Communicable Diseases

Viral Meningitis

Identification

A relatively common but rarely serious clinical syndrome with multiple viral etiologies, characterized by sudden onset of febrile illness with signs and symptoms of meningeal involvement. CSF findings are pleocytosis (usually mononuclear, occasionally polymorphonuclear in early stages), increased protein, normal sugar and absence of bacteria. A rubella-like rash characterizes certain types caused by echoviruses and coxsackieviruses; vesicular and petechial rashes may also occur. Active illness seldom exceeds 10 days. Transient paresis and encephalitic manifestations may occur; paralysis is unusual. Residual signs lasting a year or more may include weakness, muscle spasm, insomnia and personality changes. Recovery is usually complete. GI and respiratory symptoms may be associated with enterovirus infection.

Various diseases caused by non-viral infectious agents may mimic aseptic meningitis: these include inadequately treated pyogenic meningitis, tuberculous and cryptococcal meningitis, meningitis caused by other fungi, cerebrovascular syphilis, and lymphogranuloma venereum. Post-infectious and post-vaccinal reactions require differentiation from sequelae to measles, mumps, varicella and immunization against rabies and smallpox; these syndromes are usually encephalitic in type. Leptospirosis, listeriosis, syphilis, lymphocytic choriomeningitis, viral hepatitis, infectious mononucleosis, influenza and other diseases may produce the same clinical syndrome, as discussed in the chapters dealing with those diseases.

Infection by enteroviruses transmitted from the mother is a frequent cause of neonatal fever with neurological signs. In countries that are polio-free, the most prevalent infectious agent causing paralysis is enterovirus 71, responsible for outbreaks of meningitis and paralysis in many countries. Children and adults with B cell deficiencies are subject to chronic relapsing meningitis, usually caused by enteroviruses.

Under optimal conditions, specific identification is possible in about half of all cases, through serological and isolation techniques. Viral agents may be isolated in early stages from throat washings and stool, occasionally from CSF and blood, and through cell culture techniques and animal inoculation. PCR identification in CSF (and stool for enteroviruses) yields a more rapid diagnosis and probes are available for the identification of most viruses.

Viral Meningitis has been found in Communicable Diseases

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