Viral meningitis

Viral meningitis is the commonest form of meningitis.
It is an aseptic meningitis. 

It is most common in young children

Causes include:
  • Enteroviruses – coxsackie A and B, echoviruses, polioviruses – 46% of cases 
  • Herpes simplex virus type 2 – 31% 
  • Varicella zoster virus – 11% 
  • Herpes simplex virus type 1 – 4% 
  • HIV 
  • Epstein-Barr virus 
  • Mumps virus 
  • CMV – consider in immunocompromised host 
  • West Nile virus – consider if there is a history of travel and acute distal weakness 
  • Lymphocytic choriomeningitis virus – consider if there has been contact with rodent droppings or urine 
  • CSF analysis
    • WCC 50-1000 x 106 cells/l 
    • Lymphocytosis (but there may be a neutrophilia in early disease)
    • CSF:serum glucose >0.5 (=normal) – but may be low in mumps and lymphocytic choriomeningitis viral infection 
    • Protein 0.4-0.8g/l 
  • CSF PCR 

  • Supportive 
  • Generally self-limiting 

Small print gems: 
HSV-2 meningitis reccurs in 20-50% of cases 
Enteroviral meningitis peaks in the summer months 

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