Denise Grandea

CNB

Disease

Viral Meningitis

Causative Agents

Meningitis (def) is the inflammation of the meninges (def), the membranes that cover the central nervous system. In many references, it is often associated with the coverings of the brain specifically. Viral meningitis is a non-bacterial form of meningitis that is usually caused by enteroviruses (def), which are smaller viruses, non-enveloped, composed of protein and RNA about 22-30 nm.  However, it is possible to develop the disease from other viral infections, such as, herpes simplex, measles, mumps, and arboviruses (def) (from insects like mosquitoes).

Although most healthcare providers still refer to viral meningitis as being aseptic (def) because of the lack of bacteria, in recent years meningitis has been divided into three types: bacterial, viral, and aseptic. Aseptic meningitis is not caused by bacteria or viruses, but may be caused from an allergic reaction to medication or other illnesses.

Epidemiology

Viral meningitis can affect anyone but is most common in infants from birth to one month old and people with weak immune systems. Viral meningitis rarely results in death, although hospitalization may be needed in severe cases. Viral meningitis is not a disease that is required to be reported to the state or government but in 2008, it was estimated that 75,000-150,000 cases of viral meningitis were in the U.S.  That equates to about 10-20 people per 100,000.

Since many countries other than the U.S. do not have more advanced vaccinations, a childhood disease like mumps can be a more common cause for the disease. Also, due to poor healthcare in other countries, herpes simplex and arboviruses are quite common causes as well.

Transmission

Pinpointing the actual virus that caused the viral meningitis determines how it is spread. Although enteroviruses can be spread through direct contact of stool, like the varicella-zoster and mumps viruses, it can also be spread through respiratory secretions indirectly or directly. That includes saliva, nasal mucus, or sputum, e.g. shaking hands with or kissing someone infected. The viruses can live on surfaces for days and can be transmitted from objects to people. In essence, being around someone who is infected with viral meningitis will make the person more susceptible to the virus that caused the meningitis, but more than likely the person will not become infected with the disease itself.

Signs and Symptoms

Signs and symptoms for viral meningitis are the same as bacterial meningitis. However, bacterial meningitis may also cause seizures and the severity of the symptoms may be worse. Identifying the signs and symptoms for infants compared to adults vary for meningitis. Although infants may also have the same symptoms as an adult, the ability to convey where and what hurts is unlikely.

When diagnosing infants, the doctor will look for these signs and symptoms that are visually and physically detectable:

• Irritability
• Fever
• Difficult to awaken
• Abnormal eating habits
• Vomiting

When examining older children and adults, the doctor will look for these signs and symptoms:

• Severe headache
• Lack of appetite
• Nausea, vomiting
• High fever
• Stiff neck
• Sensitivity to bright light
• Sleepiness or trouble waking up

The next step after the examination is cerebrospinal fluid (CSF) (def) and blood testing. If the physician determines that the patient may have meningitis, the patient will undergo a procedure called a lumbar puncture (def) or spinal tap. This procedure involves inserting a hollow needle between the L3/L4 or L4/L5 of the lumbar vertebrae intending to extract the CSF. The amount of fluid taken will vary from patient to patient and will indicate if the body is producing more fluid than normal. Also, the coloring of the CSF is very important. In its normal state it should remain clear, like water. Any other coloring is a sign of infection. If the CSF is red or brown, that indicates a hemorrhage (def), or bleeding and is very serious. The CSF and the patient’s blood are tested for bacteria and viruses, along with cell count abnormalities. The results help determine what type of meningitis is present and what type of treatment the patient will receive.

Prevention and Treatment

The most important method in preventing viral meningitis is good hygiene. Washing hands, sanitizing surfaces, wearing gloves, and proper cleanliness can reduce the risk of infection and transmission. Avoiding insect bites is also recommended in the prevention of the disease. There is no specific treatment for viral meningitis as antibiotics do not work on viruses. The physician can treat most symptoms of the disease to relieve some of the discomfort for the patient. The virus usually works its’ way out of the body between 7 and 10 days.

Bibliography

CDC, . "Meningitis." Centers for Disease Control and Prevention. CDC, 24Jun2009. Web. 24 Mar 2010. <http://www.cdc.gov/meningitis/index.html>.

Davis, MD, Larry E. "Acute and Recurrent Viral Meningitis." SpringerLink. Current Medicine Group LLC, 16May2008. Web. 24 Mar 2010. <http://resources.metapress.com/pdf-preview.axd?code=042q127272136737&size=largest>.

Grandea, Denise. Personal knowledge/experience. Franklin Square Hospital. February-March 2009. Hospitalization due to aseptic meningitis caused by sinusitis and an allergic reaction to Bactrim.

"Viral Meningitis." Directors of Health Promotion and Education. DHPE, 2010. Web. 24 Mar 2010. <http://www.dhpe.org/infect/vmenin.html>.