What is Viral Meningitis?

Viral meningitis, which mostly affects children under five, sees up to 15 people in every 100,000 admitted into hospital in the UK each year, though the mortality rate for this type of meningitis remains extremely low.

Very few people who become infected with any of the viruses that can trigger meningitis will actually develop the illness. Still, it is important to know the signs and symptoms of viral meningitis and act swiftly to prevent any further complications.

What is viral meningitis?

Meningitis is a condition which results in inflammation of membranes, or meninges, in the cerebrospinal fluid surrounding your brain and the spinal cord. Viral meningitis, also known as aseptic meningitis, refers to this inflammation being caused by a virus, which in most cases is an enterovirus.

Coxsackie or echovirus groups within enteroviruses are common viruses that live in the stomach. Viral meningitis begins with symptoms that are similar to that of the flu virus, including fever, headache and body aches.

There are different forms of meningitis, of which viral meningitis is the most commonly occurring. Other forms of meningitis include bacterial meningitis, fungal meningitis, parasitic meningitis, amoebic meningitis and non-infectious meningitis.

Viral meningitis is the least aggressive type and, for most people, it rarely becomes dangerous, but in some cases it can be life-threatening. For some people, the physical impact of meningitis can change their lives, though most people will be able to make a full recovery. Viral meningitis is only usually dangerous for people with underlying conditions that result in compromised immunity.

What causes viral meningitis?

The brain and spinal cord are surrounded by three different layers of tissues known as the meninges. In between the middle and inside layers is the subarachnoid space, which holds the cerebrospinal fluid. The purpose of this fluid is to provide a cushion between the brain and the skull to protect the brain and the spinal cord from injury.

It also transports nutrients from the blood and discards waste from the brain cells. The meninges can become inflamed when the cerebrospinal fluid becomes infected with a virus or bacteria, as well as through injuries and diseases such as cancer.

Enteroviruses are thought to cause 80% of cases of viral meningitis in adults. Alongside enteroviruses, other causes of viral meningitis are Herpesviridae, HIV, measles, mumps, West Nile virus, some include the herpes simplex virus (HSV and HSV-2), gastroenteritis, cytomegalovirus, tick-borne encephalitis, lymphocytic choriomeningitis virus, and St. Louis encephalitis virus.

However, as the measles, mumps and rubella vaccination (MMR) is widely taken up by most babies, these conditions are no longer the leading causes of viral meningitis.

People with HSV-2 have usually contracted the virus through sexual contact, causing genital herpes. HSV-2 remains dormant in the body, and can be reactivated, meaning that meningitis caused by HSV-2 can happen more than once. Similarly, the chickenpox causing virus, varicella-zoster, stays dormant in the body after infection, and can cause meningitis to occur.

Viral meningitis can be contracted through:

• The bloodstream by another infection spreading.
• Inhaling virus particles in the air, either as a result of sneezing or coughing.
• Sharing infected items such as toothbrushes and utensils.
• Touching infected surfaces, or through contact with infected faeces.
• Sexual intercourse or kissing.
• Insect bites from insects that carry particular viruses, usually falling in specific seasons that are conducive for mosquitoes.
• Sharing needles with people carrying the causative viruses.

The virus can be spread to others for many weeks after being exposed to the virus, and even after the symptoms have disappeared. Whilst some of the viruses that cause viral meningitis are contagious, some are not, such as those spread through mosquitoes.

Who is at risk of catching viral meningitis?

Anyone can contract viral meningitis, though it is more common in the following groups of people:

• Children under five, due to their underdeveloped immune systems, which allow viruses to enter their bloodstream more easily.
• People who are immunodeficient, such as those with autoimmune diseases, those undergoing chemotherapy, those with AIDS, and those who have recently had organ transplants.
• People with diabetes.

There are risk factors that need to be investigated by any medical professional who suspects the presence of viral meningitis.

These are as follows:

• Any symptoms within the person’s immediate contacts.
• Whether the person have travelled abroad.
• Whether the person has received their full MMR, pneumococcal and polio vaccination course.
• The presence of any underlying conditions.
• Whether there has been exposure to rodent faeces.
• Whether there has been exposure to ticks.
• Sexual history.

Viral meningitis is most commonly spread in the late summer and early autumn months, which is thought to be when enteroviruses spread most easily, but are determined by other factors too, such as age group and geography.

Signs and symptoms of viral meningitis

Viral meningitis is often marked by the following symptoms, which tend to present within three to six days of infection:

• Fever (temperature over 38°C).
• Cold hands and feet.
• Headache.
• Photophobia (sensitivity to light).
• Stiff neck.
• Nausea.
• Vomiting.

As a fever, headache and nausea can be symptoms of many other conditions, photophobia and stiffness of the neck are the most telling signs of distinguishing viral meningitis from other illnesses.

Some additional symptoms may include:

• Swollen glands.
• A rash on the skin that does not disappear when a glass is held against the skin.
• Muscle pain.
• Sore throat.
• Genital herpes.
• Fatigue.
• Seizures.
• Confusion.

Children and babies may display the following symptoms:

• No appetite.
• Distress when they are touched.
• Fast breathing.
• Crying in a non-typical way.
• Their fontanelle (the soft part in the middle of the skull) is swollen.

Within young children, encephalitis (swelling of the brain) may also be present, which can be indicated by a swollen fontanelle, and can be life-threatening. Encephalitis needs to be treated in the hospital.

How is viral meningitis diagnosed?

Medical professionals base their prognosis on reported symptoms of a headache, fever and stiffness in the neck. As both viral meningitis and bacterial meningitis have similar symptoms to begin with, the only sure way to distinguish between the two is through analysing the cerebrospinal fluid.

This is done by carrying out a lumbar puncture. A lumbar puncture, also known as a spinal tap, is a procedure where a very thin needle withdraws fluid from the area in between your bones in the lower part of the spine, known as the spinal canal.

A test is carried out to determine whether there are any bacteria present by studying the number of white blood cells present, as well as protein and glucose levels. High levels of white blood cells indicate viral meningitis rather than bacterial meningitis.

There are risks associated with a spinal tap, particularly when there is pressure in the skull:

• Up to 25% of people who have a spinal tap have a headache afterwards due to the cerebrospinal fluid seeping into the surrounding tissue.
• Pain in the lower back where the needle was inserted.
• Bleeding.
• Brain herniation caused by pressure in the brain that moves the brain tissues around.
• Nerve dysfunction.

Nevertheless, the procedure is typically safe, and complications are not usual. In some cases, the medical professional may want to check why there has been an increase in the pressure in the skull, so they may order a scan of the skull or rule out any immediate threat to life, such as a tumour.

Sometimes medical professionals will take a sample of other bodily fluids to diagnose the viral condition that has caused the meninges to swell. These may be blood, nasal mucus, saliva from the back of the throat or stool. They will then check these secretions for the presence of high levels of antibodies for different viruses, and be able to conclude which was the cause of the meningitis.

How is viral meningitis treated?

As viral meningitis is caused by a virus, antibiotics will not be administered, as they would have no effect. People who are healthy will usually recover from viral meningitis within 10 days of their first symptoms, with no need for treatment.

In some cases, antiviral medication will be given to people where the meningitis has been caused by a particular type of virus. If a person becomes extremely ill, they will be treated in hospital to alleviate symptoms and address secondary conditions. In hospital, the patients might be provided with intravenous fluids and oxygen, as well as by administering antiviral medications.

Antiviral medications might include:

• Acyclovir; used to treat the herpes simplex virus (HSV) and varicella-zoster.
• Antiretrovirals for HIV, which work by preventing retroviruses from multiplying.

The best way to avoid meningitis is to try and prevent it from spreading.

This can include:

• Ensuring that your child is up to date with their vaccinations for measles, mumps and chickenpox.
• Thoroughly washing your hands after changing a baby’s nappy.
• Frequently disinfecting surfaces, particularly in nurseries and play centres.
• Keeping children home from school when they are unwell.
• Adults can take the flu vaccine to avoid this triggering viral meningitis.
• Avoiding bites from ticks and mosquitoes.
• Using pest control if your home is known to have mice or rats.

To relieve symptoms of meningitis, the following measures can be taken:

• Taking analgesic painkillers to relieve headaches.
• Taking acetaminophen (paracetamol) to reduce fever, and using cold compresses.
• Staying hydrated.

If an adult has viral meningitis, it is not required for them to isolate. If you suspect a child has meningitis, you should not hesitate to seek medical care immediately. Babies that have a fever, a rash, are vomiting, are eating less than usual, or are not urinating frequently should be taken to A&E.

If your child has been in close contact with someone who has meningitis, you can contact your GP to enquire about any extra precautions you can take.

If someone with viral meningitis has encephalitis, they will likely be treated with steroidal medications, antiviral medication, painkillers, anti-seizure medications and oxygen. This remains a rare complication of viral meningitis in healthy children and adults.

Who can help with viral meningitis?

A diagnosis of meningitis, particularly in a child, can be worrying.

There are a number of organisations that can provide support and advice to anyone who is worried about the impact of the condition:

• Meningitis Now is a UK based charity that helps to support children and adults impacted by meningitis, with a free helpline run by qualified nurses.
• The Meningitis Research Foundation works to drive action to defeat meningitis by running awareness campaigns and offering support to different people.
• The Brain Charity offers information, practical advice and support for families affected by viral meningitis. Including counselling, group therapy and activities.