Diagnostic Considerations
Aseptic meningitis
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Noninfectious
Sarcoidosis
Nonsteroidal anti-inflammatory drug (NSAID) use
Intravenous immunoglobulin (IVIG) use
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Infectious
Partially treated bacterial meningitis
Viruses (eg, HIV, lymphocytic choriomeningitis virus, adenovirus)
Encephalitis
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Arboviruses
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Herpes simplex virus (HSV)
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Lymphocytic choriomeningitis virus
Myopericarditis
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Adenovirus
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Influenza A virus
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Mumps virus
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Epstein-Barr virus (EBV)
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Varicella-zoster virus (VZV)
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Measles
Exanthems
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HFMD
Herpes simplex: Patients are more ill, have higher fever and cervical adenopathy, and have no lesions on extremities.
VZV: Patients are also more ill, rarely have oral lesions, and the palms of the hands and soles of the feet are rarely affected.
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Herpangina
Other viral causes of pharyngitis and bacterial tonsillitis: These do not produce vesicular lesions.
Primary herpetic gingivostomatitis: Gingivitis is prominent, and systemic toxicity and cervical lymphadenitis are present; scrapings of lesions do not reveal giant cells or intranuclear inclusions.
HFMD: These lesions also occur on extremities.
Aphthous stomatitis: Lesions tend to be larger and occur in older children and adults.
Epidemic pleurodynia
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Pulmonary infarct
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Early zoster infection
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Acute abdomen
Acute hemorrhagic conjunctivitis
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Adenovirus causing keratoconjunctivitis: The incubation period is 1-3 weeks, whereas the incubation period is 1 day with acute hemorrhagic conjunctivitis (AHC). In addition, subconjunctival hemorrhage is usually not observed with keratoconjunctivitis.
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Bacterial or chlamydial conjunctivitis must be considered, but these conditions usually do not cause an extensive outbreak.