Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Key Features

  • Nonpolio enteroviruses cause over 80% of cases of aseptic meningitis at all ages, especially in the summer and fall

  • Nosocomial outbreaks also occur

  • Usual incubation period is 4–6 days

  • Most infections are subclinical or not associated with central nervous system (CNS) symptoms, therefore a history of sick contact is unusual

  • Neonates may acquire infection from maternal blood, vaginal secretions, or feces at birth; occasionally the mother has had a febrile illness just prior to delivery

Clinical Findings

  • Sudden onset of fever, marked irritability, and lethargy in infants

  • Older children also describe frontal headache, photophobia, and myalgia

  • Abdominal pain, diarrhea, and projectile vomiting may occur

  • Incidence of rash varies with the infecting strain; if rash develops,

    • Usually seen after several days of illness

    • Appears as diffuse, macular or maculopapular, occasionally petechial, but not purpuric

  • Illness may be biphasic, with nonspecific symptoms and signs preceding those related to the CNS

  • In older children, meningeal signs are more frequent, but seizures are unusual, and focal neurologic findings are rare, which should lead to a search for an alternative cause


  • Blood leukocyte counts are often normal

  • Spinal fluid leukocyte count is 100–1000/μL with polymorphonuclear cells predominating early and shifting to mononuclear cells within 8–36 hours

  • Culture of CSF may yield an enterovirus within a few days (< 70%)

  • PCR is the most useful diagnostic method in many centers (sensitivity > 90%)

  • Cerebral imaging is not often indicated


  • No specific antiviral therapy exists

  • Infants are usually hospitalized, isolated, and treated with fluids and antipyretics

  • Moderately to severely ill infants are given empiric antibiotics for bacterial pathogens until cultures are negative for 48–72 hours

  • Codeine compounds or other strong analgesics may be needed

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.