Viral meningitides correspond to a relatively common and self-limited type of CNS infection clinically diagnosed based on the cerebrospinal fluid analysis and proportionally more frequent in young children than adults. Enteroviruses represent nowadays the most common cause of viral meningitis for all ages in the developed world.
For viral infection of the brain parenchyma, please refer to the general article on viral encephalitides.
Aseptic meningitis is a term frequently used as a synonym for viral meningitis, nonetheless, to avoid misleading interpretations, we prefer to save this term only for those noninfective inflammatory processes involving the meninges (e.g. leptomeningeal carcinomatosis, sarcoidosis, vasculitis, and connective tissue diseases).
Viral meningitides are more common in young children, particularly in those with less than one year or between 5 to 10 years.
After a long term period since the implementation of highly effective conjugate vaccines, there has been a significant change in the aetiology and the incidence and hospital admissions for viral meningitis have dropped 1,3.
Classically, patients present with fevers and clinical signs of meningeal irritation (e.g. neck stiffness, Brudzinski sign). Other nonspecific symptoms such as vomiting, headache, anorexia, exanthems, and myalgia may be also associated. As most of the viral infections start affecting the mucosa of the respiratory or gastrointestinal tracts, symptoms involving these organs may be present 4,5.
Neurologic dysfunction (e.g. altered state of consciousness, cranial nerve palsies, abnormal reflexes, and paralysis) is not a feature of meningitis and its presence should alert to a mixed picture with also the involvement of the brain parenchyma, meningoencephalitis 4.
Most viral infections will primarily affect the respiratory and gastrointestinal tracts, as the are either inhaled (e.g. measles, mumps) or ingested (e.g. enteroviruses), and thus will have their replication in the regional lymph nodes or small bowel lymphoid tissues. From the secondary lymphoid tissues, the viruses get into the blood stream resulting in systemic infection and subsequent seeding of other organs 5.
- enteroviruses 1-5
- represent ~90% of cases of viral meningitis
- genus Enterovirus (family Picornaviridae) includes 5
- 3 polioviruses
- 28 echoviruses
- 23 group A coxsackieviruses
- 6 group B coxsackieviruses
- 4 numbered enteroviruses
- respiratory and fecal-oral transmission
- human parechoviruses
- herpesviruses (family Herpesviridae)
- herpes simplex viruses (HSV)
- HSV 1
- HSV 2
- varicella-zoster virus (VZV)
- human herpesvirus (HHV) 6 and 7
- Epstein-Barr virus (EBV)
- cytomegalovirus (CMV)
- herpes simplex viruses (HSV)
- arboviruses ( a group of virus transmitted by the bite of an insect or arthropod
Treatment and prognosis
Most cases require only supportive management 1,3.
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- 2. Maller VV, Bathla G, Moritani T, Helton KJ. Imaging in viral infections of the central nervous system: can images speak for an acutely ill brain?. Emergency radiology. 24 (3): 287-300. doi:10.1007/s10140-016-1463-5 - Pubmed
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- 4. Romero JR, Newland JG. Viral meningitis and encephalitis: traditional and emerging viral agents. Seminars in pediatric infectious diseases. 14 (2): 72-82. doi:10.1053/spid.2003.127223 - Pubmed
- 5. Swanson PA, McGavern DB. Viral diseases of the central nervous system. Current opinion in virology. 11: 44-54. doi:10.1016/j.coviro.2014.12.009 - Pubmed