Viral meningitis is a notifiable disease in england and wales, but many cases undoubtedly go unreported. Guidelines for the management of acute meningitis in. Several diagnostic algorithms have been developed to help the clinician differentiate between bacterial meningitis and viral meningitis. Most cases of meningitis in the united states are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Meningococcal meningitis is an acute form of bacterial meningitis caused by neisseria meningitidis. This form of meningitis is also known as aseptic meningitis. Etiology and prognosis of acute viral encephalitis and. Some cases of meningitis improve without treatment in a few weeks. Rare causes of viral meningitis include influenza, parainfluenza, rotavirus, vaccinia, and encephalomyocarditis virus. This could especially be helpful in patients without a positive csf gram stain or culture, as the diagnosis of acute bacterial meningitis.
However, anyone with symptoms of meningitis should see a doctor right away because some types of meningitis can be. However, bacterial meningitis can be severe and result in brain damage, hearing loss, kidney damage, or even death. John attia, md, phd rose hatala, md, msc deborah j. Wallgren 1889 1973 coined the term acute aseptic meningitis 3. The aims of this study were to characterize the etiology and prognosis of acute viral encephalitis and meningitis in chinese children. The average time between the onset of symptoms of meningitis and acute retention is about 8 days, which was a little shorter in our patient 4. Algorithm for the initial management of suspected acute meningitis. In case that there are no complications of viral meningitis the disease lasts up to 10 days. Clinicians need a low threshold for suspecting meningitis, to undertake appropriate investigations and provide treatment in a timely manner, to minimise the risk of poor outcome in bacterial disease, while limiting unnecessary treatment in viral meningitis.
Guidelines for the management of acute meningitis in children and adults in south africa this guideline provides a rational and costeffective approach to patients with acute meningitis, which causes considerable morbidity and mortality, predominantly in children. It results in inflammation of the meninges the membranes covering the brain and spinal cord. Hsv1 typically causes encephalitis rather than meningitis. Aseptic meningitisa syndrome characterised by acute onset of meningeal. Subacute and chronic meningitis brain, spinal cord, and. Viral meningitis is a virusborne inflammation of the meninges, which are the protective membranes surrounding the brain and spinal cord. Some of the most common causes of bacterial meningitis include neisseria meningitidis, streptococcus. More than 90% of cases are caused by herpes simplex virus. Viral meningitis is generally less severe and resolves without specific treatment. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Pdf cerebrospinal fluid analysis acute bacterial versus. Feb 02, 2017 viruses get into the central nervous system either via hematogenous spread or via retrograde axonal transport, and cause meningitis or encephalitis.
The key to proving that the patient has meningitis is to perform a lumbar puncture and examine the cerebrospinal fluid csf. Aseptic meningitis often has a similar presentation to that of bacterial meningitis ie, fever, headache, altered mental status, stiff neck, photophobia, which can be a lifethreatening illness. Encephalitis is characterized by fever, neurologic deficits, seizures, pleocytosis, and neuroimaging and eeg abnormalities. A group of viruses called enteroviruses is the most common cause of viral meningitis. Most cases of acute meningitis are infectious and result from a potentially wide range of bacterial and viral pathogens.
Meningitis is an inflammation of the meninges, the membranes covering the brain and spinal cord. Meningitis is an inflammation of the membranes meninges surrounding your brain and spinal cord. Viral meningitis is a central nervous system cns infection characterized by signs and. Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. However, in contrast to bacterial meningitis, many patients with aseptic meningitis particularly those who have disease caused by viruses or.
Terminology meningitis meningitis is inflammation of the meninges, manifest by cerebrospinal fluid pleocytosis ie, an increased number of white blood cells. Jul 14, 2017 in china, there were few studies about the pathogens of acute viral encephalitis and meningitis in children in recent years. All cases of viral meningitis are reportable to lac. Chronic mastoiditis and epidural empyema in a patient with. Viral meningitis oxford academic journals oxford university press.
Acute viral meningitis avm constitute an important cause of mortality. Viral meningitis is most commonly caused by the enteroviruses and is self. Its causes, symptoms, diagnosis, and treatment are similar to those of chronic meningitis. Treatment for viral meningitis is mostly supportive. Its typically mild and goes away without treatment. Epidemiology, pathogenesis, and etiology in children and viral meningitis. With treatment, mortality risk of death from bacterial meningitis depends on the age of the person and the underlying cause. Untreated, bacterial meningitis is almost always fatal. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7. Chronic meningitis is slowly developing meningitis that lasts 4 weeks or longer. Viral meningitis and bacterial meningitis are both characterised by acute onset of fever, headache, photophobia, and neck stiffness, often accompanied by nausea and vomiting. Viral meningitis is the most common type of meningitis, an inflammation of the lining of the brain and spinal cord. The disease is rarely serious and recovery is usually complete.
Cerebrospinal fluid analysis acute bacterial versus viral meningitis article pdf available in pakistan journal of medical sciences online 245 october 2008 with 424 reads how we measure reads. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. The onset of viral meningitis or viral meningoencephalitis is also generally acute over hours to days, but sometimes is preceded by a nonspeci. This contrastenhanced, axial t1weighted magnetic resonance image shows leptomeningeal enhancement arrows. Viral meningitis is a virusborne inflammation of the meninges, which are the. Viral meningitis, also known as aseptic meningitis, is a type of meningitis due to a viral infection.
Viral meningitis is an infection of the meninges a thin lining covering the brain and spinal cord by any one of a number of different viruses. Subacute meningitis develops over a longer period of time than acute meningitis and over a shorter period than chronicover a few weeks. Diagnosis, initial management, and prevention of meningitis. Human enteroviruses were the leading cause both in acute viral encephalitis and viral meningitis in children. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Acute bacterial meningitis beyond the neonatal period. Predictors of infectious meningitis or encephalitis. Young children often exhibit only nonspecific symptoms, such as. It can be caused by a variety of organisms that include bacteria, fungi or viruses. Meningitis in children beyond the basics acute flaccid myelitis.
The incidence of sequelae and fatality rate of viral encephalitis with confirmed etiology were 7. About 90% of meningitis cases are caused by viruses. Acute, recurrent and chronic viral meningitis international. The prognosis of viral meningitis was favorable with only 0. Mr images showed right optic nerve enlargement and highintensity signal abnormalities in the region of the left lateral geniculate body and the left occipital lobe. These viruses are spread from persontoperson through direct or indirect contact with feces, usually on unclean hands or surfaces.
Meningitis is an inflammation of the tissue that covers the brain and spinal cord that can be caused by several different types of, as well as viruses and fungibacteria. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Diagnostic advances in acute viral meningitis openventio publishers. In china, there were few studies about the pathogens of acute viral encephalitis and meningitis in children in recent years.
There are many aetiologies, but a small number of bacteria and viruses. Introduction to viral meningitis, encephalitis, and. For diagnosis of bacterial meningitis the recommendations of the european society of clinical microbiology and infectious diseases were followed. This could especially be helpful in patients without a positive csf gram stain or culture, as the diagnosis of acute bacterial meningitis can be difficult to establish or reject in these patients. Guidelines for the management of acute meningitis in children. Table 1 lists the causes of viral meningitis by frequency. Several different viruses can cause viral meningitis. Viral meningitis disease plan utah department of health. Viruses probably account for most cases of acute meningitis. Acute bacterial meningitis ubc critical care medicine.
Findings in a patient with herpes simplex viral meningitis. General physical findings in viral meningitis are common to all causative agents. Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the csf. Can we use clinical characteristics to predict the absence of intracranial abnormalities associated with increased risk. Etiology aseptic meningitis clues viral cns infections children management of suspected meningitis in children csf analysis in cns infections csf patterns viral meningitis related topics. Bacterial meningitis may be subacute rather than acute. Viral meningitis is an inflammation of the meninges caused by the certain viruses. Patients who have subacute or chronic meningitis present over weeks to months, and even years. Subacute meningitis is inflammation of the layers of tissue that cover the brain and spinal cord meninges and of the fluidfilled space between the meninges subarachnoid space when it develops over days to a few weeks. Enteroviral infection is suggested by the following. Viruses get into the central nervous system either via hematogenous spread or via retrograde axonal transport, and cause meningitis or encephalitis. Viral meningitis, also called aseptic meningitis, is much more common than bacterial meningitis. In chronic viral meningitis or meningoencephalitis, the mri may show focal brain or spinal cord abnormalities.
Viral meningitis, in contrast, tends to resolve spontaneously and is rarely fatal. Infectious meningitis andor encephalitis were defined as the composite outcome. The organized approach to the patient with suspected meningitis enables the prompt administration of antibiotics, possibly corticosteroids, and diagnostic testing with neuroimaging and spinal fluid analysis. For clinical guidelines, we accessed the websites of the uk health protection. Jul 16, 2019 acute bacterial meningitis in otherwise healthy patients who are not at the extremes of age presents in a clinically obvious fashion. Viral meningitis is the most common form of meningitis. Jan 05, 2008 viral meningitis is a notifiable disease in england and wales, but many cases undoubtedly go unreported. Most cases of aseptic meningitis are viral and require supportive care. Two hundred and sixty one viral encephalitis patients and 285 viral meningitis patients were.
Almost all of the cases occur as single, isolated events. Two hundred and sixty one viral encephalitis patients and 285 viral meningitis. Its far less severe than bacterial meningitis, and generally only produces mild symptoms, such as headache, nausea, brightlight sensitivity, and lethargy. The most common symptoms are fever, headache, and neck stiffness.
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