Observations on Progeny of Thalidomide-treated Male Rabbits
Authors: C. Lutwak-Mann
Journal: BMJ (1964)

Aseptic Meningitis-Klemola and Lapinleimu BRSHr seem to be uncommon both in our own experience and according to the literature, where we have been unable to find any reports of similar cases.A total of 450 patients with the diagnosis of aseptic meningitis were treated during 1952-62 at Aurora Hospital (formerly the Hospital for Infectious Diseases in Helsinki), which admits the majority of children and adults taken ill with meningitis in Helsinki.Three of the 450 patients suffered from aseptic meningitis on two or more occa- sions during this period.This incidence, 0.7%, can naturally be regarded as a minimum.The occurrence of two attacks of aseptic meningitis is not in itself extraordinary.But an explanation is required when, as with two of our patients, there are still further attacks.When this happens it is necessary to try very carefully to exclude all other possible diseases of the C.N.S. as well as bacterial para- meningeal infections.Nothing indicative of such diseases was found in our cases.It is, of course, regrettable that no carotid- angiography or pneumo-encephalography was performed on these patients.On the other hand, these procedures are not very readily undertaken when the disease is cured rapidly with- out sequelae.The histories indicated that these patients had no predisposition to infectious diseases.Electrophoresis showed normal amounts of gamma-globulins.Anyway, the patients with repeated attacks of aseptic meningitis in their history must have a special tendency toward such infections.However, we were unable to find any local or general reason for lowered resistance in these patients.A local congenital or acquired anatomical anomaly must nevertheless be seriously considered.Nor can the possibility be excluded that these individuals have some defect in their cell-bound defence mechanisms.A third possible explanation may be the development of hypersensitive (allergic) reactivity of the meningeal tissue to certain viral antigens. SummaryMultiple attacks of typical aseptic meningitis were established in four patients: in two adults, one three times and the other four times, and in two children, twice in each.The follow-up periods were 18 months to 11 years.The intervals between the individual attacks were from four months to eight years.An enterovirus isolation from the stools succeeded in 5 attacks out of 11: Coxsackie B5 three times, Coxsackie B2 once, and an untyped virus (E.C.H.O. 9?) once.Antibody responses indicated that the attacks may have been caused by the viruses isolated.In addition to the virus isolations, serological evidence of infection with E.C.H.O. 7was obtained in one attack.In two patients different viruses appeared to be responsible for the successive attacks of meningitis.No general or local cause was found for the predisposition towards aseptic meningitis in these patients.This investigation indicates that different viruses may be responsible for successive attacks of aseptic meningitis in the same individual.We express our gratitude to the following microbiologists who co-operated with us in clarifying the aetiology of meningitis: Dr.