Viral menigitis and encephalitis Flashcards
What is meningitis?
Inflammation of the meninges.
What is encephalitis?
Inflammation of the brain.
What is meningo-encephalitis?
Inflammation of the brain and meninges.
What is ‘aseptic’ meningitis?
Clinical picture of meningitis
White cell count >5x10^6/L (5/mm3) in cerebrospinal fluid (CSF)
Negative bacterial culture of the CSF
What are the possible causes of ‘aseptic’ meningitis?
- Partially treated bacterial meningitis
- Listeria
- TB
- Syphilis
- Malignancy
- Autoimmune conditions
- Drugs
What is the epidemiology of viral meningitis?
Common, especially in children/neonates
- Incidence 5-15 cases per 100,000
- around 3400 hospital cases in UK 2009-10
2 peaks of hospital admission:
- Neonates
- around age 5
What is the most common genera of viruses to cause viral meningitis?
Enteroviruses
- Echoviruses
- Coxsackie viruses
- Parecho viruses
- Enteroviruses 70 and 71
- Poliovirus
Which herpes viruses can cause meningitis?
Herpes Simplex Virus 2
- HSV 2»_space; HSV 1
Varicella Zoster Virus (VZV)
Cytomegalovirus (CMV)
Epstein Barr Virus (EBV)
HHV6, HHV7
In what percentage of viral meningitis cases is the aetiology unknown?
35%
What is the pathogenesis of infective meningitis?
Colonisation of mucosal surfaces
Invasion of epithelial surface
Replication in cells
Dissemination and CNS invasion
- Via cerebral microvascular endothelial cells
- Via choroid plexus epithelium
- Spread along the olfactory nerve
What causes the symptoms of meningitis?
Symptoms mainly due to inflammatory response in the CNS.
What is the clinical presentation of meningitis?
Fever
‘Meningism’
- Headache
- Neck stiffness
- Photophobia
Sometimes ‘viral’ prodrome (e.g. lethargy, myalgias, arthralgias, sore throat, D&V, rash)
What is the clinical presentation in neonates?
In neonates/infants meningeal signs may be absent
- Look for nuchal rigidity (neck stiffness) and bulging anterior fontanelle
What is Kernig’s sign?
With hip and knee flexed to 90 degrees, the knee cannot be extended due to pain/stiffness in the hamstrings
What is Brudzinski’s sign?
Flexing the neck causes the hips and knees to flex