Viral meningitis: Causes, Symptoms, Daignosis & Treatments
Causes & Symptoms
When we look at viral meningitis, symptoms are similar to bacterial meningitis, but they are usually much weaker. Neurological symptoms may be relatively low or absent. However, in neonates, herpes simplex virus meningitis is associated with a higher risk of severe systemic diseases such as pneumonia, hepatitis, and myocarditis. When infected with enteroviruses (poliovirus, coxsackievirus, echovirus, numbered enteroviruses), which are the most common cause of viral meningitis, sudden fever of 38 ~ 40 ℃ occurs in more than half of cases. In addition, if the child has symptoms such as conjunctivitis, pharyngitis, rash, and wrist disease, enterovirus may be suspected. Herpes simplex virus, arbovirus, lymphocytic choriomeningitis virus, influenza virus, and mumps virus.
Diagnosis
The Bacterial Meningitis Score (BMS) can be used to predict if the cause is due to the virus. CSF pleocytosis (WBC count ≥10 cells / μL for CSF) In children who have not received antibiotic treatment before, we can conclude that it is very unlikely to be bacterial meningitis if the following conditions are not met: "Positive CSF Gram stain , CSF absolute neutrophil count (ANC) ≥1000 cells / μL, CSF protein of ≥80 mg / dL, peripheral blood ANC of ≥10,000 cells / μL, History of seizure before or at the time of presentation. CSF WBC count <500 / μL, mononuclear cells> 50%, CSF protein <80-100 mg / dL (not exceeding 150 mg / dL) and normal or slightly reduced CSF glucose may be suspected of viral meningitis rather than bacterial, Since there is overlap between bacterial and viral on the CSF results (especially in the early stages of the disease), this alone can not be reliably distinguished. Therefore, the diagnosis of viral meningitis is made through bacterial culture negative results and virus detection through PCR, culture, antigen detection or serology. WBC count of CSF may be normal in young infants with enteroviral meningitis.
Treatments
Most viral meningitis can be solved only by conservative treatment. Relief, fluid supply, antipyretics, analgesics and anti-inflammatory drugs are prescribed (mainly acetaminophen). However, in the case of less than 3 months of age, severe disease, or immunocompromised patients, empirical antibiotics should be used even though the viral is suspected until the test results are obtained. In the case of meningitis due to herpes simplex virus, acyclovir is used in immunocompromised or encephalitis patients. Most viral meningitis patients recover completely. In particular, enteroviral meningitis is usually benign, leaving little aftereffects. The cause of meningitis must be clearly distinguished so that bacterial meningitis can be ruled out and proper treatment can be started immediately to prevent neurological sequelae.
When we look at viral meningitis, symptoms are similar to bacterial meningitis, but they are usually much weaker. Neurological symptoms may be relatively low or absent. However, in neonates, herpes simplex virus meningitis is associated with a higher risk of severe systemic diseases such as pneumonia, hepatitis, and myocarditis. When infected with enteroviruses (poliovirus, coxsackievirus, echovirus, numbered enteroviruses), which are the most common cause of viral meningitis, sudden fever of 38 ~ 40 ℃ occurs in more than half of cases. In addition, if the child has symptoms such as conjunctivitis, pharyngitis, rash, and wrist disease, enterovirus may be suspected. Herpes simplex virus, arbovirus, lymphocytic choriomeningitis virus, influenza virus, and mumps virus.
Diagnosis
The Bacterial Meningitis Score (BMS) can be used to predict if the cause is due to the virus. CSF pleocytosis (WBC count ≥10 cells / μL for CSF) In children who have not received antibiotic treatment before, we can conclude that it is very unlikely to be bacterial meningitis if the following conditions are not met: "Positive CSF Gram stain , CSF absolute neutrophil count (ANC) ≥1000 cells / μL, CSF protein of ≥80 mg / dL, peripheral blood ANC of ≥10,000 cells / μL, History of seizure before or at the time of presentation. CSF WBC count <500 / μL, mononuclear cells> 50%, CSF protein <80-100 mg / dL (not exceeding 150 mg / dL) and normal or slightly reduced CSF glucose may be suspected of viral meningitis rather than bacterial, Since there is overlap between bacterial and viral on the CSF results (especially in the early stages of the disease), this alone can not be reliably distinguished. Therefore, the diagnosis of viral meningitis is made through bacterial culture negative results and virus detection through PCR, culture, antigen detection or serology. WBC count of CSF may be normal in young infants with enteroviral meningitis.
Treatments
Most viral meningitis can be solved only by conservative treatment. Relief, fluid supply, antipyretics, analgesics and anti-inflammatory drugs are prescribed (mainly acetaminophen). However, in the case of less than 3 months of age, severe disease, or immunocompromised patients, empirical antibiotics should be used even though the viral is suspected until the test results are obtained. In the case of meningitis due to herpes simplex virus, acyclovir is used in immunocompromised or encephalitis patients. Most viral meningitis patients recover completely. In particular, enteroviral meningitis is usually benign, leaving little aftereffects. The cause of meningitis must be clearly distinguished so that bacterial meningitis can be ruled out and proper treatment can be started immediately to prevent neurological sequelae.
