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]

  Medications to relieve fever and associated symptoms along with plenty of rest are advised. [symptoma.com]

  Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation. [fpnotebook.com]

  At first, you may have no symptoms or symptoms similar to a cold or stomach virus, such as: Fever Cough Muscle aches Throwing up Not feeling hungry Later, you’ll have: Fever Headache Stiff neck that makes you unable to touch your chin to your chest or [merckmanuals.com]

• Fatigue

  […] some fatigue states. [ncbi.nlm.nih.gov]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [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]

  Nausea, vomiting and photophobia (light sensitivity) also commonly occur, as do general signs of a viral infection, such as muscle aches and malaise. [en.wikipedia.org]

  Viral meningitis usually begins with symptoms of a viral infection, such as fever, a general feeling of illness (malaise), cough, muscle aches, vomiting, loss of appetite, and headache. However, occasionally, people have no symptoms at first. [merckmanuals.com]

• Unconsciousness

  Unconscious patients with viral encephalitis may be in nonconvulsive status epilepticus, and EEG is used to reveal and monitor subclinical seizures. [emedicine.medscape.com]

  Jul 13, 2014 This guy last year was seemingly done in his profession, he didn't even know his own name after a lengthy spell unconscious but Dr. [tt.tennis-warehouse.com]

  They usually occur much more quickly in bacterial meningitis and, if untreated, can lead to unconsciousness. Meningitis Diagnosis A clinical and neurological examination can be used to diagnose meningitis. [healthcommunities.com]

  These are possible symptoms of meningoencephalitis: Headache Fever Neck stiffness Sensitivity to light Seizures Trouble thinking clearly Personality changes Hallucinations, visual and auditory Unusual behaviors Unconsciousness How is herpes meningoencephalitis [hopkinsmedicine.org]

• Cerebral Palsy

  CNS infections explained 7.6% of all deaths from 28 days to 14 years, 3% of the handicapping cases of cerebral palsy, mental retardation and epilepsy or some combination of these, and 6.6% of the hearing defects. [doi.org]

• Vomiting

  Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation. [fpnotebook.com]

  RESULTS: 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]

  Nausea and vomiting ↑ ICP stimulates the area postrema (vomiting centre), causing nausea and vomiting. Petechial rash Meningococcemia (due to N. meningitidis ) In the pediatric population, all of the above signs and symptoms are applicable. [pathophys.org]

• Nausea

  Nausea, vomiting and photophobia (light sensitivity) also commonly occur, as do general signs of a viral infection, such as muscle aches and malaise. [en.wikipedia.org]

  Bacterial meningitis typically begins with headache, nausea and vomiting, stiff neck (nuchal rigidity), and chills and fever. [medical-dictionary.thefreedictionary.com]

  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]

  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]

• Loss of Appetite

  General symptoms of aseptic meningitis in children and adults include: fever chills stomachache painful headache body aches sensitivity to light, or photophobia loss of appetite vomiting fatigue Infants and toddlers may show the following symptoms: fever [healthline.com]

  Adults with viral meningitis suffer from high fever along with severe headache, irritability, confusion, stiffness in neck and loss of appetite. [symptoma.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]

  Viral meningitis usually begins with symptoms of a viral infection, such as fever, a general feeling of illness (malaise), cough, muscle aches, vomiting, loss of appetite, and headache. However, occasionally, people have no symptoms at first. [merckmanuals.com]

• Abdominal Pain

  Chest and abdominal pain 15. Paresthesia (abnormal sensation) Nuchal rigidity develops and there are almost always stiffness of the back and pain on flexion. The Kernig and Brudzinski signs may or may not be elicited. Leukocyte count is normal. [atsu.edu]

  There may also be abdominal pain, aches and pains in muscles and joints. Sometimes viral meningitis causes confusion and altered consciousness. People with severe symptoms should seek medical assistance. [meningitis.ca]

  pain, stiffness of the neck and back, and a short uncomplicated course. [medical-dictionary.thefreedictionary.com]

  The characteristic presentation of West Nile fever is arthralgia, rash and fever [ 19 ], whilst Japanese B encephalitis may present with abdominal pain or nausea and vomiting. [academic.oup.com]

• Photophobia

  Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation. [fpnotebook.com]

  Abstract 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]

  Photophobia is due to meningeal irritation. [en.wikipedia.org]

  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]

• 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]

  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]

• 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]

  Symptoms and Signs of Viral Meningitis Viral meningitis, like acute bacterial meningitis, usually begins with symptoms that suggest viral infection (eg, fever, myalgias, gastrointestinal or respiratory symptoms), followed by symptoms and signs of meningitis [merckmanuals.com]

• Neck Pain

  Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation. [fpnotebook.com]

  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]

• 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]

• Meningism

  viral meningitis (diagnosis), Meningitis, Viral [Disease/Finding], aseptic meningitis viral, aseptic viral meningitis, meningitis - viral, meningitis viral, Meningitis viral NOS, Meningitis - viral NOS (disorder), Viral meningitis NOS (disorder), [X [fpnotebook.com]

  The condition is called aseptic meningitis when not caused by bacteria. Viruses cause most aseptic meningitis cases, which is why the condition is also known as viral meningitis. Aseptic meningitis is more common than bacterial meningitis. [healthline.com]

  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. [symptoma.com]

  Viral names the causative agent, and the term meningitis implies lack of parenchymal and spinal cord involvement (otherwise called encephalitis and myelitis, respectively). Viral meningitis is also often referred to as aseptic meningitis. [emedicine.medscape.com]

• 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]

  Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation. [fpnotebook.com]

• 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]

  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 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 characteristically presents with fever, headache and neck stiffness. Fever is the result of cytokines released that affect the thermoregulatory neurons of the hypothalamus. [en.wikipedia.org]

  If you have viral meningitis, symptoms may include fever, light sensitivity, headache, and a stiff neck. [hopkinsmedicine.org]

• 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]

  In severe cases, people may experience concomitant encephalitis (meningoencephalitis), which is suggested by symptoms such as altered mental status, seizures or focal neurologic deficits. [en.wikipedia.org]

  Altered mental status Decreased Glasgow Coma Scale (GCS) ↑ ICP → brain herniation → damage to the reticular formation (structure in the brainstem that governs consciousness) Focal neurological deficits, e.g. vision loss Examples: cranial nerve palsies [pathophys.org]

  Louis or California group encephalitis viruses may not exhibit any neurologic signs or altered mental status. St. [emedicine.medscape.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]

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 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].

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.

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].

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].

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].

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.

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.

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.

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3. Hviid A, Rubin S, Mühlemann K. Mumps. Lancet. Mar 15 2008;371(9616):932-44
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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.
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10. Canada Communicable Disease Report. International Note: Global Advisory Committee on Vaccine Safety, 11-12 June, 2003. April 1, 2004.