viral meningitis
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Introduction
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
- more common cause of meningitis than Herpes simplex type 1 (HSV1)
- enterovirus (< 34 years of age) between May & Nov[2][4][6]
- arbovirus[2]
- HIV1
- Herpes zoster
- West Nile virus
- other viruses
- Herpes simplex type 2 (HSV2)
Clinical manifestations
- headache, fever, nuchal rigidity, photophobia, nausea/vomiting
- Enterovirus
- 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
- 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
- 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
- no growth on cultures
Differential diagnosis
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]
- 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]
More general terms
More specific terms
Additional terms
References
- ↑ Nigrovic LE et al. Trends in the management of viral meningitis at United States children's hospitals. Pediatrics 2013 Apr 1; 131:670. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23530164
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ Davis LE. Acute and recurrent viral meningitis. Curr Treat Options Neurol. 2008 May;10(3):168-77. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18579020
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/23448849
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/18680414
- ↑ 6.0 6.1 6.2 6.3 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: https://www.ncbi.nlm.nih.gov/pubmed/34088872 https://n.neurology.org/content/97/5/e454