Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study

Kotaro Kunitomo; Takahiro Tsuji; Yanosuke Kouzaki; Fumitaka Yoshimura; Jyunko Kubosaki; Taro Shimizu

doi:10.1515/dx-2024-0183

Article

Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study

Kotaro Kunitomo , Takahiro Tsuji , Yanosuke Kouzaki , Fumitaka Yoshimura , Jyunko Kubosaki and Taro Shimizu

Published/Copyright: December 31, 2024

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From the journal Diagnosis Volume 12 Issue 2

Abstract

Objectives

The purpose of this study was to determine the actual diagnostic status of aseptic meningitis and consider the factors that cause difficulties in its diagnosis.

Methods

This study retrospectively reviewed the medical records of aseptic meningitis treated at our hospital from 2013 to 2022 and compared biometric data to distinguish between timely diagnose and difficult diagnose cases.

Results

This retrospective observational study included 127 patients aged 18 years or older. 66 (52.0 %) were female, with a median age of 35.9±15.9 years. The main symptoms were headache (122, 96.1 %), general malaise (110, 86.6 %), vomiting (79, 62.2 %). The 127 patients were classified into two groups: A timely diagnosis group diagnosed within 6 days of symptom onset, and a difficult diagnosis group diagnosed within 7 days or longer. There were significant differences between the two groups in the proportion of patients with a history of antimicrobial treatment and fever above 38 °C, and in the positive rates of neck stiffness and jolt accentuation of headache (JAH). The total number of hospitals involved in the process of diagnosis was significantly higher in the difficult diagnosis group and the length of inpatient stay was significantly longer. Multivariate analysis revealed significant differences in neck stiffness, JAH, and prior antibacterial therapy.

Conclusions

Atypical cases, such as neck stiffness and JAH negativity, may make the diagnosis difficult. Clinicians should be aware of this atypical presentation of aseptic meningitis.

Keywords: diagnostic difficulties; aseptic meningitis; atypical case; stiffness of the neck; jolt accentuation of headache

Corresponding author: Kotaro Kunitomo, MD, Department of General Medicine, NHO Kumamoto Medical Center, 1-5, Ninomaru, Kumamoto, 860-0008, Japan, E-mail: m05035kk@yahoo.co.jp

Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

Research ethics: This study was approved by the Ethical Review Committee of the National Hospital Organization Kumamoto Medical Center (No. 1206) and conducted in accordance with the Declaration of Helsinki.
Informed consent: Owing to the retrospective study design, written informed consent was not required.
Author contributions: K.K. and T.T. had full access to all of the data in the study, and they take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: K.K., T.T. and T.S. Acquisition, analysis, or interpretation of data: K.K., T.T., Y.K., F.Y. and J.K. Drafing of the manuscript: K.K., T.T. and T.S. Critical review of the manuscript for important intellectual content: K.K., T.T., Y.K., F.Y., J.K. and T.S. Statistical analysis: K.K. and T.S. Obtained funding: None. Administrative, technical, or material support: K.K., T.T. and T.S.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

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Received: 2024-11-05

Accepted: 2024-12-16

Published Online: 2024-12-31

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Articles in the same Issue

https://doi.org/10.1515/dx-2024-0183

Keywords for this article

diagnostic difficulties; aseptic meningitis; atypical case; stiffness of the neck; jolt accentuation of headache