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Postgraduate Medicine Jun 1993Viral meningitis is a common illness among children and is most often caused by enteroviruses. Diagnosis is made on the basis of clinical findings and analysis of the... (Review)
Review
Viral meningitis is a common illness among children and is most often caused by enteroviruses. Diagnosis is made on the basis of clinical findings and analysis of the cerebrospinal fluid. Important conditions to consider in diagnosis are partially treated bacterial meningitis, tuberculous meningitis, fungal meningitis, other infections, and central nervous system tumor. Ruling out treatable causes early is important. Treatment of enteroviral meningitis is supportive, and the prognosis is usually very good, although significant neurologic sequelae have been reported.
Topics: Cerebrospinal Fluid; Child; Child, Preschool; Diagnosis, Differential; Family Practice; Female; Humans; Infant; Male; Meningitis, Viral; Prognosis
PubMed: 8506174
DOI: 10.1080/00325481.1993.11701723 -
The Journal of Emergency Medicine Dec 2012Even in an era when cases of viral meningitis outnumber bacterial meningitis by at least 25:1, most patients with clinical meningitis are hospitalized.
BACKGROUND
Even in an era when cases of viral meningitis outnumber bacterial meningitis by at least 25:1, most patients with clinical meningitis are hospitalized.
OBJECTIVE
We describe the clinical characteristics of an unusual outbreak of viral meningitis that featured markedly elevated cerebrospinal fluid white blood cell counts (CSF WBC). A validated prediction model for viral meningitis was applied to determine which hospital admissions could have been avoided.
METHODS
Data were collected retrospectively from patients presenting to our tertiary care center. Charts were reviewed in patients with CSF pleocytosis (CSF WBC > 7 cells/mm(3)) and a clinical diagnosis of meningitis between March 1, 2003 and July 1, 2003. Cases were identified through hospital infection control and by surveying all CSF specimens submitted to the microbiology laboratory during the outbreak.
RESULTS
There were 78 cases of viral meningitis and 1 case of bacterial meningitis identified. Fifty-eight percent of the viral meningitis cases were confirmed by culture or polymerase chain reaction to be due to Enterovirus. Mean CSF WBC count was 571 cells/mm(3), including 20 patients with a CSF WBC count > 750 cells/mm(3) (25%) and 11 patients with values > 1000 cells/mm(3) (14%). Sixty-four of 78 patients (82%) were hospitalized. Rates of headache, photophobia, nuchal rigidity, vomiting, and administration of intravenous fluids in the Emergency Department were no different between admitted and discharged patients. Only 26/78 (33%) patients with viral meningitis would have been admitted if the prediction model had been used.
CONCLUSIONS
Although not all cases of viral meningitis are necessarily suitable for outpatient management, use of a prediction model for viral meningitis may have helped decrease hospitalization by nearly 60%, even though this outbreak was characterized by unusually high levels of CSF pleocytosis.
Topics: Antibiotic Prophylaxis; Cerebrospinal Fluid; Child; Child, Preschool; Disease Outbreaks; Echovirus 9; Echovirus Infections; Emergency Service, Hospital; Female; Hospitalization; Humans; Infant; Leukocyte Count; Male; Meningitis, Bacterial; Meningitis, Viral; Patient Discharge
PubMed: 22709622
DOI: 10.1016/j.jemermed.2012.03.021 -
The Pediatric Infectious Disease Journal Feb 2021We report first viral meningitis associated with coronavirus disease 2019 (COVID-19) in a patient hospitalized at Imam Hassan Hospital in Bojnurd. The patient was a...
We report first viral meningitis associated with coronavirus disease 2019 (COVID-19) in a patient hospitalized at Imam Hassan Hospital in Bojnurd. The patient was a 9-year-old child with no history of internal disease who referred to the emergency with a complaint of fever, headache and low back pain, about 3 days after the onset of symptoms. finally, viral meningitis was diagnosed with COVID-19.
Topics: COVID-19; Child; Emergency Service, Hospital; Female; Fever; Hospitalization; Humans; Iran; Low Back Pain; Meningitis, Viral; SARS-CoV-2; Thorax
PubMed: 33181787
DOI: 10.1097/INF.0000000000002979 -
Revista de Saude Publica Aug 2006
Topics: Brazil; Humans; Meningitis, Viral
PubMed: 17063255
DOI: No ID Found -
American Family Physician Oct 1993The diagnosis and treatment of acute meningitis is a challenge for the primary care physician. Differentiating between bacterial meningitis and aseptic meningitis is not... (Review)
Review
The diagnosis and treatment of acute meningitis is a challenge for the primary care physician. Differentiating between bacterial meningitis and aseptic meningitis is not always straightforward. The aseptic meningitis syndrome is usually viral in origin, and enteroviruses account for most cases. The aseptic syndrome also may be caused by unusual bacterial organisms such as Mycobacterium tuberculosis, Leptospira species, Brucella species, Borrelia burgdorferi and others. The classic presentation consists of the acute onset of meningismus, headache, fever, malaise with pleocytosis and normal glucose and slightly elevated protein in the cerebrospinal fluid. Cerebrospinal fluid lactate and serum C-reactive protein measurements may be helpful in differentiating aseptic meningitis from treatable bacterial meningitis. Aseptic meningitis of viral origin usually responds to expectant care. Other causes of aseptic meningitis must be searched for and treated if present.
Topics: Clinical Protocols; Diagnosis, Differential; Humans; Meningitis, Aseptic; Meningitis, Viral; Syndrome
PubMed: 8213411
DOI: No ID Found -
Journal of Medical Virology Jan 2023The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for...
The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management. All cerebrospinal fluid samples collected in 1 year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS), and treatment were analyzed. Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs = 0.3822, p = 0.0003). Forty-one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56% vs. 24%; p = 0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as human immunodeficiency virus and syphilis if the viral PCR panel was negative. The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes require further assessment.
Topics: Humans; Adult; Infant; Retrospective Studies; Meningitis, Aseptic; Enterovirus Infections; Enterovirus; Polymerase Chain Reaction; Meningitis, Viral; Anti-Bacterial Agents; Acyclovir; Cerebrospinal Fluid
PubMed: 36207770
DOI: 10.1002/jmv.28198 -
Clinical Medicine (London, England) Mar 2018Acute meningitis remains a devastating disease. Clinicians need a low threshold for suspecting meningitis, to undertake appropriate investigations and provide treatment...
Acute meningitis remains a devastating disease. Clinicians need a low threshold for suspecting meningitis, to undertake appropriate investigations and provide treatment in a timely manner, to minimise the risk of poor outcome in bacterial disease, while limiting unnecessary treatment in viral meningitis.
Topics: Acute Disease; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Diagnosis, Differential; Humans; Meningitis, Viral
PubMed: 29626023
DOI: 10.7861/clinmedicine.18-2-164 -
The Lancet. Infectious Diseases Sep 2018Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine... (Observational Study)
Observational Study
BACKGROUND
Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning.
METHODS
We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission.
FINDINGS
1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3-7), increasing to 9 days (6-12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year.
INTERPRETATION
Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services.
FUNDING
Meningitis Research Foundation and UK National Institute for Health Research.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Incidence; Male; Meningitis, Viral; Middle Aged; Population Surveillance; Prospective Studies; United Kingdom
PubMed: 30153934
DOI: 10.1016/S1473-3099(18)30245-7 -
PloS One 2017We undertook a systematic review and meta-analysis to address the question "what is the impact of meningitis on IQ and development." (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We undertook a systematic review and meta-analysis to address the question "what is the impact of meningitis on IQ and development."
METHODS
Search: conducted using standardized search terms across Medline, PsychInfo and EMBASE to 06/2014. Eligibility: human studies of any infectious aetiology of meningitis reporting IQ or infant developmental age or stage outcomes. Quality: Centre for Evidence Based Medicine, Oxford, quality tools. Analysis: random effects meta-analysis by organism.
RESULTS
39 studies were included in the review, 34 providing data on IQ (2015 subjects) and 12 on developmental delay (382 subjects). Across all bacterial organisms, meningitis survivors had a mean IQ 5.50 (95% CI: -7.19, -3.80; I2 = 47%, p = 0.02) points lower than controls. IQ was significantly lower than controls for Neisseria meningitides (NM: 5 points) and Haemophilus influenzae b (Hib: 6 points) but not in viral meningitis, with only single studies included for Streptococcus pneumoniae (SP) and group B streptococcus (GBS). The pooled relative risk (RR) for low IQ (IQ<70) in survivors of bacterial meningitis compared with controls was 4.99 (95% CI: 3.17, 7.86) with no significant heterogeneity (I2 = 49%, p = 0.07). Developmental delay of approximately 0.5SD was reported in studies of bacterial meningitis but no delay in the only study of viral meningitis.
CONCLUSIONS
We found moderate evidence that surviving bacterial meningitis has a deleterious impact on IQ and development but no evidence that viral meningitis had meaningful cognitive impacts. Survivors of bacterial meningitis should be routinely offered screening for cognitive deficits and developmental delay in addition to hearing loss.
Topics: Humans; Intelligence; Meningitis, Bacterial; Meningitis, Viral
PubMed: 28837564
DOI: 10.1371/journal.pone.0175024 -
Nursing Feb 2006
Topics: Adult; Hand Disinfection; Humans; Infection Control; Meningitis, Viral; Self Care
PubMed: 16462267
DOI: 10.1097/00152193-200602000-00043