Enteroviral Meningitis

Background

• Enteroviruses are among the most common causes of viral meningitis.
  • The fecal-oral route is the primary route of transmission.
  • Prevalence is increased in the summer and early fall in temperate climates, but has high year-round incidence in tropical and subtropical areas.
  • Incidence is higher in children.
• Humoral immune deficiencies predispose patients to disease acquisition, severe disease, and chronic infection.

Evaluation

• Symptoms are similar to other forms of meningitis and include headache, fever, stiff neck, irritability, malaise, and photophobia.
• Prodrome of fever, upper respiratory symptoms, gastrointestinal symptoms, or rash may precede neurologic symptoms.
• Cerebrospinal fluid (CSF) analysis typically shows mild-to-moderate inflammation but pleocytosis may be absent in children.
• CSF enteroviral polymerase chain reaction (PCR) is the test of choice to confirm disease.
  • CSF enteroviral PCR is highly sensitive and specific.
  • A diagnosis of enteroviral meningitis by PCR has been shown to shorten hospital stay and antibiotic use.

Management

• Treatment of enteroviral meningitis is largely supportive.
• IV immunoglobulin (IVIG) is sometimes used in patients with severe disease or in patients with immunodeficiency, but supporting data is mixed and limited.
• No specific antiviral therapies are currently available.
• Prognosis is good overall, with notable exceptions of children < 3 months old and patients with humoral immune deficits.