | issue=  | pages= 55-58 | pmid=32251791 | doi=10.1016/j.ijid.2020.03.062 | pmc=7195378 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32251791  }}</ref>'''.
* If a [[COVID-19]] patient with [[meningitis]] develops [[seizures]] [[anti-epileptic drugs]] like [[levetiracetam]] (50-60 mg/kg/day) may be necessary..
*[[Tocilizumab]] (8mg/kg/dose)<ref name="urlA Study to Evaluate the Efficacy and Safety of Tocilizumab in Hospitalized Participants With COVID-19 Pneumonia - Full Text View - ClinicalTrials.gov">{{cite web |url=+https://clinicaltrials.gov/ct2/show/NCT04372186 |title=A Study to Evaluate the Efficacy and Safety of Tocilizumab in Hospitalized Participants With COVID-19 Pneumonia - Full Text View - ClinicalTrials.gov |format= |work= |accessdate=}}</ref> is IL-6 anatgonist, that reduces cytokine storm syndrome responsible for neurological manifestations in a COVID-19 patient. <ref name="pmid32234467">{{cite journal| author=Zhang C, Wu Z, Li JW, Zhao H, Wang GQ| title=Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. | journal=Int J Antimicrob Agents | year= 2020 | volume= 55 | issue= 5 | pages= 105954 | pmid=32234467 | doi=10.1016/j.ijantimicag.2020.105954 | pmc=7118634 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32234467  }}</ref>
*[[Tocilizumab]] (8mg/kg/dose) is IL-6 anatgonist, that reduces cytokine storm syndrome responsible for neurological manifestations in a COVID-19 patient.  
*[[Intubation]] and [[mechanical ventilation]] may be needed <ref name="pmid32479911">{{cite journal| author=Efe IE, Aydin OU, Alabulut A, Celik O, Aydin K| title=COVID-19-Associated Encephalitis Mimicking Glial Tumor. | journal=World Neurosurg | year= 2020 | volume= 140 | issue=  | pages= 46-48 | pmid=32479911 | doi=10.1016/j.wneu.2020.05.194 | pmc=7256557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32479911  }}</ref>.
*[[Intubation]] and [[mechanical ventilation]] may be needed .
* To see treatment protocol to manage the underlying cause i.e., COVID-19, [[COVID-19 medical therapy|click here]].<br />
* To see treatment protocol to manage the underlying cause i.e., COVID-19, [[COVID-19 medical therapy|click here]].<br />


Line 670: Line 400:
==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Up-To-Date]]


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{{WikiDoc Help Menu}}
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Latest revision as of 23:47, 12 December 2020

For COVID-19 frequently asked outpatient questions, click here.

For COVID-19 frequently asked inpatient questions, click here.

For COVID-19 patient information, click here.


WikiDoc Resources for COVID-19-associated meningitis

Articles

Most recent articles on COVID-19-associated meningitis

Most cited articles on COVID-19-associated meningitis

Review articles on COVID-19-associated meningitis

Articles on COVID-19-associated meningitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated meningitis

Images of COVID-19-associated meningitis

Photos of COVID-19-associated meningitis

Podcasts & MP3s on COVID-19-associated meningitis

Videos on COVID-19-associated meningitis

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated meningitis

Bandolier on COVID-19-associated meningitis

TRIP on COVID-19-associated meningitis

Clinical Trials

Ongoing Trials on COVID-19-associated meningitis at Clinical Trials.gov

Trial results on COVID-19-associated meningitis

Clinical Trials on COVID-19-associated meningitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated meningitis

NICE Guidance on COVID-19-associated meningitis

NHS PRODIGY Guidance

FDA on COVID-19-associated meningitis

CDC on COVID-19-associated meningitis

Books

Books on COVID-19-associated meningitis

News

COVID-19-associated meningitis in the news

Be alerted to news on COVID-19-associated meningitis

News trends on COVID-19-associated meningitis

Commentary

Blogs on COVID-19-associated meningitis

Definitions

Definitions of COVID-19-associated meningitis

Patient Resources / Community

Patient resources on COVID-19-associated meningitis

Discussion groups on COVID-19-associated meningitis

Patient Handouts on COVID-19-associated meningitis

Directions to Hospitals Treating COVID-19-associated meningitis

Risk calculators and risk factors for COVID-19-associated meningitis

Healthcare Provider Resources

Symptoms of COVID-19-associated meningitis

Causes & Risk Factors for COVID-19-associated meningitis

Diagnostic studies for COVID-19-associated meningitis

Treatment of COVID-19-associated meningitis

Continuing Medical Education (CME)

CME Programs on COVID-19-associated meningitis

International

COVID-19-associated meningitis en Espanol

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Business

COVID-19-associated meningitis in the Marketplace

Patents on COVID-19-associated meningitis

Experimental / Informatics

List of terms related to COVID-19-associated meningitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Wajeeha Aiman, M.D.[2], Muhammad Adnan Haider, M.B.B.S.[3] Tayebah Chaudhry[4] Fahimeh Shojaei, M.D., Syed Musadiq Ali M.B.B.S.[5]


Overview

Covid-19 associated meningitis was first discovered by Moriguchi T. et al. a Japanese critical care physician in late February 2020 during the pandemic of SARS-CoV-2. Duong L et. reported a case of a young female with COVID-19 who developed meningoencephalitis without respiratory failure in Downtown Los Angeles in early April, 2020. Bernard-Valnet R et al. reported two cases of meningoencephalitis in patients with concomitant SARS-CoV-2 infection. There is no established system for the classification of SARS-CoV-2 related meningitis. There are three mechanisms proposed for pathophysiology of COVID-19-associated meningitis. SARS-CoV-2 directly reaches brain through cribriform plate which is located in close proximity to olfactory bulb. This is supported by the facts that some patients of COVID-19 present with anosmia and hyposmia. Viral interaction with ACE2 expressed on neurons lead to damage to neurons and inflamation (encephalitis) and inflammation of brain membranes (meningitis). SARS-CoV-2 can reach brain via anterograde or retrograde transport with the help of motor proteins kinesin and dynein via sensory nerve endings, especially afferent nerve endings of vagus nerve from lungs.

Historical Perspective

  • Neurological symptoms in COVID-19 patients were first reported in February 2020 in a retrospective case series study by Mao L. et al. in hospitalized COVID-19 patients in Wuhan.
  • Ling Mao from Tongji Medical College in Wuhan, and his group reviewed the data retrospectively from January 16, 2020, to February 19, 2020.
  • One third of the 214 hospitalized laboratory- confirmed COVID-19 patients included in this study reported at least one neurological symptom.
  • Covid-19 associated meningitis was first discovered by Moriguchi T. et al. a Japanese critical care physician in late February 2020 during the pandemic of SARS-Coronavirus-2: SARS-CoV-2 [1].
  • Duong L et. reported a case of a young female with COVID-19 who developed meningoencephalitis without respiratory failure in Downtown Los Angeles in early April, 2020 [2].
  • Bernard-Valnet R et al. reported two cases of meningoencephalitis in patients with concomitant SARS-CoV-2 infection.[3]

Classification

  • There is no established system for the classification of COVID-19-associated meningitis.

Pathophysiology

The exact pathogenesis of COVID-19-associated meningitis is not fully understood.

The proposed pathophysiology of COVID-19-associated meningitis is by following three mechanisms;

1.Direct pathway

2. Blood circulation pathway

3. Neuronal Pathway


Causes

Differentiating COVID-19-associated meningitis from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for COVID-19-associated meningitis.
  • To view screening for COVID-19, click here.

Natural History, Complications, and Prognosis

History

  • If left untreated, COVID-19-associated meningitis may cause long term neurological complications.
  • To view Natural History for COVID-19, click here.

Complications

If left untreated, meningitis in COVID-19 patients may develop following complications.

Prognosis

  • Exact prognosis of COVID-19 associated meningitis is not known.
  • However, treating the underlying cause i.e., COVID-19, including treatment with steroids, have shown improvement in meningitis symptoms in a COVID-19 patient.
  • To view Prognosis for COVID-19, click here.

Diagnosis

Diagnostic Study of Choice

  • The diagnostic study of choice for meningitis in COVID-19 patients is CSF analysis and ruling out other causes of meningitis (e.g., other viruses, bacteria, fungi).

History and Symptoms

History

  • The disease course of 5 cases of COVID-19 associated meningitis include:
Patient No. Early symptoms Late symptoms CSF analysis Viral panel (HSV,VZV, enterovirus) Bacterial panel SARS-CoV-2 analysis Imaging CT/MRI
Protein(mg/L) Glucose(CSF:serum ratio) Cells (mm3) RT-PCR CSF RT-PCR Nasopharyngeal swab
  1. 24 year old male, presented with meningitis in Japan[16]
Headache,

Fever,

fatigue

Worsening headache, Sore throat. (Day 5)

Impaired consciousness and transient generalized seizure, (Day 9)

NA NA Cell count was 12/μL–10

mononuclear and 2 polymorphonuclear cells

Negative Positive Negative Brain MRI:

Hyperintensity in the right lateral ventricle's inferior horn along the wall,

pan-paranasal sinusitis.

2. 64 year old female with a known contact with SARS-CoV-2 (her husband tested positive 15 days before)[17] Mild flue like symptoms

myalgia

cough

Tonic-clonic seizures

disorientation

psychotic symptoms

466 mg/L 0.59 17 cells with 97% lymphocytes negative negative positive Brain MRI normal at admission
3. 67 year old female with known SARS-CoV-2 for 17 days with mild respiratory symptoms[18] wake up severe headache Drowsiness, disoriented was lying on the floor, brought to hospital with confusion, disorientation, 461

mg/L

0.62 21 cells with 87 % cells were lymphocytes negative negative positive Brain MRI normal at admission
4. 69 year old man who returned from Middle East 15 days ago (French Indies)[19] 7 day history of

fever

cough

myalgia

cervical pain

ageusia

anosmia

Severe headache

neck stiffness

confusion

84

mg/L

normal 37 cells, purely lymphocytes, with no RBCs negative neagtive negative on nasopharyngeal swab but became positive on bronchoalveolar lavage on 4th day of admission Brain MRI normal on admission
5. 41 year old female, presented with meningoencephalitis without respiratory failure in Downtown Los Angeles in April 2020[20] fever

headache

new onset seizure

severe headache

neck stiffness

photophobia

100

mg/L

0.60 70 cells with 100% lymphocytes negative NA positive CT head without contrast was normal

Common Symptoms

Less Common Symptoms

Physical Examination

Vitals:

Neuromuscular:

Laboratory Findings

Cerebrospinal fluid level Normal level Bacterial meningitis[26] SARS-CoV-2 meningitis Viral meningitis[26] Fungal meningitis Tuberculous meningitis[28] Malignant meningitis[23]
Cells/ul < 5 >300 10-1000 10-1000 10-500 50-500 >4
Cells Lymphos:Monos 7:3 Gran. > Lymph predominantly lymphocytes Lymph. > Gran. Lympho.>Gran Lymphocytes Lymphocytes
Total protein (mg/dl) 45-60 Typically 100-500 Normal or slightly high Normal or slightly high High Typically 100-200 >50
Glucose ratio (CSF/plasma)[24] > 0.5 < 0.3 > 0.6 > 0.6 <0.3 < 0.5 <0.5
Lactate (mmols/l)[25] < 2.1 > 2.1 N/A < 2.1 >3.2 > 2.1 >2.1
Others ICP:6-12 (cm H2O) CSF gram stain, CSF culture, CSF bacterial antigen RT-PCR for SARS-CoV-2 RNA in CSF (still not approved by FDA) PCR of HSV-DNA, VZV CSF gram stain, CSF india ink PCR of TBC-DNA CSF tumour markers such as alpha fetoproteins, CEA

Electrocardiogram

X-ray

  • There are no x-ray findings associated with COVID-19-associated meningitis.
  • To view the x-ray finidings on COVID-19, click here.

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

  • There are no other imaging findings associated with COVID-19 associated meningitis.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with COVID-19 associated meningitis.

Treatment

Medical Therapy

The mainstays of medical therapy for viral meningitis are:[29][30][31][32][33][34][35]

Symptomatic treatments:

Surgery

Primary Prevention

Secondary Prevention

References

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  32. Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y (May 2015). "Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase". Brain Dev. 37 (5): 471–7. doi:10.1016/j.braindev.2014.08.003. PMID 25174548.
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  34. [+https://clinicaltrials.gov/ct2/show/NCT04372186 "A Study to Evaluate the Efficacy and Safety of Tocilizumab in Hospitalized Participants With COVID-19 Pneumonia - Full Text View - ClinicalTrials.gov"] Check |url= value (help).
  35. Zhang C, Wu Z, Li JW, Zhao H, Wang GQ (2020). "Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality". Int J Antimicrob Agents. 55 (5): 105954. doi:10.1016/j.ijantimicag.2020.105954. PMC 7118634 Check |pmc= value (help). PMID 32234467 Check |pmid= value (help).


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