Aseptic Meningitis and Meningoencephalitis in Cold-agglutinin-positive Infections.

The syndromes of aseptic meningitis and meningoencephalitis have a varied aetiology. They are most often caused by a virus -in Sweden, so far as we know at present, mostly by parotitis virus, several types of enterovirus (polio, Coxsackie, E.C.H.O.), and tick-borne encephalitis virus. In patients at the Stockholm Hospital for Infectious Diseases different enteroviruses have dominated at different periods in the past decade (Svedmyr, 1963), and some of them have caused major epidemics: polio type 1 in 1953-4 (Strom, 1956), E.C.H.O. 6 in 1954-5 (von Zeipel and Svedmyr, 1957), E.C.H.O. 9 in 1957 (Kahlmeter, 1961), Coxsackie B5 in 1961-2. To a fairly large extent, however, the aetiology remains unknown. Similar experience has been reported from elsewhere. For example, 407 cases of aseptic meningitis were reported from Cleveland during the years 1955-8 (Lepow et al., 1962). In 54% a viral cause was discovered, 17 different enteroviruses being isolated. Meningoencephalitis has also been reported on a few occasions in cold-agglutinin-positive infections (Keizer, 1949; Sterner, 1956). Chanock et al. (1960) observed aseptic meningitis in a child infected with Eaton's agent (Mycoplasma pneumoniae). Museteanu et al. (1963) published a report of six fatal cases of primary atypical pneumonia and encephalitis in children aged 6 to 7 months. Necropsies of these cases revealed the presence of a large virus in nerve and glia tissue of the brain and in blood-vessels. At the Stockholm Hospital for Infectious Diseases additional cases have been observed in the past few years with temporal association between cold-agglutinin-positive infection and aseptic meningoencephalitis or meningitis. These cases are reported here.