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Meningitis, Viral

Meningitis, Viral is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A clinical syndrome characterized by signs/symptoms of acute meningeal inflammation from a viral etiology
  • Viral meningitis (VM) is the most common cause of aseptic meningitis (no identifiable bacterial pathogen in CSF).
  • System(s) affected: nervous

Epidemiology

Incidence
  • Estimated 30,000 to 75,000 VM cases and 26,000 to 42,000 VM hospitalizations annually in United States
  • Most common form of infectious meningitis
    • Annual incidence of VM is higher than all other causes of meningitis combined.
  • Peaks June 1 to October 31
    • Nonpolio enteroviruses and arthropod-borne viruses predominate in warm months (70% of cases July to October).
    • Mumps usually occurs in the winter and spring, often in epidemics.
  • Occurs in both outbreak and sporadic forms

Etiology and Pathophysiology

  • In immunocompetent hosts, VM is generally caused by a systemic viral infection with neurotropic predilection.
  • Less commonly, direct neural transmission occurs from an acute flare of a chronic viral illness (such as HSV) already present in an immunocompetent host.
  • 85–95% of cases are caused by enterovirus family, (often transmitted by the fecal–oral route) including coxsackievirus A and B, echovirus, and nonpolio E variants: E9 and E30.
  • Less common: HSV-1, HSV-2, varicella-zoster virus (VZV), adenovirus, lymphocytic choriomeningitis virus (LCMV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HIV, parvovirus B19, mumps virus, Toscana virus
  • Parechovirus 3 is the most common cause of VM in infants <90 days old.
  • Arthropod-borne viruses: West Nile virus, St. Louis encephalitis virus, California encephalitis virus
  • Recurrent benign lymphocytic (Mollaret) meningitis is 80% associated with HSV-2.

Genetics
None identified

Risk Factors

  • Close contact with known cases of VM
  • Age (common in children <5 years)
  • Immunocompromised hosts may be more susceptible to CMV, HSV, and adenovirus.
  • LCMV is transmitted via exposure to rodent feces, bite, bodily fluids, or nesting materials.

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

General Prevention

Limit exposure to known hosts; hand washing and general hygiene procedures

Commonly Associated Conditions

Encephalitis; neurologic deficits; myopericarditis; neonatal enteroviral sepsis

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Citation

Stephens, Mark B., et al., editors. "Meningitis, Viral." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116373/all/Meningitis__Viral.
Meningitis, Viral. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116373/all/Meningitis__Viral. Accessed March 24, 2019.
Meningitis, Viral. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116373/all/Meningitis__Viral
Meningitis, Viral [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116373/all/Meningitis__Viral.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Meningitis, Viral ID - 116373 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116373/all/Meningitis__Viral PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -