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Viral Meningitis

Aseptic Meningitis

Viral meningitis, as the name suggests, is a viral disease that causes inflammation of the meninges which are essentially membranes that cover the brain and the spinal cord. Individuals with poor immune system are more prone to develop viral infections [1].


Presentation

The symptoms of viral meningitis often mimic those of bacterial meningitis. It is therefore required that individuals seek immediate medical attention whenever they notice preliminary signs and symptoms of the condition. Children infected with viral meningitis suffer from fever, reduced appetite, become irritable and lethargic. Children also experience extreme sleepiness so much so that it gets difficult to wake them up [6].

Adults with viral meningitis suffer from high fever along with severe headache, irritability, confusion, stiffness in neck and loss of appetite. Affected individuals also exhibit intolerance towards bright light and also experience extreme state of sleepiness.

Fever
  • Enteric fevers are caused by invasive strains of Salmonella. Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C.[ncbi.nlm.nih.gov]
  • The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases.[ncbi.nlm.nih.gov]
  • Symptoms commonly include headache , fever , sensitivity to light , and neck stiffness .[en.wikipedia.org]
  • Louis encephalitis virus, eastern and western equine viruses, varicella-zoster virus), as well as several of the less common (Powassan virus, lymphocytic choriomeningitis virus, Colorado tick fever virus, rabies virus, influenza viruses, etc.) and emerging[ncbi.nlm.nih.gov]
  • A 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia.[ncbi.nlm.nih.gov]
Fatigue
  • For the 159 patients and controls the prevalence of chronic fatigue syndrome was 12.6%, a rate higher than previously reported from primary care attenders, suggesting that moderate to severe viral infections may play a part in the aetiology of some fatigue[ncbi.nlm.nih.gov]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: November 30, 2018[patientslikeme.com]
  • Mumps virus Herpes simplex and varicella viruses Lymphocytic choriomeningitis virus Adenovirus Measles HIV Signs and Symptoms Sudden headache Vomiting Fever Confusion Stiff neck Photophobia (eyes sensitive to bright light) Nausea Fatigue Rash Sore throat[deputyprimeminister.gov.mt]
  • Health officials say symptoms of viral meningitis are often similar to those of the flu - fever, headache, stiff neck, fatigue, rash, sore throat and intestinal problems. No unusual rate of absenteeism has been reported at the school, Neilitz said.[waow.com]
  • The symptoms may include fever, headache, stiff neck, and fatigue, rash, sore throat and intestinal symptoms may also occur. How soon after infection do symptoms appear? Symptoms generally appear within one week of exposure.[www1.nyc.gov]
Malaise
  • The presence of headache, neck pain, and malaise was similar for the two groups, but the duration of these symptoms was significantly longer among LM patients. Five children with LM had cranial neuropathies.[ncbi.nlm.nih.gov]
  • It usually has a short uncomplicated course characterized by malaise, fever, headache, stiffness of neck and back, and nausea.[medical-dictionary.thefreedictionary.com]
  • Malaise 6. Drowsiness 7. Sore throat 8. Myalgia 9. Nausea 10. Vomiting There may also be (but not commonly): 11. Photophobia 12. Tinnitus (noise in the ears) 13. Vertigo 14. Chest and abdominal pain 15.[atsu.edu]
  • ., malaise, myalgia, anorexia, nausea, abdominal pain, diarrhea-may accompany fever. Mild lethargy is common. Occurrence of stupor, marked confusion or coma is rare, and these symptoms generally are not indicative of a meningitis with a viral cause.[nursing.advanceweb.com]
  • Systemic flu-like symptoms before hospital admission in patients with enterovirus infection included sore throat and myalgia (in 8 patients), malaise (4), diarrhea (3), and abdominal discomfort (2).[cid.oxfordjournals.org]
Vomiting
  • An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism.[ncbi.nlm.nih.gov]
  • Fever (83%), headache (70%) and vomiting (67%) were the most prominent symptoms with signs of meningeal irritation recorded in 67% of the patients.[ncbi.nlm.nih.gov]
  • The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases.[ncbi.nlm.nih.gov]
  • Rates of headache, photophobia, nuchal rigidity, vomiting, and administration of intravenous fluids in the Emergency Department were no different between admitted and discharged patients.[ncbi.nlm.nih.gov]
  • A large majority of the EV-positive patients experienced fever, headache, vomiting, and neck stiffness. Some patients also showed cold symptoms, sore throat, altered mental status, and seizures.[ncbi.nlm.nih.gov]
Nausea
  • Bacterial meningitis typically begins with headache, nausea and vomiting, stiff neck (nuchal rigidity), and chills and fever.[medical-dictionary.thefreedictionary.com]
  • Symptoms may include a headache, nausea or vomiting, fever, generally feeling unwell, neck stiffness, discomfort with bright lights, joint aches and pains, muscle aches, drowsiness or confusion, and sometimes a rash or sore throat, stomach pains or diarrhoea[conditions.health.qld.gov.au]
  • Viral meningitis typically involves severe headaches, fevers, nausea, vomiting and sometimes dehydration, according to director David McBride, the director of the University of Maryland Health Center.[nbcwashington.com]
  • Mumps virus Herpes simplex and varicella viruses Lymphocytic choriomeningitis virus Adenovirus Measles HIV Signs and Symptoms Sudden headache Vomiting Fever Confusion Stiff neck Photophobia (eyes sensitive to bright light) Nausea Fatigue Rash Sore throat[deputyprimeminister.gov.mt]
Loss of Appetite
  • Many people with viral meningitis experience non-specific symptoms such as vomiting, cough, diarrhea, loss of appetite, and rash. Many such cases are mistaken as influenza (flu).[encyclopedia.com]
  • The most common symptoms of meningitis are fever , headache , vomiting , loss of appetite, tiredness, drowsiness or altered consciousness, irritability, stiff neck and sensitivity to light. Some people with meningitis can have seizures .[healthdirect.gov.au]
Neck Pain
  • The patient experienced near-complete resolution of his symptoms, his only residual complaint being that of neck pain with head movement.[ncbi.nlm.nih.gov]
  • A 30-year-old Caucasian woman, without significant medical history or immunosuppression, presented with a 7-day history of severe headache and neck pain.[ncbi.nlm.nih.gov]
  • The presence of headache, neck pain, and malaise was similar for the two groups, but the duration of these symptoms was significantly longer among LM patients. Five children with LM had cranial neuropathies.[ncbi.nlm.nih.gov]
  • Your child may have symptoms such as fever, headache, neck pain or stiffness, pain when looking at bright lights, nausea, vomiting, poor appetite, tiredness and sleepiness.[ncbi.nlm.nih.gov]
  • Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation.[fpnotebook.com]
Myalgia
  • […] virus Herpes simplex and varicella viruses Lymphocytic choriomeningitis virus Adenovirus Measles HIV Signs and Symptoms Sudden headache Vomiting Fever Confusion Stiff neck Photophobia (eyes sensitive to bright light) Nausea Fatigue Rash Sore throat Myalgia[deputyprimeminister.gov.mt]
  • Other nonspecific symptoms such as vomiting, headache, anorexia, exanthems, and myalgia may be also associated.[radiopaedia.org]
  • Myalgia 9. Nausea 10. Vomiting There may also be (but not commonly): 11. Photophobia 12. Tinnitus (noise in the ears) 13. Vertigo 14. Chest and abdominal pain 15.[atsu.edu]
  • Constitutional symptoms-e.g., malaise, myalgia, anorexia, nausea, abdominal pain, diarrhea-may accompany fever. Mild lethargy is common.[nursing.advanceweb.com]
  • Patients with VZV infection had prior symptoms recorded, including myalgia (in 2 patients), diarrhea (1), and scalp tenderness (1).[cid.oxfordjournals.org]
Low Back Pain
  • In 2012, fungal meningitis was linked to a contamination in a specific steroid product, methylprednisolone , manufactured in a single pharmacy and injected in the spine of people suffering from low back pain .[emedicinehealth.com]
Photophobia
  • An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism.[ncbi.nlm.nih.gov]
  • Rates of headache, photophobia, nuchal rigidity, vomiting, and administration of intravenous fluids in the Emergency Department were no different between admitted and discharged patients.[ncbi.nlm.nih.gov]
  • Mumps virus Herpes simplex and varicella viruses Lymphocytic choriomeningitis virus Adenovirus Measles HIV Signs and Symptoms Sudden headache Vomiting Fever Confusion Stiff neck Photophobia (eyes sensitive to bright light) Nausea Fatigue Rash Sore throat[deputyprimeminister.gov.mt]
  • Symptoms include: headache fever vomiting neck stiffness and joint pains drowsiness (excessive sleepiness) or confusion photophobia (discomfort on looking at bright lights).[sahealth.sa.gov.au]
  • Photophobia 12. Tinnitus (noise in the ears) 13. Vertigo 14. Chest and abdominal pain 15. Paresthesia (abnormal sensation) Nuchal rigidity develops and there are almost always stiffness of the back and pain on flexion.[atsu.edu]
Diplopia
  • A 43-year-old woman who reported diplopia and headache was found to have comitant esotropia at distance fixation and normal alignment at reading distance (divergence paralysis).[ncbi.nlm.nih.gov]
  • A 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia.[ncbi.nlm.nih.gov]
  • This patient manifested with variable symptoms including fever, headache, diplopia, vertigo, confusion, and ataxia.[bmcneurol.biomedcentral.com]
  • Viral meningitis can present with visual problems, like diplopia (double vision) or esotropia (one or both eyes turned inward), or divergence paralysis.[livestrong.com]
Eye Pain
  • Any of the following may develop within a few hours to a few days: A high fever, stiff neck, and a severe headache Neck pain or the chills Nausea or vomiting Red or purple rash Eye pain when your child looks into bright lights Sleepiness or confusion[drugs.com]
  • Symptoms of meningitis Meningitis is commonly manifested by: severe headache vomiting high fever stiffness of the neck sensitivity and eye pain on exposure to light skin rash Symptoms can differ in young children and babies.[news-medical.net]
Chemosis
  • A 24-year-old male was admitted to our institute because of periorbital pain, decreased vision, pulsatile tinnitus, chemosis, and exophthalmos on the right side after he had suffered viral meningitis four months before.[ncbi.nlm.nih.gov]
Meningism
  • The normal cytokine levels in meningism may possibly reflect the lack of direct viral infection and may be helpful in differentiating both meningism and viral meningitis at an early stage.[ncbi.nlm.nih.gov]
  • Viral meningitis Synonyms Aseptic meningitis Viral meningitis causes inflammation of the meninges Specialty Neurology Viral meningitis , also known as aseptic meningitis , is a type of meningitis due to a viral infection .[en.wikipedia.org]
  • The incidence per 10,000 children in rural and urban regions, respectively, was as follows: meningitis, 1.13 and 8.99; bacterial meningitis, 0.16 and 2.40; suspected bacterial meningitis, 0.52 and 3.00; and viral meningitis, 0.44 and 3.58.[ncbi.nlm.nih.gov]
  • Three hundred twenty-five consecutive patients with CSF culture-proven bacterial meningitis, for whom Gram stain was negative in 55 cases, and 182 children with proven or presumed viral meningitis.[ncbi.nlm.nih.gov]
  • Even in an era when cases of viral meningitis outnumber bacterial meningitis by at least 25:1, most patients with clinical meningitis are hospitalized.[ncbi.nlm.nih.gov]
Headache
  • A 33-yr-old man came to the emergency department with the chief complaint of a severe headache and decreased sensation in his right hand following a deep dive on scuba.[ncbi.nlm.nih.gov]
  • The patient was presumed to have tension headache versus migraine, but was admitted because her symptoms did not resolve.[ncbi.nlm.nih.gov]
  • The five patients with meningism all showed fever and meningeal signs such as severe headache and nuchal stiffness without CSF pleocytosis ( 5 cells/mm3).[ncbi.nlm.nih.gov]
  • Symptoms commonly include headache , fever , sensitivity to light , and neck stiffness .[en.wikipedia.org]
Confusion
  • A 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia.[ncbi.nlm.nih.gov]
  • This patient manifested with variable symptoms including fever, headache, diplopia, vertigo, confusion, and ataxia.[bmcneurol.biomedcentral.com]
  • Symptoms may include a headache, nausea or vomiting, fever, generally feeling unwell, neck stiffness, discomfort with bright lights, joint aches and pains, muscle aches, drowsiness or confusion, and sometimes a rash or sore throat, stomach pains or diarrhoea[conditions.health.qld.gov.au]
  • Mumps virus Herpes simplex and varicella viruses Lymphocytic choriomeningitis virus Adenovirus Measles HIV Signs and Symptoms Sudden headache Vomiting Fever Confusion Stiff neck Photophobia (eyes sensitive to bright light) Nausea Fatigue Rash Sore throat[deputyprimeminister.gov.mt]
  • Symptoms include fever, severe headache, stiff neck, bright lights hurt the eyes, drowsiness, confusion, and nausea and vomiting. In babies, the symptoms are more difficult to identify.[medicinenet.com]
Neck Stiffness
  • Neck stiffness was absent in 28.6% cases.[ncbi.nlm.nih.gov]
  • Symptoms commonly include headache , fever , sensitivity to light , and neck stiffness .[en.wikipedia.org]
  • A large majority of the EV-positive patients experienced fever, headache, vomiting, and neck stiffness. Some patients also showed cold symptoms, sore throat, altered mental status, and seizures.[ncbi.nlm.nih.gov]
  • Symptoms may include a headache, nausea or vomiting, fever, generally feeling unwell, neck stiffness, discomfort with bright lights, joint aches and pains, muscle aches, drowsiness or confusion, and sometimes a rash or sore throat, stomach pains or diarrhoea[conditions.health.qld.gov.au]
  • Symptoms include: headache fever vomiting neck stiffness and joint pains drowsiness (excessive sleepiness) or confusion photophobia (discomfort on looking at bright lights).[sahealth.sa.gov.au]
Altered Mental Status
  • Some patients also showed cold symptoms, sore throat, altered mental status, and seizures. We did not observe a higher fatality rate in children with E6 or E30 infection. Most of the patients recovered uneventfully.[ncbi.nlm.nih.gov]
  • Louis or California group encephalitis viruses may not exhibit any neurologic signs or altered mental status. St.[emedicine.medscape.com]
  • Perhaps the most helpful finding was that 95% of patients who had meningitis had at least two of the classic findings of fever, neck stiffness, and altered mental status/headache, and that 99-100% had at least one such finding.[emlyceum.com]
  • There are often other symptoms, such as Nausea Vomiting Photophobia (increased sensitivity to light) Altered mental status (confusion) In newborns and babies, the meningitis symptoms of fever, headache, and neck stiffness may be absent or difficult to[cdc.gov]

Workup

Diagnosis of viral meningitis involves evaluation of routine chemical parameters and hematological tests. Arterial blood gas analysis, liver function tests and coagulation studies are carried out in children suspected of viral meningitis. In addition, swabs from nasooropharyngeal route and rectum are tested for the type of virus present. The blood and stool samples are also collected for analysis of the condition. Cerebrospinal fluid (CSF) may also be tested for HIV and CMV [7] [8].

Treatment

Treatment of viral meningitis involves administration of medications to relieve fever and other related symptoms. No specific kind of antiviral agents are prescribed until the causative agent identified is herpes virus. In majority of the cases, individuals should do well within 7 to 10 days and usually hospital admission is not required until the patient is serious or has a low immunity profile. Affected individuals are advised to take plenty of rest and drink fluids as much as possible. These along with medications are the only available treatment for viral meningitis [9].

Prognosis

The prognosis of the disease condition is usually favorable and majority of the individuals tend to recover within 7 to 10 days. However, if viral meningitis has affected the infants or young children then the outcome can be fatal and can be a significant cause of morbidity.

Etiology

Enteroviruses such as echovirus, enterovirus 71, coxsackie A virus and poliovirus are the major causative agents of viral meningitis. In addition to these types, some other groups of viruses are also known to play a role, which include mumps virus, human immunodeficiency virus (HIV), measles virus, West Nile virus, St. Louis Encephalitis virus, Herpes simplex virus, Epstein-Barr virus, La Cross virus and Lymphocytic choriomeningitis virus [3].

Epidemiology

The exact incidence of viral meningitis is unknown due to underreporting of the cases. According to the CDC, there are estimated 25,000 to 50,000 cases of hospitalization each year due to viral meningitis. In addition, it has also been reported that 10,000 cases of viral meningitis occur globally; but the actual number of cases is more than 75,000. Based on the WHO reports, in the year 1997, enteroviral meningitis along with sepsis was recorded to be the 5th most frequent cause of neonatal mortality [4].

Sex distribution
Age distribution

Pathophysiology

Viral meningitis is basically an infectious disease wherein the virus is spread through contact with the infected person. Enteroviruses are more commonly transmitted through the fecal route. Such a type of contamination can occur during diaper change or using the same toilet of an infected person without disinfecting it. Failure to wash hands properly after using toilet can also make individuals susceptible to contract enterovirus infections. In addition to fecal contamination, the virus can spread from respiratory secretions such as saliva, mucus or sputum of a person infected with the virus [5].

Prevention

Many cases of viral meningitis cannot be prevented. Also, no vaccinations exist for the common viruses that cause the disease. Thus, the best way to prevent development of new cases is to stop the spread of the infection. The following steps can be taken to prevent the spread of viral meningitis:

  • It is necessary to minimize contact with infected persons.
  • Hand washing after diaper changing and using toilet should be made a habit.
  • It is also necessary to appropriately disinfect surfaces that are frequently touched. These include the door knobs and the television remote.
  • Certain vaccines are available which protect against specific viruses. Vaccination schedule designed for children can protect them from viral meningitis. The vaccines include MMR vaccine for mumps and measles and varicella-zoster vaccine for chickenpox [10].
  • Individuals are also advised to protect themselves from mosquito bites as they are considered to be good carriers of viral agents.

Summary

Viral meningitis also known as aseptic meningitis is a less severe condition than bacterial meningitis. Children and immunecompromised population are at increased risk of developing this condition [2]. There is usually no specific treatment regime that helps in warding off the virus from the body. Methods are employed to relieve the symptoms with medications and rest. Typically individuals show signs of improvement within 7 to 10 days.

Patient Information

Definition

Viral meningitis is a viral disease characterized by inflammation of the meninges. Majority of the incidence of this viral disease take place during the summer season. It has been estimated that in the year 1988 – 1999 about 36,000 new cases of viral meningitis occurred in the US.

Cause

Enteroviruses are the major causative agent for viral meningitis. In addition, other type of viral infections can also lead to development of such a type of disease condition. These infections include mumps, measles, herpes simplex, influenza, arboviruses and lymphocytic choriomeningitis virus.

Symptoms

Symptoms of viral meningitis in children include high fever, poor appetite, irritability and extreme sleepiness. Adults who contract this viral infection suffer from severe fever accompanied by headache, stiffness in the neck, difficulty in waking up, nausea, vomiting and intolerance towards bright light.

Diagnosis

Diagnosis of viral meningitis includes testing of stool and blood samples for the type of viral agent. The swab samples of nose, saliva and rectum are also analyzed for the presence of virus. Arterial gas measurement and liver function test should be considered in severe cases of viral meningitis.

Treatment

Viral meningitis usually requires minimum treatment. Affected individuals begin to show improvement within 7 to 10 days. Antiviral agents are usually not prescribed if enteroviruses are the causative agent. Medications to relieve fever and associated symptoms along with plenty of rest are advised.

References

Article

  1. Rotbart H. Viral meningitis and the aseptic meningitis syndrome. In: Infections of the Central Nervous System, Scheld W, Whitley RJ, Durack DT (Eds), Raven, New York 1991. p.19.
  2. Newland JG, Shah SS, Zaoutis TE. The child with aseptic meningitis. Pediatr Case Rev 2003; 3:218.
  3. Hviid A, Rubin S, Mühlemann K. Mumps. Lancet. Mar 15 2008;371(9616):932-44
  4. Centers for Disease Control and Prevention (CDC). Outbreaks of aseptic meningitis associated with echoviruses 9 and 30 and preliminary surveillance reports on enterovirus activity--United States, 2003. MMWR Morb Mortal Wkly Rep 2003; 52:761.
  5. Johnson RT, Mims CA. Pathogenesis of viral infections of the nervous system. N Engl J Med 1968; 278:23.
  6. Landry ML, Greenwold J, Vikram HR. Herpes simplex type-2 meningitis: presentation and lack of standardized therapy. Am J Med. Jul 2009;122(7):688-91.
  7. King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics. Sep 2007;120(3):489-96.
  8. Ramers C, Billman G, Hartin M, et al. Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA 2000; 283:2680.
  9. Sawyer MH. Enterovirus infections: diagnosis and treatment. Semin Pediatr Infect Dis 2002; 13:40.
  10. Canada Communicable Disease Report. International Note: Global Advisory Committee on Vaccine Safety, 11-12 June, 2003. April 1, 2004.

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Last updated: 2018-06-22 08:27