Introduction

Meningitis is the inflammation of the meninges (membranes covering the brain and the spinal cord). Viral meningitis is the inflammation of the meninges caused by a virus. It is the most common and least severe form of meningitis.

Viral meningitis is self-limiting, meaning the patient typically recovers on their own without treatment. It is found in all ages but is most common in young children.

What are the symptoms of viral meningitis?

The symptoms of viral meningitis vary according to the patient’s age and immune status. People who have a weak immune system and infants younger than 1 month are more likely to develop severe illness due to viral meningitis.

Viral meningitis in babies presents with the following signs and symptoms:¹

• Fever
• Irritability
• Poor eating
• Lack of sleep
• Lethargy (lack of energy)

Common symptoms of viral meningitis in adults and children are as follows:

• Fever
• Headache
• Irritability
• Light sensitivity (photophobia)
• Neck stiffness
• Lack of appetite
• Lack of energy
• Nausea
• Vomiting

As viral meningitis is a self-limiting condition, most patients with mild viral meningitis normally recover on their own within 7-10 days. 

Consult a physician if you suspect that you or your child may have meningitis. A physician can determine whether you have viral meningitis, what causes it and how to best treat the disease.

What causes viral meningitis?

The most common cause of viral meningitis is enteroviruses (e.g. Coxsackie or Echovirus groups). Other causes include herpes viruses, which may include:¹

• Herpes simplex virus (1 and 2)
• Varicella-zoster virus (VZV)
• Cytomegalovirus
• Epstein-Barr virus

Other viruses that give rise to viral meningitis are:¹

• Measles virus
• Mumps virus
• Influenza virus
• Adenovirus
• Arboviruses (e.g.West Nile virus (WNV))
• Lymphocytic choriomeningitis virus (LCMV)

It is crucial to obtain travel history in patients suspected of having viral meningitis, as many viruses have specific distribution patterns and are more common in some areas than others.

How do you get viral meningitis?

Viruses that cause viral meningitis can be transmitted from one person to another either through coughing, sneezing, close contact, sharing food or personal items or touching contaminated surfaces.

What are the risk factors of viral meningitis?

Risk factors are the components that make a person more vulnerable to developing a disease. The following are the people that at higher risk of developing viral meningitis:²

• People with a weak immune system, either due to some therapy (e.g. chemotherapy) or some disease (e.g. cancer, AIDS, autoimmune disorders)
• Young children (less than 5 years old)
• People residing in crowded living conditions

What is the difference between viral and bacterial meningitis?

Viral meningitis is the most common and least severe form of meningitis, caused by viruses. Bacterial meningitis is rare but can be fatal, and is caused by bacteria. Patients with viral meningitis recover on their own and do not require treatment, while those with bacterial meningitis require treatment. 

There is no absolute way to differentiate between the two types of meningitis without consulting a physician. Seek medical help from a physician if you suspect you or your child may have viral or bacterial meningitis.

How is viral meningitis diagnosed?

The healthcare provider diagnoses viral meningitis by performing the following tests:

• Nose or throat swab: The physician will swab your throat or nose to get a mucus sample, which is then tested to determine the presence of causative viruses³
• Stool sample: A Stool (poop) sample is taken to check the presence of viruses or other causative factors
• Spinal tap/lumbar puncture: A sample of cerebrospinal fluid is taken, which is then analysed⁴
• Imaging studies: CT scan (computed tomography) as well as MRI (magnetic resonance imaging) are conducted to capture images of your brain, and the physician reviews the images for inflammation or other changes associated with meningitis⁴
• Blood tests are also done

How is viral meningitis treated?

As viral meningitis is self-limiting, patients typically do not require specific treatment and get better within 1-2 weeks.⁵ Viral meningitis is mainly treated with supportive care, in which symptoms are managed. 

Supportive care

Supportive care is utilised for symptomatic management. Proper rest is recommended. Dehydration is prevented by keeping the patient properly hydrated. Drink plenty of fluids to prevent dehydration. Body temperature is reduced with the help of antipyretics (such as paracetamol) for the purpose of fever management. Pain is relieved with the help of analgesics (painkillers).⁶ Anti-inflammatory medications are also used to reduce inflammation and include corticosteroids such as prednisone and dexamethasone.

Antiviral therapy

Antiviral medications are rarely used in the management of viral meningitis. Acyclovir and valacyclovir are used to treat herpes simplex 2-induced meningitis.

Antibiotic therapy

Although antibiotics are not effective against viruses, they are given as empirical therapy when the diagnostic results have not confirmed the presence of viruses or the results are still pending. This is done because symptoms of both viral and bacterial meningitis are similar, and bacterial meningitis can be life-threatening, thus requiring immediate treatment.⁵ Antibiotics are usually stopped once viral meningitis is diagnosed.⁷ Antibiotics in empiric therapy for viral meningitis include vancomycin in combination with ceftriaxone or cefotaxime.

How do you prevent viral meningitis?

In cases where the viral meningitis is caused by enteroviruses, preventive measures should be taken, as there are no vaccines available against this type of virus. These preventive measures include good hygiene and are following:²

• Wash your hands for at least 20 seconds, especially after using the toilet.
• Do not touch your face with unclean hands.
• Avoid going out if you are infected.
• Steer clear of close contact with infected people.

If viral meningitis is caused by the measles, mumps or influenza virus, patients should receive vaccination. As viral meningitis is common in young children, ensure that your child receives vaccinations on time according to the childhood vaccination schedule. Before the introduction of the MMR vaccine (measles, mumps, and rubella vaccine), mumps was identified as a common causative agent of viral meningitis in children.⁷

In order to avoid getting viral meningitis due to arbovirus, mosquito repellent chemicals, proper clothing, and bed nets should be utilised, particularly during travel.⁵

What is the prognosis of viral meningitis?

The prognosis (prediction about the disease outcome) of viral meningitis is generally good. Viral meningitis has a swift recovery that occurs within 1-2 weeks, while in comparison, bacterial meningitis can lead towards mental health deterioration along with other complications. Most patients with viral meningitis recover within 7 to 10 days without needing any treatment. Hospitalisation is very rare and is required only in cases of severe viral meningitis.

Summary

Viral meningitis is the least severe type of meningitis and does not necessitate treatment. It affects people of all ages, but it is most common in young children. Common symptoms of viral meningitis include fever, headache, and stiff neck. As the symptoms of both viral and bacterial meningitis are similar, it is essential to seek immediate medical help, as bacterial meningitis can be fatal. Treatment of viral meningitis is usually supportive and includes hydration, pain management and fever control. Viral meningitis can be prevented by adopting certain preventive measures, such as routine vaccination and good hygiene.

FAQs

What is viral meningitis?

Viral meningitis is the inflammation of the meninges, which are the membranes covering the brain and spinal cord. Viral meningitis is the most common and prevalent type of meningitis. Although it is self-limiting, you should consult with a physician if you’re experiencing symptoms of viral meningitis so that the physician can determine the best course of action.

What are the causes of viral meningitis?

Viral meningitis is caused by viruses, with enteroviruses being the most common. Other viral causes of this disease are given in the article above.

What are the common symptoms of viral meningitis?

Viral meningitis typically presents with symptoms such as fever, stiff neck, light sensitivity, and headache. You may also experience nausea and vomiting.

How do I know I have viral meningitis?

Seek medical help if you have the above-mentioned symptoms of viral meningitis. The physician will diagnose whether you have viral meningitis or not by taking a history of symptoms, performing a physical examination and specific laboratory tests.

Can viral meningitis be prevented?

Yes, practising good hygiene, such as regular handwashing, and getting vaccinated against viruses that can cause meningitis can help minimise the risk. Avoiding close contact with individuals who are infected or have viral meningitis can also be important.

Is viral meningitis contagious?

Yes, viral meningitis can be contagious. It is transferred from an infected person through respiratory secretions such as saliva or mucus. However, transmission of causative viruses does not necessarily mean that the person will develop meningitis.

Is viral meningitis treatable?

Yes, viral meningitis is treatable. Although it is self-limiting and the patient gets better on their own, the treatment typically involves supportive care, such as proper hydration, management of pain and fever. 

How long does it take to recover from viral meningitis?

The recovery period for viral meningitis varies and depends on the patient’s age and overall health. 

Is there vaccine available for viral meningitis?

There are vaccines available for specific causative viruses of viral meningitis, such as the MMR vaccine, which protects against measles, mumps and rubella. Nonetheless, not all viruses that cause meningitis have a specific vaccine to prevent them.