Viral infections meningitis

Clinical features of acute aseptic meningitis

Fever Malaise Sore throat prodromal pi

Fever Malaise Sore throat prodromal pi

recovery 7-14 days signs:

Mild meningism Neck stiffness Kernig's sign + ve No focal signs

Parotitis ± Diarrhoea Myalgia

Skin rashes complications: Febrile seizures Inappropriate ADH secretion.

Enterovirus infection e.g. Coxsackie or echo viruses - affects children/young adults and occurs seasonally in late summer. Spread is by the faecal/oral route. Accounts for 80% of cases in USA. Mumps - affects children/young adults. Winter/spring incidence. Commonest world-wide cause.

Herpes simplex (type 2) - accounts for 5% of viral meningitis. Develops in 25% of patients with primary genital infection (suspect in sexually active adults). Lymphocytic choriomeningitis - affects any age and is a consequence of airborne spread from rodent droppings. Human Immunodeficiency Virus (HIV) - suspect in high risk groups (page 495) with meningitis. HIV antibodies are often absent and develop 1-3 months later during convalescence. Investigations

CSF, obtained early, often contains recoverable virus. The CSF cell count is elevated (lymphocytes or monocytes). PCR detection of viral DNA/RNA in CSF though diagnostic, is rarely thought necessary. Virus may be cultured from throat swabs or stool. Serological tests on serum in acute and convalescent phases are especially valuable in detecting mumps and herpes simplex (type 2).

Differential diagnosis

From other causes of an aseptic meningitis which are usually subacute or chronic in onset:

- Tuberculous or fungal meningitis

- Leptospirosis

- Sarcoidosis

- Carcinomatous meningitis

- Partially treated bacterial meningitis

- Parameningeal chronic infection which evokes a meningeal response, e.g. mastoiditis. The self-limiting and mild nature of viral meningitis should not lead to confusion with these more serious disorders.

Prognosis is excellent and treatment symptomatic.

In severe herpes simplex meningitis with an encephalitic component intravenous acyclovir is required. 485

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