Viral meningitis virus

It is most common in young children but is seen across all age groups. This activity reviews the evaluation and management of viral meningitis and explains the role of the interprofessional team in evaluating and treating patients with viral meningitis.

Objectives: Identify the common etiologies of viral meningitis. Review the typical presentation of patients with viral meningitis. Outline the treatment and management options available for viral meningitis. Describe interprofessional team strategies for improving care coordination and communication to advance the management of viral meningitis and improve outcomes. Access free multiple choice questions on this topic. Meningitis is the inflammation of the meninges with an associated abnormal cell count in the cerebrospinal fluid CSF.

Viral meningitis is usually a self-limiting illness with a good prognosis. Enteroviruses Coxsackie or Echovirus groups are the most common cause of viral meningitis across all age groups; parechoviruses are also common in children. Other viral causes include adenovirus, lymphocytic choriomeningitis virus LCMV , influenza, parainfluenza, and mumps. Viral meningitis most commonly occurs in young children, with the incidence decreasing with age. Vaccinations for Haemophilus influenza type B, Streptococcus pneumoniae , and Neisseria meningitidis have significantly decreased cases of bacterial meningitis.

In the United States, there are up to cases of enteroviral meningitis annually. Enteroviruses rank as the most common cause of viral meningitis in many places in the world, with up to 12 to 19 cases per population annually in some high-income countries. Mortality is higher in patients who are elderly, immunosuppressed, or have diabetes. Half of the patients with WNV encephalitis have long-term neurological or psychological sequelae.

VZV can cause viral meningitis, more commonly with reactivation than in primary infection. Varicella meningitis can occur without cutaneous lesions. HSV 1 and 2 can cause viral meningitis. HSV-1 is more commonly associated with sporadic encephalitis, while HSV-2 can cause a benign recurrent viral meningitis; meningitis usually occurs in the absence of genital lesions or a history of prior genital herpes infection.

It is more common in winter and early spring. It is more common in male patients. Meningitis is an inflammatory pathology of the meninges surrounding the brain. The clinical findings of viral meningitis can vary by age and immune status.

Young children may present with fever and irritability without evidence of meningeal irritation. In the initial presentation, there are no reliable clinical indicators to differentiate viral versus bacterial meningitis.

Older infants and children may have a biphasic fever, first peaking with systemic constitutional symptoms and a second febrile phase with the onset of neurological signs. Children with viral meningitis are more likely to have a fever, respiratory symptoms, and leukocytosis. It is important to obtain a travel history in patients with suspected viral meningitis, as many viruses have specific geographical distributions.

A lumbar puncture is necessary unless there are contraindications such as focal neurologic deficits, papilledema, recent seizures, age 60 or greater. Viral meningitis characteristically has a CSF mononuclear pleocytosis, although there may initially be a neutrophilic predominance. Serum white blood cell count and C-reactive protein do not reliably distinguish viral and bacterial meningitis.

Because of the lack of clinical findings to help distinguish between viral and bacterial meningitis and the risk of untreated bacterial meningitis, there has been much interest in identifying predictors of bacterial meningitis. The bacterial meningitis score BMS was originally developed for and validated in children with meningitis.

A positive Gram stain is worth 2 points, and the other predictors are worth 1 point each if present. In adults, researchers have studied individual predictors of bacterial rather than viral meningitis.

Most viruses causing meningitis have no specific treatment other than supportive care. Rash, sore throat and intestinal symptoms may also occur. Some of the enteroviruses that cause viral meningitis are contagious while others, such as mosquito-borne viruses, cannot be spread from person to person.

Fortunately, most people exposed to these viruses experience mild or no symptoms. Most people are exposed to these viruses at some time in their lives, but few actually develop meningitis. Strict isolation is not necessary.

Since most cases are due to enteroviruses that may be passed in the stool, people diagnosed with viral meningitis should be instructed to thoroughly wash their hands after using the toilet. Navigation menu. Who gets viral meningitis? Cytomegalovirus CMV. New York State Department of Health. October Antimicrobial Agents and Chemotherapy. July Meningitis and Encephalitis Fact Sheet.

National Institute of Neurological Disorders and Stroke. May 8, European Journal of Applied Sciences. Meningitis FAQs. Meningitis Now. Viral Meningitis Fact Sheet. Boston Public Health Commission. Health Topics. Health Tools. Reviewed: April 3, Prevalence of MDR pathogens of bacterial meningitis in Egypt and new synergistic antibiotic combinations.

Alzein K. Revision of meningitis surveillance system in Jordan during and years. Epidemiol sunnyvale ; 6 Epidemiology of different types of meningitis cases in gaza governorates, occupied Palestinian Territory, December —January J Antivir Antiretrovir.

Dumaidi K, Al-Jawabreh A. Haydar SM, et al. Adherence to international guidelines for the treatment of meningitis infections in Lebanon. Saudi Med J. Selim HS, et al. Microbial study of meningitis and encephalitis cases. J Egypt Public Health Assoc. Shaker OG, Abdelhamid N. Detection of enteroviruses in pediatric patients with aseptic meningitis. Clin Neurol Neurosurg.

Visintin C, et al. Management of bacterial meningitis and meningococcal septicaemia in children and young people: summary of NICE guidance.

Mehndiratta M, et al. Appraisal of Kernig's and Brudzinski's sign in meningitis. Ann Indian Acad Neurol. Waghdhare S, et al. Accuracy of physical signs for detecting meningitis: a hospital-based diagnostic accuracy study.

Infections of the nervous system. Irani DN. Aseptic meningitis and viral myelitis. Neurol Clin. Skin rash in meningitis and meningoencephalitis. Shukla B, et al. Aseptic meningitis in adults and children: diagnostic and management challenges. J Clin Virol. Iguchi M, et al. Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting. Cochrane Database Syst Rev. Butterworths, Boston.

PMID: Buch K, et al. Infect Dis Lond ; 50 7 — Cerebrospinal fluid analysis. Am Fam Physician. Characteristics of pediatric patients with enterovirus meningitis and no cerebral fluid pleocytosis.

Eur J Pediatr. Alhazmi A, et al. Paediatric enterovirus meningitis without cerebrospinal fluid pleocytosis. J Infect. Seiden JA, et al. Lack of cerebrospinal fluid pleocytosis in young infants with enterovirus infections of the central nervous system. Pediatr Emerg Care. Jaijakul S, et al. The clinical significance of neutrophilic pleocytosis in cerebrospinal fluid in patients with viral central nervous system infections. Verstrepen WA, et al. Rapid detection of enterovirus RNA in cerebrospinal fluid specimens with a novel single-tube real-time reverse transcription-PCR assay.

J Clin Microbiol. De Crom S, et al. Prospective comparison of the detection rates of human enterovirus and parechovirus RT-qPCR and viral culture in different pediatric specimens. Alhazmi A et al Repeated viral meningitis in a newborn.

J NeuroVirol 1—3 [ PubMed ]. Kupila L, et al. Diagnosis of enteroviral meningitis by use of polymerase chain reaction of cerebrospinal fluid, stool, and serum specimens.

Clin Infect Dis. Methods for rapid diagnosis of meningitis etiology in adults. Biomark Med. Kim JV, et al. Myelomonocytic cell recruitment causes fatal CNS vascular injury during acute viral meningitis. Persistence of neuroadapted mumps virus in brains of newborn hamsters after intraperitoneal inoculation.

J Infect Dis. Wong KT, et al. The distribution of inflammation and virus in human enterovirus 71 encephalomyelitis suggests possible viral spread by neural pathways. J Neuropathol Exp Neurol. Munster VJ, et al. Rapid Nipah virus entry into the central nervous system of hamsters via the olfactory route.

Sci Rep. Frei K, et al. Production of B cell stimulatory factor-2 and interferon gamma in the central nervous system during viral meningitis and encephalitis.

Evaluation in a murine model infection and in patients. J Exp Med. Ramilo O, et al. Am J Dis Child. Enteroviruses: a gut-wrenching game of entry, detection, and evasion. Akuzawa N, et al. Myocarditis, hepatitis, and pancreatitis in a patient with coxsackievirus A4 infection: a case report. Chapter 32—picornaviruses. Mereaux J, et al. Enterovirus infection during pregnancy: Underestimated cause of fetal and neonatal complications? Molecular pathogenicity of enteroviruses causing neurological disease.

Front Microbiol. Rotbart HA Viral meningitis. In: Seminars in neurology. Huang H-I, et al. Enterovirus 71 infects brain-derived neural progenitor cells. Puccini JM, et al. Distinct neural stem cell tropism, early immune activation, and choroid plexus pathology following coxsackievirus infection in the neonatal central nervous system. Lab Invest.

Brown DM, et al. Contemporary circulating enterovirus D68 strains have acquired the capacity for viral entry and replication in human neuronal cells. Palacios G, Oberste M. Enteroviruses as agents of emerging infectious diseases. J Neurovirol. Enterovirus and parechovirus infection in children: a brief overview. Berger JR, et al. Persistent coxsackie B encephalitis: report of a case and review of the literature. J NeuroVirol. Tabor-Godwin JM, et al. A novel population of myeloid cells responding to coxsackievirus infection assists in the dissemination of virus within the neonatal CNS.

J Neurosci. Neurotropic enterovirus infections in the central nervous system. Opavsky MA, et al. J Clin Investig.