Transcript Viral Meningitis

Viral Meningitis
Myra Lalas Pitt
Definition
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Meningeal inflammation with negative cultures for routine
bacterial pathogens in a patient who did not receive
antibiotics before lumbar puncture .
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Most commonly due to enterovirus.
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Mainly affects infants < 1 year and children 5 to 10 years
of age.
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Peak incidence occurs from late spring to autumn,
reflecting the peak activity of enteroviral and arthropodborne infections
Signs and Symptoms
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Fever
Headache
Sore throat
Cough
Runny nose
Vomiting
Photophobia
Neck pain
Bulging fontanelle
Seizures
Lethargy
Differentials
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Severe pharyngitis
Pharyngeal abscess
Musculoskeletal strain
Upper lobe pneumonia
Cervical spine
osteomyelitis
Epidural abscess
Subarachnoid hemorrhage
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Encephalitis
Ingestions
Mass lesions of the CNS
Simple febrile seizure.
Sinusitis
Mastoiditis
Brain abscess
Diagnosis
CSF Interpretation
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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
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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
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Harper Marvin B, "Chapter 16. Meningitis" (Chapter).
Samir S. Shah: Pediatric Practice: Infectious Disease:
http://www.accesspediatrics.com/content/6903048.
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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.
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