Viral meningitis

Viral meningitis is considered one of the relatively favorable types of inflammation and is most often treated as an outpatient. Viral meningitis is affected mainly by children, less often by young people under 30 years old, the epidemiological peak falls on the summer period and is associated with the outbreak of enterovirus infections, respectively, the causative agent of the disease in 80% of cases - RNA-containing enterovirus ECHO. Like other kinds of meningitis, viral inflammation in the pathogenetic sense can be both primary and secondary - developing as a symptom or concomitant complication of an infectious disease (pneumonia, parotitis, poliomyelitis, rheumatism, brucellosis and others).

Meningitis, an inflammation of the meninx - cerebral membrane, can be caused by various pathogens - viruses, bacteria, mycoplasmas and even parasites. Most often the very concept of "meningitis" causes panic fear, especially when the child is ill. Indeed, the inflammatory process of the soft, arachnoid membrane of the brain, both the head and spinal cord, is a serious disease, but it is different according to the classification etiology, so it can proceed in different forms and has different localization - spinal, cerebral.

How is viral meningitis transmitted?

Serous, aseptic meningitis is a contagious inflammatory process that previously had a high epidemiological threshold due to poliomyelitis. Since the 60-ies of the last century, epidemic outbreaks have become much less common, due to widespread polio vaccination. Nevertheless, in the summer and early autumn, individual forms of meningitis are regularly recorded, mainly among young children.

How is viral meningitis transmitted? The answer is one - only by contact through the nose or mouth. The source of infection is always a sick person - a virus carrier, the transmission route is most often airborne, less often - oral-fecal. Very rarely, viral meningitis is transmitted by the placental pathway, that is, from the infected mother to the fetus. Depending on the path of infection, the virus can get into the digestive tract or into the nasopharynx, provoking inflammation of the throat, respiratory system, and less frequent abdominal pain. Penetrating into the bloodstream, the virus enters the serous membranes of the brain, but in the cerebrospinal fluid, the cerebrospinal fluid penetrates infrequently.

Viral meningitis is transmitted in the following ways:

• Saliva.
• Sputum when coughing.
• Nasal mucus when sneezing, blowing.
• Cal (rarely).

Basically, the way meningitis is transmitted in children is through dirty hands that have had contact with virus-infected items infected by people (hugs, kisses, and so on). You can also get infected through the virus-infected water, products. Being in contact with a sick person, an adult most often risks getting a viral infection, but not a meningitis, children are more prone to this disease, as their immune system is still forming.

Causes of Viral Meningitis

Most often, the causes of viral meningitis are associated with Enterovirus, that is, viruses that reproduce in the digestive tract. Reproducing in the intestine, enteroviruses like ECHO and Coxsackie very rarely provoke actual enteritis, more often causing encephalitis, meningitis, acute respiratory disease, myocarditis, specific conjunctivitis (hemorrhagic), epidemic myalgia (pleurodynia).

The group of enteroviruses is included in the family Picornaviridae - picornaviruses, very small in size and containing RNA. Of all the 67 serotypes known to medicine, 40 are extremely pathogenic strains. In 90% of cases, the causes of viral meningitis are Coxsackie viruses and Enteric Citopatthogenic Human Orphan serotypes abbreviated to ECHO. It is interesting that part of the definition of the Human Orphan virus is translated as an "orphan". Indeed, a long time since the opening day in 1951, he could not be considered a specific disease. Also, prior to the discovery of the polio-fighting vaccine, a long period of meningitis was provoked by polioviruses, at present, such cases are almost not met.

In a quantitative relationship, the causes of viral meningitis look like this: 

• Most often in 85-90% of cases: 
  • ECHO viruses and Coxsackie viruses.
• Less often, in 10-15% of cases: 
  • Parotitis.
  • Herpes simplex virus (type II).
  • Coryomeningitis.
  • Arthropod borne viruses are arboviruses (by the bites of arthropods).
  • Cytomegalovirus.
  • Influenza viruses.
  • Togaviruses (rubella).

[1], [2], [3], [4],

Symptoms of viral meningitis

The clinical picture of serous aseptic meningitis is fairly clear, although in the prodromal stage there may be a symptomatology characteristic of the underlying infection, for example, influenza. Symptoms of viral meningitis may appear later and differentiate fairly quickly.

In addition, in clinical practice, characteristic signs, distributed by age groups of patients: 

• In newborns, serous meningitis is more often manifested by the symptoms of encephalomyocarditis.
• Children under the age of six months suffer from enterovirus diarrhea.
• Children between the ages of one to three are polio-like symptoms (convulsive, paralytic forms).
• Children from three years and older - high blood pressure, hyperthermia, severe headache, vomiting, fever.
• Adults are ill in a lighter form by the type of pleurodynia - epidemic myalgia.

Common typical symptoms of viral meningitis: 

• Prodromal stage - malaise, inflammation of the mucous membranes of the nasopharynx (catarrhal symptoms).
• Strong headache.
• Pressing pain in the eyeballs.
• Hyperthermia up to 40 degrees.
• Pain in the neck and along the spine.
• Nausea and vomiting.

Meningic signs appear 3-5 days later and can be as follows: 

• Rigidity, tonic tension of neck muscles.
• Kernig's symptom (the inability to unbend his leg in the knee) and the Buddinsky symptom (flexion of the lower leg and thigh) are rare in the acute form of meningitis.
• Hyperesthesia - photophobia, intolerance to noise, sounds, body contact.
• Inflammation of lymph glands - with secondary serous meningitis against mumps.
• Rashes on the skin - with viral meningitis caused by the serotype of Coxsackie, ECHO-virus.
• The asymmetry of tendon reflexes is anisoreflection.
• Herpetic laryngeal vesicles in meningitis caused by the Coxsackie virus.
• Rarely - subcomatose state - sopor.

It should be noted that the symptomatology in aseptic meningitis, as a rule, is similar to the clinical picture of the influenza state, typical meningeal manifestations, such as rigidity, rashes, are weakly expressed and not in complex. Despite the general poor state of health, a person who has contracted viral meningitis tolerates the disease much more easily than bacterial meningitis.

It is not only impossible to diagnose meningitis on your own or at the child yourself, but it is also dangerous, but there are the following signs that should alert you and make you urgently seek medical attention: 

• Severe headache, vomiting on the background of any infectious disease - SARS, rubella chickenpox, mumps (mumps), herpes.
• Increased body temperature, accompanied by pain in the back and neck (pain increases with bends, raising the head).
• Confused, delirious consciousness against a background of high temperature.
• Convulsive syndrome.
• Newborns have a high fever and bulging fontanel.
• Skin rash against the background of high fever.
• Incubation period in viral meningitis.

Incubation of the virus can vary from 2 to 10 days, but most often the incubation period for viral meningitis lasts no more than four days. At the end of it begins to manifest a clinical picture of the disease, the symptoms that are typical for serous meningitis. The patient is dangerous in the sense of infection of others within ten, less than twelve days, as soon as the first signs of meningitis show up, a person ceases to allocate viruses. It should be noted that, depending on the type of pathogen, the incubation period for viral meningitis can vary in this way: 

• Enteroviruses (Coxsackie, ECHO) - 1-18 days, most often from 3 to 8 days.
• Meningitis caused by the mumps virus is up to three weeks, more often from 10 to 18 days.
• Acute aseptic meningitis (Armstrong choromeningitis) is from eight to twelve days.

Whatever the form of meningitis, its incubation period, people who care for a patient, one should observe personal hygiene rules, handle objects, toys, utensils in order to minimize the risk of infection.

Viral serous meningitis

Meningitis, which is diagnosed as viral, is a whole group of diseases that provokes inflammation of the serous, soft membranes of the brain and spinal cord. Meningitis of this type, like other species, can be primary or secondary, that is, developing against the background of the main infectious process. The main pathogens are more than 40 serotypes of enteroviruses, as well as Armstrong arenovirus, which causes choriomeningitis (lymphocytic).

Pathogenetically viral serous meningitis is divided into the following types: 

Meningitis, provoked by Coxsackie serotypes, ECHO viruses

The source of infection is a person with meningitis, as well as persons who are in contact with it. The enteroviruses are transported by animals, insects, the standard way of infection is airborne, and more rarely - oral-fecal. Epidemiology is characterized by seasonality, most often such meningitis are affected by children in the summer. Viral serous meningitis provokes inflammation of the brain envelopes, edema of its substance, the virus can also affect the internal organs: 

• heart (myocarditis, pericarditis), 
• lungs (pleurisy), 
• muscles (myalgia).

Incubation of the virus lasts from 3 to 9 days. Symptoms can be expressed clearly in the acute form of primary meningitis, or be lubricated in the mild course of the disease. As a rule, serous meningitis proceeds quickly, without a prodromal period and ends with a successful outcome. 2.

Aseptic choriomeningitis or Armstrong's lymphocytic meningitis

It is an inflammatory disease that affects the soft meninges, as well as substance, vascular plexuses of the ventricles of the brain. Lymphocytic meningitis, as a rule, is accompanied by myocarditis, pneumonia, orchitis, or mumps. Aseptic viral serous meningitis can occur in an erased form, most often they are sick young people under 30 years, less often children. Source of infection - rodents (rats, mice) that carry the virus. A person is infected with areniovirus through contaminated water (oral route), and also by alimentary route, when he consumes products infected with the virus. Seasonality of epidemiological manifestations - winter and early spring, the incubation of the virus lasts up to 12 days. Symptomatics is characterized by its hydrocephalic manifestations (cerebral edema), increased blood pressure. 

[5], [6], [7], [8], [9], [10], [11], [12], [13]

Meningitis caused by mumps, more precisely paramyxovirus

This is serous meningitis, which is more often diagnosed in children than in adults, and the boys are mostly sick. The path of infection is airborne, the source is a sick person. The incubation period lasts a long time, up to three weeks. Stages of penetration of the virus into the brain envelope - nasopharynx, blood flow, blood-brain barrier and subarachnoid zone. Also, the virus penetrates into the internal organs - testicles in males, appendages and ovaries - in women, in the pancreas.

Viral meningitis in children

Viral meningitis in children is a less dangerous form of the disease than bacterial meningitis. Nevertheless, the disease belongs to the category of infectious, provoked by environmentally resistant viruses - Coxsackie and ECHO, less often with arenovirus or mumps virus. The main reservoir of infection is a sick person or someone who is in contact with it. The causative agent of the disease is transmitted as follows: 

• Through infected water.
• Through dirty food - fruits, vegetables.
• Through dirty hands.
• In places of congestion people airborne droplets.
• When swimming in polluted waters - a swimming pool, a lake, a pond.

Viral meningitis in children is characterized by the fact that they are infected more often by children from 2-3 years to 6 years. Children under six months are ill with meningitis, rarely due to the inherent immune defenses obtained from the mother's immunity, especially if the children are breastfed. Most often, outbreaks of serous meningitis are noted in the summer and autumn, sporadic cases of "winter" viral meningitis almost never occur.

Symptoms of viral serous meningitis: 

• Increased body temperature, up to 40 degrees.
• Severe headache, pain in the eyes.
• Nausea and indomitable vomiting.
• Myalgia (pain in the muscles).
• Stiff neck muscles are possible.
• Rarely is diarrhea.
• Rarely is a convulsive syndrome.
• Typical meningeal manifestations for viral meningitis are not characteristic.

As a rule, viral meningitis in children occurs within 7-10 days, the temperature drops after 5-7 days, but relapses are possible. Treatment is carried out both permanently in the acute form of the disease, and outpatient, and consists of symptomatic therapy and compliance with bed rest.

The prognosis of the disease is favorable, there can rarely be residual events in the form of fatigue, periodic headaches. Children who have been ill with serous meningitis are subject to follow-up and follow-up at a neurologist.

Consequences of viral meningitis

Serous meningitis is considered less dangerous than bacterial meningitis. Viral meningitis consequences are favorable in 90% of cases with timely diagnosis and started symptomatic treatment. Meningitis of this kind is benign, but it can recur and be accompanied by such phenomena: 

• Cerebrenia - transient headaches, fatigue, temporary decline in cognitive functions - in 35% of cases.
• Neurosis, irritability, sensitivity, emotional instability - in 10% of cases.
• Increase in blood pressure, hypertension-hydrocephalic syndrome - in 5% of cases.

Viral meningitis, the consequences of which, as a rule, take place within half a year, may manifest as periodic complications and later in a year or two. This is due solely to non-compliance with medical recommendations, including those relating to bed rest. In addition, possible negative phenomena can be provoked by premature mental, emotional and physical stress. Thus, the main type of treatment after the discharge of a child or an adult is adherence to a sparing regimen and certain time limits.

[14], [15], [16], [17], [18], [19], [20]

Treatment of viral meningitis

Treatment of viral meningitis is most often etiotropic, symptomatic, aimed at anesthesia, rehydration, lower body temperature. As a rule, the classical course of viral meningitis is a form of a cold, slightly more complicated than usual, so it does not require any special treatment.

Very rarely prescribed antibiotic therapy, in cases of secondary meningitis against a certain form of infection. Interferon, acyclovir, immunoglobulins can be used.

Acute forms of serous meningitis require infusion therapy, detoxification with the help of polyionic drugs - hemodez, rheopolyukin, plasma. Less commonly prescribed corticosteroids and barbiturates, mainly with convulsive symptoms. After relief of the most alarming signs, the patient is shown nootropic drugs, B vitamins, a certain diet with the inclusion of protein, vitamin-rich food. After discharge, each person who has recovered with meningitis, becomes a dispensary account, observed in the treating neurologist and therapist.

Treatment of viral meningitis requires compliance with the sparing regimen, lifestyle for 4 weeks at least, but it is better not to be physically, emotionally and mentally stressed for 2-3 months until the body is fully restored.

How to prevent viral meningitis?

Since viral meningitis is transmitted by airborne droplets, and directly depends on hygiene compliance, rules for processing products, items, preventive measures are fairly simple: first of all, hygiene, exclusion of contacts with ARI patients, influenza, mumps and water treatment products.

In addition, the prevention of viral meningitis is the timely access to the doctor at the first sign of the disease, because it is the identification of sources of infection that helps to significantly reduce the rate and the quantitative rate of infection. Timely isolation of virus carriers, up to the appearance of the first symptoms, can minimize the risk of infection of both the patient's native and many other people around him. Also, the prevention is immunotherapy, for example, instillation of interferon three times a day for a week.

If the child who visits the kindergarten is ill with meningitis, the institution is declared quarantine for two weeks, all premises should be disinfected. The same applies to the home where the patient lives - within 14 days all contacts are limited, the rooms are treated with disinfectant solutions (3% chloramine solution, ventilation, destruction of insects, rodents).

It should be noted that the prevention of viral meningitis in the epidemiological sense is difficult, since the viruses are extremely common and resistant to external factors. In addition, their diversity (up to 40 known typical pathogens) does not allow the development of uniform norms and standards suitable for all cases. That is why, compliance with personal hygiene rules, reasonable approach to nutrition, simple action - frequent sanitation, washing hands, can be the most effective way to minimize the risk of infection with serous meningitis.