Meningitis, Viral

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Basics

Description

  • A clinical syndrome characterized by fever with signs/symptoms of acute meningeal inflammation (including but not limited to headache, photophobia, neck stiffness, and/or nausea/vomiting)
  • Viral meningitis (VM) is the most common cause of aseptic (nonbacterial) meningitis.
  • System(s) affected: nervous

Epidemiology

Incidence

  • Estimated 75,000 VM cases caused by enterovirus annually in the United States
  • Most common form of meningitis
  • Peaks summer to fall in temperate climates (but is year round in subtropical or tropical climates)
    • Nonpolio enteroviruses are the most common cause of viral meningitis.

Etiology and Pathophysiology

  • In immunocompetent hosts, VM is a rare complication of an acute viral infection like gastroenteritis, mumps, HSV, VZV, and arthropod-borne viruses.
    • Case reports in the literature indicate that SARS-CoV-2 can also cause VM as a rare complication.
    • In immunocompromised hosts, viral pathogens may also include CMV and EBV.
  • 23–61% of VM cases are caused by nonpolio human enteroviruses. These viruses are typically transmitted via the fecal-oral route.
  • Mosquito-borne viruses include West Nile, Zika, chikungunya, dengue, St. Louis encephalitis virus, and Eastern equine encephalitis virus. Tick-borne viruses include Powassan virus, Colorado tick fever virus, tick-borne encephalitis virus.
  • Recurrent benign lymphocytic (Mollaret) meningitis is generally associated with HSV-2 (80% of cases).

Genetics
None identified

Risk Factors

  • Close contacts of people with VM are unlikely to get VM but may get the primary viral syndrome.
  • Age (most common in children <5 years)
    • Babies <1 month of age are more likely to have severe disease.
  • Immunocompromised host (patients more susceptible to CMV, HSV, and EBV)

Geriatric Considerations
Cases of VM in the elderly are rare (most common cause is VZV, HSV); consider alternative diagnoses (e.g., cancer, medication-induced aseptic meningitis).

General Prevention

  • Practice hand washing and general hygiene procedures.
  • Avoid sharing drinks/cups and silverware with others, especially those who are ill.
  • Avoid exposure to mosquitos and ticks; if outdoors, recommend use of appropriate clothing, DEET, and mosquito nets.

Commonly Associated Conditions

Encephalitis; myopericarditis; neonatal enteroviral sepsis; meningoencephalitis; flaccid paralysis

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Basics

Description

  • A clinical syndrome characterized by fever with signs/symptoms of acute meningeal inflammation (including but not limited to headache, photophobia, neck stiffness, and/or nausea/vomiting)
  • Viral meningitis (VM) is the most common cause of aseptic (nonbacterial) meningitis.
  • System(s) affected: nervous

Epidemiology

Incidence

  • Estimated 75,000 VM cases caused by enterovirus annually in the United States
  • Most common form of meningitis
  • Peaks summer to fall in temperate climates (but is year round in subtropical or tropical climates)
    • Nonpolio enteroviruses are the most common cause of viral meningitis.

Etiology and Pathophysiology

  • In immunocompetent hosts, VM is a rare complication of an acute viral infection like gastroenteritis, mumps, HSV, VZV, and arthropod-borne viruses.
    • Case reports in the literature indicate that SARS-CoV-2 can also cause VM as a rare complication.
    • In immunocompromised hosts, viral pathogens may also include CMV and EBV.
  • 23–61% of VM cases are caused by nonpolio human enteroviruses. These viruses are typically transmitted via the fecal-oral route.
  • Mosquito-borne viruses include West Nile, Zika, chikungunya, dengue, St. Louis encephalitis virus, and Eastern equine encephalitis virus. Tick-borne viruses include Powassan virus, Colorado tick fever virus, tick-borne encephalitis virus.
  • Recurrent benign lymphocytic (Mollaret) meningitis is generally associated with HSV-2 (80% of cases).

Genetics
None identified

Risk Factors

  • Close contacts of people with VM are unlikely to get VM but may get the primary viral syndrome.
  • Age (most common in children <5 years)
    • Babies <1 month of age are more likely to have severe disease.
  • Immunocompromised host (patients more susceptible to CMV, HSV, and EBV)

Geriatric Considerations
Cases of VM in the elderly are rare (most common cause is VZV, HSV); consider alternative diagnoses (e.g., cancer, medication-induced aseptic meningitis).

General Prevention

  • Practice hand washing and general hygiene procedures.
  • Avoid sharing drinks/cups and silverware with others, especially those who are ill.
  • Avoid exposure to mosquitos and ticks; if outdoors, recommend use of appropriate clothing, DEET, and mosquito nets.

Commonly Associated Conditions

Encephalitis; myopericarditis; neonatal enteroviral sepsis; meningoencephalitis; flaccid paralysis

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