Viral Meningitis

Viral meningitis is actually a subset of aseptic meningitis. Aseptic meningitis antedates the modern science of virology and signifies an infection of the subarachnoid space and meninges with no obvious bacterial cause. Encephalitis occurs when there is inflammation of brain tissue. Viral meningitis presents with similar signs and symptoms as bacterial meningitis, but with less severity. A history of a preceding viral respiratory infection is common. Obtaining LP for CSF evaluation is the only method for determining the difference. There are numerous causes of viral meningitis (Box 42-11). Outbreaks are often seasonal.

Treatment is mainly supportive, with the exception of her-pesvirus (herpes simplex virus [HSV]) and HIV, for which specific antiviral therapy is available. Data regarding herpes meningitis treatment are limited, and both high-dose acyclovir (60 mg/kg/day) and lower-dose therapies have been advocated (Kohlhoff et al., 2004). For HIV and acquired immunodeficiency syndrome (AIDS)-dementia complex (ADC), many antiviral combinations have been suggested. The factors to be considered when choosing a combination therapy for ADC include toxicity, the many potential drug interactions, CNS penetration, and resistance. Because the treatments for HIV and its complications are often changing, consultation with an infectious disease specialist should be considered.

With the exception of HSV encephalitis and ADC, the prognosis is generally very good for other viral meningitides. Children seem to recover within 1 to 2 weeks, whereas adults may take several months.

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