title: Adult meningism and viral meningitis, 1997-2004: clinical data and cerebrospinal fluid cytokines.
abstract: OBJECTIVE
  Although meningism manifesting acute headache has been observed to be associated with common viral and bacterial infections, its definition and pathogenesis have not been clarified. Clinical findings and cerebrospinal fluid (CSF) cytokines in adult patients with meningism were investigated and compared with those in viral meningitis.
  
  
  METHODS
  Among the adult inpatients in our hospital from 1997 to 2004, 5 with meningism and 17 with viral meningitis were identified according to the criteria described in this study, and their clinical data were analyzed. In the CSF samples of the 5 patients with meningism and the 17 with viral meningitis, the concentrations of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), IL-4, IL-6, and IL-10 were determined using a cytometric bead array.
  
  
  RESULTS
  The five patients with meningism all showed fever and meningeal signs such as severe headache and nuchal stiffness without CSF pleocytosis (<5 cells/mm3). Four patients were associated with herpetic Kaposi's eczema, herpes simplex, or herpes zoster, and all five patients had favorable outcomes. The levels of all CSF cytokines in patients with meningism were below normal values, whereas IFN-gamma and IL-6 in patients with viral meningitis were moderately elevated.
  
  
  CONCLUSIONS
  The normal cytokine levels in meningism may possibly reflect the lack of direct viral infection and may be helpful in differentiating both meningism and viral meningitis at an early stage.
authors.affiliation: The Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume.
authors.forename: Masako
authors.initials: M
authors.lastname: Nagafuchi
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Nagafuchi
authors.forename: Rumi
authors.initials: R
authors.lastname: Sato
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Imaizumi
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ayabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shoji
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichiyama
mesh_terms: D000328:Adult; D000368:Aged; D016207:Cytokines / Q000134:cerebrospinal fluid*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008580:Meningism / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D008875:Middle Aged
chemical_list: D016207:Cytokines