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viral meningitis

see meningitis Etiology: - meningitis due to viral infection - Herpes simplex type 2 (HSV2) - more common cause of meningitis than Herpes simplex type 1 (HSV1) - HSV1 more commonly associated with viral encephalitis - occurs year round - enterovirus (< 34 years of age) between May & Nov [2,4,6] - arbovirus [2] - dengue virus - HIV1 - Herpes zoster - West Nile virus - other viruses - mumps virus, lymphocytic choriomeningitis virus, parainfluenza virus, influenza A virus, influenza B virus, measles, rubella, poliovirus, rotavirus, parvovirus B19 Clinical manifestations: - headache, fever, nuchal rigidity, photophobia, nausea/vomiting - Enterovirus - pharyngitis, myalgias, rash, cough [2] - Herpes simplex - genital lesions generally precede or accompany the onset of viral meningitis due to HSV2 - shingles rash often occurs after onset of meningitis [5] - parotitis or orchitis with mumps virus [2] - rash, pharyngitis with HIV1 [2] - West Nile virus may present with acute flaccid paralysis Laboratory: lumbar puncture - opening pressure < 250 mm Hg - CSF analysis - no growth on cultures - negative gram stain - latex agglutination for bacterial antigens is negative - WBC < 1000/mm3, generally < 100/mm3, predominantly lymphocytes - CSF protein normal to slightly elevated - 130-180 mg/dL is not uncommon - < 200 mg/dL - CSF glucose normal to slightly decreased (> 40-45 mg/dL) - rapid viral testing - enterovirus nucleic acid - Herpes simplex virus DNA - repeat in 1 week if negative & HSV suspected Differential diagnosis: - viral encephalitis Management: - most children with viral meningitis do not need hospitalization - viral meningitis requires only supportive care - empiric antibiotics given only until CSF cultures exclude bacterial meningitis [2] - dexamethasone given for suspected bacterial meningitis not associated with worse outcomes when cause of meningitis is viral [7] - Herpes simplex encephalitis is treated with acyclovir [2] - acyclovir for herpes simplex - prognosis: - substantial proportion of patients with moderate disability at hospital discharge, especially female patients [6] - long-term prognosis is good [6]

Related

viral encephalitis

Specific

Mollaret's meningitis (benign recurrent lymphocytic meningitis) viral meningoencephalitis

General

meningitis viral infection

References

  1. Nigrovic LE et al. Trends in the management of viral meningitis at United States children's hospitals. Pediatrics 2013 Apr 1; 131:670. PMID: 23530164
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
  3. Davis LE. Acute and recurrent viral meningitis. Curr Treat Options Neurol. 2008 May;10(3):168-77. PMID: 18579020
  4. Patriquin G, Hatchette J, Forward K. Clinical presentation of patients with aseptic meningitis, factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing. Can J Infect Dis Med Microbiol. 2012 Spring;23(1):e1-5. PMID: 23448849
  5. Ihekwaba UK, Kudesia G, McKendrick MW. Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections. Clin Infect Dis. 2008 Sep 15;47(6):783-9 PMID: 18680414
  6. Bodilsen J, Mens H, Midgley S et al. Enterovirus meningitis in adults: A prospective nationwide population-based cohort study. Neurology 2021 Aug 3; 97:e454 PMID: 34088872 https://n.neurology.org/content/97/5/e454
  7. Petersen PT, Bodilsen J, Jepsen MPG et al. Dexamethasone in adults with viral meningitis: An observational cohort study. Clin Microbiol Infect 2024 Aug 28:S1198-743X(24)00414-2. PMID: 39182578 Free article. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(24)00414-2/fulltext