Introduction 

Meningitis is the inflammation of the meninges in the brain and can be caused by viruses, bacteria or fungi. Viral meningitis is more common and affects more children compared to bacterial meningitis, so it is important to understand the causes, symptoms and treatment options. This article will examine viral meningitis instead, so you can be best prepared in spotting the symptoms and getting your child treatment in the early stages of infection.¹

Viral meningitis causes

Many viruses can cause meningitis in children; the most common virus group causing meningitis is the enteroviruses. The common spread of the viral pathogens causing meningitis is the fecal-oral route. The best method to prevent fecal-oral spread is by partaking in frequent handwashing and encouraging your children to have good hand hygiene after visiting the bathroom and before eating food. Other viruses that can cause meningitis include:

• Herpes viruses, such as herpes simplex virus 1 and 2  (HSV1, HSV2) 
• Varicella-zoster virus (VZV)
• Epstein-Barr virus
• Adenovirus
• Arboviruses, such as the West Nile virus and the Zika virus² 

These viruses can reach the meninges of the brain through the bloodstream. When they reach the meninges, they cause an inflammatory response, which consequently causes meningitis.²

Symptoms 

Young children and toddlers may be unable to express how they feel, so it is important to learn to spot signs that are suggestive of viral meningitis. Some common symptoms seen in the paediatric population are irritability, lethargy, difficulty waking up, and refusal of feeding. You may also find a non-blanching rash. To see if a rash is non-blanching, the glass test should be carried out. If you press a glass up against the rash and it does not go away, it could be a meningitis rash.^1,2 

The most common symptom seen in meningitis patients is the non-blanching rash. If a child has this type of rash, they should be seen by a GP as soon as possible.¹

The NHS has grouped symptoms into a traffic light system to help parents distinguish between non-serious and serious symptoms. Green symptoms have been described as mild and include fever, vomiting, the child becoming agitated and aching muscles. Amber symptoms are moderate and include the child becoming difficult to wake up, pale blotchy skin, stiff neck and rapid breathing or grunting. If a child experiences red symptoms, such as the child becoming floppy or experiencing seizures, it is recommended that the parent or caregiver call 999 as this is a medical emergency.¹ 

Diagnostic techniques 

It is important to diagnose meningitis quickly so that the child can get the appropriate treatment as quickly as possible. It is also important for the underlying cause of meningitis to be identified as it can dictate what treatment option would be best. Bacterial meningitis is also more fatal compared to viral meningitis, so it is important to utilise the appropriate techniques that can verify the cause. A diagnosis of viral meningitis can prevent unnecessary use of antibiotics, and viral meningitis has a better prognosis compared to bacterial meningitis.³ They include the following:⁴

Laboratory investigations

Some diagnostic techniques must take place in the lab. A common diagnostic technique to differentiate bacterial meningitis includes;

• A lumbar puncture can be very painful for the child, but it is necessary to extract cerebrospinal fluid, which can then be examined in the lab to see if bacteria are present. Blood tests and blood cultures are also important to examine white blood cell levels and to assess for complications, including sepsis. Blood tests will examine full blood count, serum glucose levels, and coagulation studies to assess for complications⁴
• Polymerase Chain Reaction PCR. This type of testing can identify the exact viral cause of the meningitis infection, which is important as some viruses are associated with more complications compared to other viruses¹
• Lumbar puncture (LP): It is necessary to establish a diagnosis and should not be delayed unless specific reasons exist
• Blood tests: performed early and generally entail a full blood count, coagulation studies, glucose (regularly checked because it is low in the case of bacterial meningitis) and electrolytes
• Blood cultures: performed when bacterial meningitis is suspected
• Polymerase chain reaction (PCR) may be used if bacterial meningitis is suspected
• Computed tomography (CT) scan: This is usually performed before LP when the child demonstrates signs of deteriorating neurological function or deficits, among others

Treatment options

Viral meningitis cannot be treated with antibiotics. Supportive care is the choice of management. This includes administration of fluids to rehydrate the child and oxygen therapy, if needed, to increase oxygen saturation levels. Anti-sickness medication can also be offered to relieve vomiting. Most viral meningitis cases get better within 7-10 days and can usually be treated at home. Rest and pain relief can improve the child’s condition.  However, meningitis can prove life-threatening if it is not treated appropriately. Contact a healthcare provider if your child has signs of the condition.⁵ 

Complications 

Viral meningitis is associated with fewer long-term complications compared to bacterial meningitis. Main complications include but are not limited to hearing loss, problems with memory and concentration. Complications in viral meningitis are associated with e. enterovirus encephalitis, which can cause neurological issues or heart issues like myocarditis or pericarditis.^2,5 

Vaccinations to prevent meningitis 

Children need to get all their recommended vaccinations at the appropriate ages. Vaccinations can offer protection against both bacterial and viral meningitis, depending on the vaccine. Some examples of these include the MenB vaccine, the 6-in-1 vaccine, the Hib/MenC vaccine and the MMR (measles, mumps, rubella) vaccine.⁵ Although these vaccinations cannot prevent viral meningitis, they can prevent bacterial meningitis, which has a worse prognosis and a higher chance of complications. It must also be noted that having good hand hygiene is essential in preventing viral meningitis.² 

Summary 

Having a meningitis diagnosis for your child is scary, but a quick diagnosis is essential in providing the best quality treatment and care. Viral meningitis is associated with a better prognosis compared to bacterial meningitis, but it is still serious and should not be overlooked. It is important to notice if your child has any symptoms related to meningitis and seek medical care as early as possible.