Infectious Diseases A to Z – Viral Meningitis

With this new column, Elite Healthcare will compile an index of various infectious diseases, with occasional highlights of emerging conditions.

Viral Meningitis

General definition and information:

Inflammation of the tissue that covers the brain and the spinal cord, viral meningitis is the most common type of meningitis (see also bacterial, fungal, parasitic, and non-infectious), and impacts more than 1 million people worldwide each year.1 Most commonly caused by non-polio enteroviruses, a group of viruses that cause a number of infectious illnesses that are usually mild, viral meningitis is typically less severe than bacterial meningitis. Prompt diagnosis is required, however, the majority of patients will recover on their own without treatment, according to the Centers for Disease Control and Prevention (CDC). Symptoms typically begin in a similar fashion to those of bacterial meningitis and will range depending on the age of the patient and commonly include fever, irritability, poor eating, sleepiness or trouble waking up from sleep, and lethargy among babies. Children and adults will also likely display, irritability, sleepiness, lack of appetite, and lethargy as well as headache, stiff neck, sensitivity to light, nausea, and vomiting. Diagnosis requires specific lab testing, including swabbing of the nose and/or throat, obtaining a stool sample, drawing blood, or drawing fluid from around the spinal cord.

Viral meningitis is not generally as severe as bacterial meningitis, which can cause serious complications including brain damage, hearing loss, and/or learning disabilities, despite the similarities in symptoms. 

Causes & Modes of Transmission:

Non-polio enteroviruses are found in an infected person’s stool; secretions of the eye, nose, and mouth; and fluid-filled blisters. The viruses can be spread through close contact with someone who has an infection; including shaking hands; touching contaminated objects or surfaces, including diapers, and passing the infection into one’s eyes, nose, and/or mouth before washing hands; and drinking contaminated water. Those who are infected with these viruses can transmit them for several weeks, even if symptoms aren’t apparent. According to the CDC, other viruses that can cause viral meningitis include mumps, herpesviruses, measles, influenza, arboviruses, and lymphocytic choriomeningitis virus, a rodent-borne viral infectious disease that impacts what the CDC describes as the “common house mouse.”2 Mumps can be spread similarly to enteroviruses, including through close contact such as playing sports, dancing, and/or kissing; and sharing items that may be contaminated. Herpes is most easily spread through skin-to-skin contact with someone who has the virus during sex. Measles is very contagious and easily spread through coughing and sneezing, as can influenza. 

Much like enteroviruses themselves, viral meningitis can be passed along through close contact with infected persons, even though only a small number of those who become infected with the viruses that cause meningitis will actually develop viral meningitis, according to the CDC. Arboviruses, such as West Nile virus, are spread through mosquitoes and other insects. Additionally, pregnant women who become infected with a non-polio enterovirus shortly before delivery can pass the virus in utero, and breastfeeding mothers may be culprits as well.
The most at-risk populations for viral meningitis are children younger than 5 years old and people with weakened immune systems caused by other diseases or medications, as well as those who have undergone recent organ or bone marrow transplantations, according to the CDC. (Babies younger than 1-month-old and people with weakened immune systems are more likely to have a severe illness.)

Treatment Strategies:

According to the CDC, there is no specific treatment for viral meningitis in most cases, and the recovery period for most people is 7-10 days. That does not include those who became infected with viral meningitis through certain viruses such as herpes and influenza, and these patients will typically need treatment.3,4 Other strategies may include bed rest, fluids, corticosteroids (to reduce swelling in the brain), anticonvulsants (to control seizures), and over-the-counter pain medications to help reduce fever and relieve body aches, according to the Mayo Clinic. Hospitalization may be required for those who develop severe illness (or are at risk for developing severe illness) and those with weakened immune systems.

Prevention Parameters:

There are also no vaccines that currently exist to protect against non-polio enteroviruses. The CDC suggests that healthcare professionals encourage patients to take the following steps to help lower their chances of becoming infected with enteroviruses and viral meningitis:

  • Wash hands often with soap and water.
  • Avoid close contact and/or sharing items with people who are sick.
  • Cover coughs and sneezes with a tissue (or shirt sleeve) instead of one’s hands.
  • Clean and disinfect surfaces frequently, including toys, doorknobs, phones, and remote controls, especially if someone is sick.
  • Stay home when sick.
  • Receive vaccinations for measles, mumps, chickenpox, and influenza, and vaccinate children who are due to be vaccinated.
  • Avoid bites from mosquitoes and other insects.
  • Control mice and rats. 

References

  1. Confederation of Meningitis Organisations. World Meningitis Day 2017 – Factsheet. Accessed online: www.comomeningitis.org/media/113073/factsheet.pdf
  2. Lymphocytic Choriomeningitis (LCM). 2014. Accessed online: www.cdc.gov/vhf/lcm/index.html
  3. Genital Herpes. CDC. 2017. Accessed online: www.cdc.gov/std/herpes/default.htm
  4. Influenza (Flu). CDC. 2019. Accessed online: www.cdc.gov/flu/index.htm

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