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Etiology of Aseptic Meningitis, Peripheral Facial Nerve Palsy, and a Combination of Both in Children

Waespe, Nicolas MD*; Steffen, Ingrid MD; Heininger, Ulrich MD*

The Pediatric Infectious Disease Journal: May 2010 - Volume 29 - Issue 5 - p 453-456
doi: 10.1097/INF.0b013e3181c3cae6
Original Studies

Background: A variety of microorganisms have been shown to cause peripheral facial nerve palsy (PFNP) and/or aseptic meningitis in children. Clinical findings and history may help to predict the specific etiology of these entities.

Method: Children ≥12 months old hospitalized at the University Children's Hospital Basel, Switzerland, from 2000 to 2005 with clinical signs of PFNP and/or aseptic meningitis were studied retrospectively. History, clinical, and laboratory findings were evaluated using analysis of variance with Bonferroni (Dunn) correction.

Results: Of 181 patients, 123 (68%) had aseptic meningitis, 28 (15%) had PFNP, and 30 (17%) had a combination of both. PFNP with aseptic meningitis was associated with Borrelia burgdorferi (Bb) infection in the majority of patients (73%) compared with 11% and 9% of patients with PFNP or aseptic meningitis, respectively. The majority of patients with aseptic meningitis without PFNP had enterovirus infection (63%). In patients with aseptic meningitis, mean leukocyte counts in cerebrospinal fluid (CSF) were higher with enterovirus (565/μL) compared with Bb infection (191/μL; P < 0.01) or unknown causes (258/μL; P < 0.01). Further, CSF mean mononuclear cell proportion was higher in patients with Bb (89%) than in those with enterovirus infection (51%; P < 0.01) or unknown causes (60%; P < 0.01). Mean time interval between onset of disease and admission to hospital showed significant differences between Bb (7.6 days) and enterovirus infection (2.8 days; P < 0.01) or unknown causes (2.0 days; P < 0.01).

Conclusions: Time interval between onset of disease and hospital admission and CSF characteristics can contribute to distinguishing the etiology of aseptic meningitis with or without PFNP. As expected, the most common etiology for aseptic meningitis with PFNP was Bb infection whereas enterovirus infection was the predominant cause for aseptic meningitis alone.


From the *Division of Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland; and †Division of Clinical Microbiology, Institute for Medical Microbiology, University of Basel, Basel, Switzerland.

Accepted for publication September 30, 2009.

Address for correspondence: Ulrich Heininger, MD, University Children's Hospital (UKBB), PO Box; CH-4005 Basel, Switzerland. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.