About Viral Meningitis

By Tom Iarocci, MD. May 7th 2016

Meningitis is an inflammation of the tissue layer that covers the brain and spinal cord, an area also known as the meninges. The disease involves immune cells in the spinal fluid and has many potential causes, including viruses, bacteria, fungi and even drugs.

It can be hard to tell the difference between viral and bacterial meningitis, at first. Typically, a person is referred for a lumbar puncture (i.e., spinal tap) to analyze the spinal fluid. When routine tests of the spinal fluid do not grow bacteria, it’s called aseptic meningitis, and a virus is often the cause.

Enteroviruses are the most common cause of viral meningitis in the United States, but a number of other viruses can cause viral meningitis, including herpes simplex virus, HIV, mumps, West Nile virus and others.

What Are Its Symptoms?

In older children and adults, the most common symptoms of viral meningitis are the same as those of bacterial meningitis, including:

  • Fever
  • Stiff neck
  • Headache

The majority of viral meningitis cases are not serious, but it’s still important to seek out medical attention right away to rule out bacterial meningitis, which can be fatal or cause permanent brain damage and disability. Not everyone with meningitis has all three symptoms, and early symptoms can be hard to tell apart from those of influenza.

Young infants with meningitis — whether viral or bacterial — do not typically have neck stiffness, and they are unable to communicate if they have a headache. In these cases, parental instinct and a good partnership with the child’s doctor plays an important role.

In newborns with meningitis, symptoms can include fever accompanied by nonspecific symptoms, such as:

  • Poor feeding
  • Vomiting
  • Diarrhea
  • Rash
  • Respiratory symptoms
  • Irritability
  • Lethargy

A few of the other symptoms that may occur in children (ages 2 years and older) and adults suffering from meningitis are:

  • Sensitivity to light (i.e., photophobia)
  • Nausea
  • Confusion (i.e., altered mental status)
  • Sleepiness or trouble waking up
  • Lack of appetite

Those affected may have other symptoms, too, depending on which kind of virus is causing the meningitis.

Who Is Most at Risk?

Although anyone can get viral meningitis, young children and people who do not have a strong immune system are most at risk. More specifically, it’s common in individuals younger than 5 years old, pregnant women and people suffering from HIV/AIDS.

Is It Contagious?

Yes and no — it depends on which virus you are talking about.

Viral meningitis is contagious in that the enteroviruses causing nearly all cases of the condition are contagious, but most people who are exposed to them experience little to no symptoms. Therefore, despite physical contact with someone suffering from viral meningitis, that individual is unlikely to develop subsequent symptoms.

Enteroviruses are spread by direct or indirect contact with fecal material, which is why young children have a high probability of getting viral meningitis (i.e., not being potty-trained and having multiple diaper changes per day). In some instances, contact with saliva, nasal mucus or sputum may also lead to the spread of these viruses.

Patients diagnosed with viral meningitis are instructed to be vigilant about their hygiene, which includes washing hands thoroughly after using the bathroom; blowing their nose with proper care; and covering up coughs and sneezes. Those with viral meningitis should also avoid activities or situations where the virus could be spread, such as kissing and sharing utensils, lip balm or cigarettes.

HIV meningitis can occur in up to 10 percent of the people who get symptoms in the process of becoming HIV positive (i.e., seroconversion), and it’s also associated with a mononucleosis-like illness.

How Is It Treated? How Long Does It Last?

There is no specific treatment, and people with viral meningitis receive care as needed for their specific type of infection and overall health.

Though antibiotics are not usually helpful, the role of antiviral agents is being explored in some circumstances. In rare cases, a hospital stay may be recommended or required, but in most instances, a doctor will suggest certain medications to help relieve symptoms such as a fever or headache. Bed rest and fluids are also recommended for most patients.

The symptoms of viral meningitis usually appear three to seven days after becoming exposed to the virus. In most cases, viral meningitis clears up, and a patient will recover completely seven to 10 days after the symptoms first appear. In immunocompromised patients, relapses are possible; complications are more likely; and infections can last much longer.

Take the Next Steps

Prevention can be an important part of this equation, but it is not always possible. Be sure to get all the recommended vaccinations, and adhere to good hygiene and healthy living.

If you or someone in your life has concerning signs and symptoms of meningitis, do not delay in seeking medical advice. Bacterial and viral meningitis can look alike and be misleading, and in the case of bacterial meningitis, prompt antibiotic therapy can reduce mortality and improve outcomes.

Each year, enterovirus is responsible for thousands of hospitalizations in the United States. Be sure to get the supportive care you need, and allow the time it takes to recover.

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