Opinion statement
Acute viral meningitis is the most common infection of the central nervous system. Most cases occur in children and young adults and are due to enteroviruses. Although the common causes of acute viral meningitis still lack treatment with an effective antiviral agent, management of patients is changing because of better and more rapid diagnostic tests to determine the exact viral etiology. These tests reduce the cost of workups and shorten hospitalizations.
Recurrent meningitis is less common, with most cases caused by herpes simplex virus 2 in young adults. Early administration of antiviral drugs such as acyclovir, valaciclovir, or famciclovir can shorten the duration of an episode of aseptic meningitis. Daily prophylactic administration of any of these medicines also reduces the frequency of future episodes.
Similar content being viewed by others
References and Recommended Reading
Centers for Disease Control and Prevention: Aseptic meningitis (viral meningitis): 1990 case definition. http://www.cdc.gov/ncphi/disss/nndss/print/ameningitiscurrent.htm. Accessed December 10, 2007.
Rantakallio P, Leskinen M, von Wendt L: Incidence and prognosis of central nervous system infections in a birth cohort of 12,000 children. Scand J Infect Dis 1986, 18:287–294.
Rotbart HA: Viral meningitis. Semin Neurol 2000, 20:277–292.
DeBiasi RL, Tyler KL: Recurrent aseptic meningitis. In Infectious Diseases of the Nervous System. Edited by Davis LE, Kennedy PGE. Oxford: Butterworth Heinemann; 2000:445–479.
Davis LE: Subacute and chronic meningitis. Continuum 2006, 12:27–57.
Shalabi M, Whitley RJ: Recurrent benign lymphocytic meningitis. Clin Infect Dis 2006, 43:1194–1197.
Davis LE, DeBiasi R, Goade DE, et al.: West Nile virus neuroinvasive disease. Ann Neurol 2006, 60:286–300.
Gnann JW Jr: Meningitis and encephalitis caused by mumps virus. In Infections of the Central Nervous System, edn 3. Edited by Scheld WM, Whitley RJ, Marra CM. Philadelphia: Lippincott Williams & Wilkins; 2004:231–241.
Chadwick DR: Viral meningitis. Brit Med Bull 2005, 75/76:1–14.
Nowak DA, Boehmer R, Fuchs H-H: A retrospective clinical, laboratory and outcome analysis in 43 cases of acute aseptic meningitis. Eur J Neurol 2003, 10:271–280.
Rorabaugh ML, Berlin LE, Heldrich F, et al.: Aseptic meningitis in infants younger than 2 years of age: acute symptoms and neurologic complications. Pediatrics 1993, 92:206–211.
Fitch MT, van de Beek D: Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis 2007, 7:191–200.
Talan DA, Guterman JJ, Overturf GD, et al.: Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med 1989, 18:856–862.
Tuncer O, Caksen H, Arslan S, et al.: Cranial computed tomography in purulent meningitis of childhood. Int J Neurosci 2004, 114:167–174.
Gerdes LU, Jorgensen PE, Nexo E, Wang P: C-reactive protein and bacterial meningitis: a meta-analysis. Scand J Clin Lab Invest 1998, 58:383–393.
Mukai AO, Vera L, Krebs J, et al.: TNF-alpha and IL-6 in the diagnosis of bacterial and aseptic meningitis in children. Pediatr Neurol 2006, 34:25–29.
Kupila L, Vuorinen T, Vainionpaa, et al.: Diagnosis of enteroviral meningitis by use of polymerase chain reaction of cerebrospinal fluid, stool, and serum specimens. Clin Infect Dis 2005, 40:982–987.
DeBiasi RL, Tyler KL: Molecular methods for diagnosis of viral encephalitis. Clin Microbiol Rev 2004, 17:903–925.
Davies NWS, Brown LJ, Gonde J, et al.: Factors influencing PCR detection of viruses in cerebrospinal fluid of patients with suspected CNS infections. J Neurol Neurosurg Psychiatry 2005, 76:82–87.
Weinberg A, Bioch KC, Li S, et al.: Dual infections of the central nervous system with Epstein-Barr virus. J Infect Dis 2005, 191:234–237.
Nagel MA, Forghani B, Mahalingam R, et al.: The value of detecting anti-VZG IgG antibody in CSF to diagnose VZV vasculopathy. Neurology 2007, 68:1069–1073.
Vaheri A, Keski-Oja J, Salonen EM, Koskiniemi ML: Cerebrospinal fluid IgG bands and virus-specific IgG, IgM, and IgA antibodies in herpes simplex virus encephalitis. J Neuroimmunol 1982, 3:247–261.
Marra CM: Human immunodeficiency virus. In Infections of the Central Nervous System, edn 3. Edited by Scheld WM, Whitley RJ, Marra CM. Philadelphia: Lippincott Williams & Wilkins; 2004:273–286.
Everberg G: Deafness following mumps. Acta Otolaryngol (Stockh) 1957, 48:397–403.
Chang LY, Huang LM, Gau SS, et al.: Neurodevelopment and cognition in children after enterovirus 71 infection. N Engl J Med 2007, 356:1226–1234.
Gary M, Hauck MA, Buck G, Gerard R: Potential cost savings through rapid diagnosis of enteroviral meningitis. Pediatr Infect Dis J 1997, 16:1086–1087.
Rotbart HA, Sawyer MH, Fast S, et al.: Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J Clin Microbiol 1994, 32:2590–2592.
Robinson CC, Willis M, Meagher A, et al.: Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis. Pediatr Infect Dis J 2002, 21:283–286.
Ramers C, Billman G, Hartin M, et al.: Impact of diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA 2000, 283:2680–2685.
Thomson Healthcare: DRUGDEX® System. http://www.thomsonhc.com. Accessed December 5, 2007.
Desmond RA, Accortt NA, Talley L, et al.: Enterovirus meningitis: natural history and outcome of pleconaril therapy. Antimicrob Agents Chemother 2006, 50:2409–2414.
Tyler KL: Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret’s. Herpes 2004, 11(suppl 2):57A–64A.
Gilden DH, Mahalingam R, Cohrs R, Tyler KL: Herpesvirus infections of the nervous system. Nat Clin Pract Neurol 2007, 3:82–94.
Ormrod D, Scott LJ, Perry CM: Valaciclovir: a review of its long term utility in the management of genital herpes simplex virus and cytomegalovirus infections. Drugs 2000, 59:839–863.
Wald A, Selke S, Warren T, et al.: Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis 2006, 33:529–533.
Reitano M, Tyring S, Lang W, et al.: Valaciclovir for suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. Valaciclovir HSV Study Group. J Infect Dis 1998, 178:603–610.
DeJesus E, Wald A, Warren T, et al.: Valacyclovir for the suppression of recurrent genital herpes in human immunodeficiency virus-infected subjects. J Infect Dis 2003, 1888:1009–1016.
Romero JR: Pleconaril: a novel antipicornaviral drug. Expert Opin Investig Drugs 2001, 10:369–379
Abzug MJ, Cloud G, Bradley J, et al.: Double blind placebo-controlled trial of pleconaril in infants with enterovirus meningitis. Pediatr Infect Dis J 2003, 22:335–340.
Rotbart HA, Webster AD: Treatment of potentially life-threatening enterovirus infections with pleconaril. Clin Infect Dis 2001, 32:228–235.
McKinney RE, Katz SL, Wilfert CM: Chronic enteroviral meningoencephalitis in agammaglobulinemic patients. Rev Infect Dis 1987, 9:334–356.
Rudge P, Webster AD, Warner RT, et al.: Encephalomyelitis in primary hypogammaglobulinemia. Brain 1996, 119:1–15.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Davis, L.E. Acute and recurrent viral meningitis. Curr Treat Options Neurol 10, 168–177 (2008). https://doi.org/10.1007/s11940-008-0018-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11940-008-0018-9