Viral Meningitis

Myra Lalas Pitt

Definition

 Meningeal inflammation with negative cultures for routine bacterial pathogens in a patient who did not receive antibiotics before lumbar puncture .

 Most commonly due to enterovirus.

 Mainly affects infants < 1 year and children 5 to 10 years of age.  Peak incidence occurs from late spring to autumn, reflecting the peak activity of enteroviral and arthropod borne infections

Signs and Symptoms

           Fever Headache Sore throat Cough Runny nose Vomiting Photophobia Neck pain Bulging fontanelle Seizures Lethargy

Differentials

       Severe pharyngitis Pharyngeal abscess Musculoskeletal strain Upper lobe pneumonia Cervical spine osteomyelitis Epidural abscess Subarachnoid hemorrhage        Encephalitis Ingestions Mass lesions of the CNS Simple febrile seizure.

Sinusitis Mastoiditis Brain abscess

Diagnosis

CSF Interpretation

    WBC ranges from 10 to 500 cells/microL (higher values can be seen with some viruses). Normal CSF WBC counts can be seen in EV meningitis (particularly in young infants).

CSF WBC usually has lymphocytic predominance.

Glucose: Normal or slightly reduced, but usually ≥40 percent of the serum value Protein: Normal to slightly elevated, but usually less than 150 mg/dL

Treatment

    Rest in a quiet, dimly lit room. Acetaminophen or NSAIDS for headache, pain, and fever; Aspirin should be avoided because of its association with Reye syndrome IVF if patient has poor PO.

Empiric antimicrobial therapy should be provided to patients in whom bacterial meningitis is suspected or cannot be excluded while awaiting the results of cultures.

References

 Harper Marvin B, "Chapter 16. Meningitis" (Chapter). Samir S. Shah: Pediatric Practice: Infectious Disease: http://www.accesspediatrics.com/content/6903048.  Modlin John F, "Chapter 232. Viral Infections of the Central Nervous System" (Chapter). Colin D. Rudolph, Abraham M. Rudolph, George E. Lister, Lewis R. First, Anne A. Gershon: Rudolph's Pediatrics, 22e: http://www.accesspediatrics.com/content/7022413.  www.uptodate.com