Chronic meningitis is slowly developing meningitis that lasts 4 weeks or longer. Subacute meningitis is inflammation of the layers of tissue that cover the brain and spinal cord meninges and of the fluidfilled space between the meninges subarachnoid space when it develops over days to a few weeks. Some cases of meningitis improve without treatment in a few weeks. Etiology and prognosis of acute viral encephalitis and. With treatment, mortality risk of death from bacterial meningitis depends on the age of the person and the underlying cause. It results in inflammation of the meninges the membranes covering the brain and spinal cord. We report the case of a 41yearold man with clinical findings of viral meningitis associated with acute retinal necrosis syndrome in his right eye. Findings in a patient with herpes simplex viral meningitis. However, bacterial meningitis can be severe and result in brain damage, hearing loss, kidney damage, or even death. General physical findings in viral meningitis are common to all causative agents. Hsv1 typically causes encephalitis rather than meningitis. Terminology meningitis meningitis is inflammation of the meninges, manifest by cerebrospinal fluid pleocytosis ie, an increased number of white blood cells. The onset of viral meningitis or viral meningoencephalitis is also generally acute over hours to days, but sometimes is preceded by a nonspeci.
Aseptic meningitis is the most common form of meningitis with an annual incidence of 7. Acute bacterial meningitis ubc critical care medicine. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Some of the most common causes of bacterial meningitis include neisseria meningitidis, streptococcus. More than 90% of cases are caused by herpes simplex virus. Guidelines for the management of acute meningitis in children and adults in south africa this guideline provides a rational and costeffective approach to patients with acute meningitis, which causes considerable morbidity and mortality, predominantly in children. Jul 16, 2019 acute bacterial meningitis in otherwise healthy patients who are not at the extremes of age presents in a clinically obvious fashion. Infectious meningitis andor encephalitis were defined as the composite outcome. However, anyone with symptoms of meningitis should see a doctor right away because some types of meningitis can be. Two hundred and sixty one viral encephalitis patients and 285 viral meningitis. Feb 02, 2017 viruses get into the central nervous system either via hematogenous spread or via retrograde axonal transport, and cause meningitis or encephalitis.
For clinical guidelines, we accessed the websites of the uk health protection. The most common symptoms are fever, headache, and neck stiffness. Predictors of infectious meningitis or encephalitis. Subacute meningitis develops over a longer period of time than acute meningitis and over a shorter period than chronicover a few weeks. There are many aetiologies, but a small number of bacteria and viruses. Meningitis is an inflammation of the membranes meninges surrounding your brain and spinal cord. Can we use clinical characteristics to predict the absence of intracranial abnormalities associated with increased risk. Viral meningitis nonbacterial meningitis fact sheet.
In china, there were few studies about the pathogens of acute viral encephalitis and meningitis in children in recent years. Viruses probably account for most cases of acute meningitis. Untreated, bacterial meningitis is almost always fatal. Algorithm for the initial management of suspected acute meningitis. Meningitis is an inflammation of the tissue that covers the brain and spinal cord that can be caused by several different types of, as well as viruses and fungibacteria. Viral meningitis is most commonly caused by the enteroviruses and is self. Etiology aseptic meningitis clues viral cns infections children management of suspected meningitis in children csf analysis in cns infections csf patterns viral meningitis related topics. Table 1 lists the causes of viral meningitis by frequency. Jul 14, 2017 in china, there were few studies about the pathogens of acute viral encephalitis and meningitis in children in recent years. Acute bacterial meningitis beyond the neonatal period. Its causes, symptoms, diagnosis, and treatment are similar to those of chronic meningitis. Acute viral meningitis avm constitute an important cause of mortality.
Viral meningitis is generally less severe and resolves without specific treatment. Enteroviral infection is suggested by the following. Several different viruses can cause viral meningitis. The disease is rarely serious and recovery is usually complete. In chronic viral meningitis or meningoencephalitis, the mri may show focal brain or spinal cord abnormalities. The incidence of sequelae and fatality rate of viral encephalitis with confirmed etiology were 7. This could especially be helpful in patients without a positive csf gram stain or culture, as the diagnosis of acute bacterial meningitis can be difficult to establish or reject in these patients. Viral meningitis, also known as aseptic meningitis, is a type of meningitis due to a viral infection. Guidelines for the management of acute meningitis in. These viruses are spread from persontoperson through direct or indirect contact with feces, usually on unclean hands or surfaces. Viral meningitis is the most common type of meningitis, an inflammation of the lining of the brain and spinal cord. Cerebrospinal fluid analysis acute bacterial versus viral meningitis article pdf available in pakistan journal of medical sciences online 245 october 2008 with 424 reads how we measure reads. Viral meningitis is a central nervous system cns infection characterized by signs and.
This could especially be helpful in patients without a positive csf gram stain or culture, as the diagnosis of acute bacterial meningitis. It can be caused by a variety of organisms that include bacteria, fungi or viruses. Almost all of the cases occur as single, isolated events. In case that there are no complications of viral meningitis the disease lasts up to 10 days. Viral meningitis disease plan utah department of health. About 90% of meningitis cases are caused by viruses. Viral meningitis is a virusborne inflammation of the meninges, which are the. Epidemiology, pathogenesis, and etiology in children and viral meningitis. Viral meningitis is a notifiable disease in england and wales, but many cases undoubtedly go unreported. Bacterial meningitis may be subacute rather than acute.
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. Two hundred and sixty one viral encephalitis patients and 285 viral meningitis patients were. Patients who have subacute or chronic meningitis present over weeks to months, and even years. Viral meningitis, in contrast, tends to resolve spontaneously and is rarely fatal. Jan 05, 2008 viral meningitis is a notifiable disease in england and wales, but many cases undoubtedly go unreported. Introduction to viral meningitis, encephalitis, and.
Human enteroviruses were the leading cause both in acute viral encephalitis and viral meningitis in children. Meningitis in children beyond the basics acute flaccid myelitis. Viral meningitis is an inflammation of the meninges caused by the certain viruses. Meningitis is an inflammation of the meninges, the membranes covering the brain and spinal cord. The organized approach to the patient with suspected meningitis enables the prompt administration of. These viruses are found in the throat and feces stool of infected people. Viral meningitis oxford academic journals oxford university press. Patients who have subacute or chronic meningitis present over weeks to.
The prognosis of viral meningitis was favorable with only 0. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Young children often exhibit only nonspecific symptoms, such as. Aseptic meningitis often has a similar presentation to that of bacterial meningitis ie, fever, headache, altered mental status, stiff neck, photophobia, which can be a lifethreatening illness. Most cases of aseptic meningitis are viral and require supportive care. The average time between the onset of symptoms of meningitis and acute retention is about 8 days, which was a little shorter in our patient 4. However, in contrast to bacterial meningitis, many patients with aseptic meningitis particularly those who have disease caused by viruses or.
Chronic mastoiditis and epidural empyema in a patient with. Rare causes of viral meningitis include influenza, parainfluenza, rotavirus, vaccinia, and encephalomyocarditis virus. Viral meningitis is an infection of the meninges a thin lining covering the brain and spinal cord by any one of a number of different viruses. Viral meningitis is the most common form of meningitis. The key to proving that the patient has meningitis is to perform a lumbar puncture and examine the cerebrospinal fluid csf. Viruses get into the central nervous system either via hematogenous spread or via retrograde axonal transport, and cause meningitis or encephalitis. Its typically mild and goes away without treatment. Viral meningitis and bacterial meningitis are both characterised by acute onset of fever, headache, photophobia, and neck stiffness, often accompanied by nausea and vomiting.
Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. It is a serious condition that can be life threatening. For viral meningitis, the criterion standard was a positive viral culture from csf, stool, or blood or a discharge diagnosis of viral meningitis with no other etiology evident. This form of meningitis is also known as aseptic meningitis. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. Diagnosis, initial management, and prevention of meningitis. Most cases of acute meningitis are infectious and result from a potentially wide range of bacterial and viral pathogens. Pdf cerebrospinal fluid analysis acute bacterial versus.
Aseptic meningitisa syndrome characterised by acute onset of meningeal. Treatment for viral meningitis is mostly supportive. It is often less severe than bacterial meningitis, and most people get better on their own without treatment. The organized approach to the patient with suspected meningitis enables the prompt administration of antibiotics, possibly corticosteroids, and diagnostic testing with neuroimaging and spinal fluid analysis. Viral meningitis is a virusborne inflammation of the meninges, which are the protective membranes surrounding the brain and spinal cord. Encephalitis is characterized by fever, neurologic deficits, seizures, pleocytosis, and neuroimaging and eeg abnormalities. This contrastenhanced, axial t1weighted magnetic resonance image shows leptomeningeal enhancement arrows. John attia, md, phd rose hatala, md, msc deborah j. All cases of viral meningitis are reportable to lac. Several diagnostic algorithms have been developed to help the clinician differentiate between bacterial meningitis and viral meningitis. Viral meningitis, also called aseptic meningitis, is much more common than bacterial meningitis.
Wallgren 1889 1973 coined the term acute aseptic meningitis 3. Most cases of meningitis in the united states are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Guidelines for the management of acute meningitis in children. Most cases of recurrent viral meningitis are caused by hsv2. Mr images showed right optic nerve enlargement and highintensity signal abnormalities in the region of the left lateral geniculate body and the left occipital lobe. Acute, recurrent and chronic viral meningitis international. Subacute and chronic meningitis brain, spinal cord, and.
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