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Viral and Non-bacterial Meningitis

by Roy Strowd, MD

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    00:00 What about other causes of meningitis, non-bacterial causes? We do see that viruses cause meningitis, this is more common in children, it's often present during the summer months and we think about certain types of viruses; enteroviruses, arboviruses, and adenoviruses. And you can see some of those specific organisms here. We ask about tick exposure, we need to think about mosquito bites particularly in seasons where this could occur and could contribute to a viral transmission. The clinical manifestations may vary just slightly from bacterial meningitis. We can see an exanthem, a rash, a viral exanthem which we see in viral processes more than bacterial, conjunctival hemorrhage, pleurodynia, pericardial rob, again we see signs that the virus is all over the body and causing irritation of other organisms in selected patients. We can see increase in LFTs from a mild hepatitis from a viral infection and often this occur in the viral prodrome prior to presentation with the acute or subacute viral meningitis.

    01:01 Signs and symptoms often abate within a week and the treatment for a viral process is typically supportive care. There are rare types of viral meningitis that we may need to consider and can show up on test questions or certain clinical vignettes. Mumps can lead to a rather rare late complication after a meningitis that's called subacute sclerosing panencephalitis.

    01:25 This is an inflammatory process that occurs and really causes substantial neurologic sequelae and it's important to remember after mumps infections. There are certain viruses that we need to think about, varicella, Epstein-Barr, human herpes virus 6, those care is supportive for those, lymphocytic choriomeningitis. There is also some non-viral causes of meningitis, rickettsial infections, listeria is something that we've talked about in treatment, and ehrlichiosis where we see other signatures in those patients. And important, we also see aseptic causes of a meningitis, non-infectious, non-bacterial infectious causes that are coming from some other source and we got to figure out what the source is. It could be a medicine and we think about methotrexate. Intravenous immunoglobulin. Carbamazepine is an antiepileptic that we can see this with. Nonsteroidal anti-inflammatories and there is a list of other medicines that are important to research when you're evaluating these patients or in considering a clinical vignette.


    About the Lecture

    The lecture Viral and Non-bacterial Meningitis by Roy Strowd, MD is from the course CNS Infections​.


    Included Quiz Questions

    1. Signs and symptoms often abate within a week.
    2. CSF analysis would reveal neutrophilic pleocytosis.
    3. Early empirical treatment with acyclovir should be considered.
    4. The incidence of viral meningitis is highest during winter months.
    5. The incidence of viral meningitis is highest among young adults.

    Author of lecture Viral and Non-bacterial Meningitis

     Roy Strowd, MD

    Roy Strowd, MD


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