Viral Meningitis Basics

Less serious than bacterial meningitis, viral meningitis is associated with a number of infections, including chickenpox, Lyme disease, and even rabies.

 Meningitis occurs when the lining protecting the brain and spinal cord — called the meninges — becomes inflamed. There are two main kinds of meningitis, bacterial meningitis and viral meningitis. Bacterial meningitis is a potentially fatal condition that can have severe after-effects, including brain damage, deafness, limb amputation, and stroke. Viral meningitis, also called aseptic meningitis, is milder and more common than bacterial meningitis, rarely has any long-term after-effects, and is seldom fatal. Statistics vary, but it is thought that viral meningitis causes between 25,000 and 50,000 hospital visits each year in the United States.

Children are more likely than adults to get viral meningitis. Children under the age of 5 are most vulnerable.

Causes of Viral Meningitis

Nearly 90 percent of viral meningitis cases are caused by viruses in the enterovirus family, which is a group of common viruses. The viruses usually enter the body through the mouth and then travel to the brain and tissues around it. Coxsackie viruses and echoviruses are among the primary offenders.

Other viruses that can cause viral meningitis are:

    Chickenpox virus (varicella virus)
    Mumps virus
    West Nile virus
    Viruses transmitted by bites from infected mosquitoes
    Rabies virus
    Type 1 and type 2 herpes viruses
    HIV

Meningitis can also be caused by a direct infection of the meninges.

Symptoms of Viral Meningitis

Viral meningitis has symptoms that are similar to the flu:

    Severe headache
    Stiff neck
    Eyes sensitive to light
    Chills
    Fever
    Muscle pain
    Sore throat
    Drowsiness
    Confusion
    Rash
    Abdominal pain, nausea, and vomiting

Symptoms may last anywhere from a week to 10 days.

Treating Viral Meningitis

As with other viruses such as the common cold, the symptoms of viral meningitis can be managed by resting, drinking plenty of fluids, and taking medication to relieve symptoms. These measures will help you feel more comfortable, but they don’t actually cure the infection.

If the meningitis is caused by a very contagious virus such as chickenpox, your doctor will prescribe antiviral medication.

Most patients recover completely from viral meningitis although, in some cases, the patient may experience continuing headaches, fatigue, and depression.

Is Viral Meningitis Contagious?

Yes. The most common causes of viral meningitis, enteroviruses, are spread when there is direct contact with an infected patient’s saliva, mucus, or sputum. This can happen when you touch a person or object that is infected and then touch your own nose or mouth. Viral meningitis is also spread by coughing and sneezing.

The stool of someone who is infected can also carry the virus. In this case, the virus is spread primarily among young children who haven’t been toilet trained. Adults who change diapers of an infected baby may also catch the virus.

Remember that catching an enterovirus doesn’t mean it will develop into viral meningitis. In fact, fewer than 1 in 1,000 people who get sick from one of the viruses associated with viral meningitis go on to develop it.

How to Prevent Viral Meningitis

There are several ways to reduce your chances of getting a virus that can turn into meningitis:

    Get vaccinated. Be sure that you and your children have been vaccinated against measles, mumps, and rubella (the MMR vaccine), and chickenpox — all viruses that can cause meningitis.
    Avoid mosquitoes. Because mosquito-borne viruses can cause meningitis, using insect repellant and avoiding the outdoors during periods when mosquitoes are most active (dusk to dawn) is important.
    Wash your hands. Another crucial way to avoid being infected is to be mindful of personal hygiene. Wash your hands thoroughly with soap and warm water after you sneeze, cough, shake hands, use the toilet, and change diapers. Also be sure to wash your hands before you cook or eat.
    Disinfect. If you are around someone who has viral meningitis, clean and disinfect surfaces and objects, first with soap and water, and then with bleach that contains chlorine. (Mix about a quarter of a cup of bleach to a gallon of water.)

Remember, your best chance of avoiding viral meningitis is to be vaccinated against diseases known to cause viral meningitis and to wash your hands regularly. Thorough hand-washing can protect you from not only viral meningitis, but lots of other diseases. 

Treating Meningitis With Corticosteroids

Early treatment of meningitis with steroids may prevent some common meningitis complications.

Prompt treatment of meningitis with steroids, such as dexamethasone may prevent two common complications associated with the condition, hearing loss and seizures. But the use of steroids in meningitis treatment is not without controversy. Some experts advocate their use, while others disagree.

Using Steroids to Treat Meningitis

Bacterial meningitis inflames the tissues and fluid around the brain, often creating pressure within the brain. Seizures may occur because of this increased pressure and inflammation. Also, this inflammation and pressure can damage the nerves coming from the brain stem that control hearing, causing hearing loss. Steroids reduce inflammation and pressure within the brain, thus lessening a person's risk of having seizures and hearing problems.

“A number of studies have shown that when steroids are given along with antibiotics, there’s a lower risk of hearing loss,” says Nathan Litman, MD, director of pediatric infectious diseases at Children’s Hospital at Montefiore Medical Center in Bronx, New York. Studies have also found that meningitis treatment with steroids significantly reduce the risk of death in adults.

When Are Steroids Used for Meningitis?

To be helpful, a steroid must be given right away. “They need to be administered at the same time that antibiotics are started,” says Dr. Litman. “If you wait eight to 12 hours, that’s too late.”

That’s because steroids work by halting the body’s inflammatory response. This will help prevent swelling and pressure in the brain and subsequent neurological complications. “Once hearing is lost due to meningitis, it’s usually irreversible,” says Litman.

Most children and adults of all ages can take steroids — the only exception is very young babies. Infants six weeks and younger are not likely to be treated with steroids because this meningitis treatment hasn’t been studied in this age group.

Pros of Steroid Treatment

A number of studies have shown that meningitis treatment with steroids clearly reduces the chance of deafness, and may lessen mortality as well.

In one review of 18 of those studies involving 2,750 patients, steroids appeared to reduce the risk of severe hearing loss in children. Additionally, an earlier study published in the British Medical Journal found that death among adult meningitis patients taking steroids was less than half that of patients not receiving steroids. Study results have been mixed regarding fatality reductions in children, however. 
Cons of Steroid Treatment

Corticosteroids can have adverse effects, including:

    Bleeding in the stomach
    Elevation of blood sugar
    Fluid retention
    Sleeping issues
    Mood swings
    Ringing in the ears (tinnitus)

There’s also concern that meningitis treatment with steroids could interfere with the body’s ability to recover from non-bacterial types of meningitis, such as meningitis caused by viruses or fungi.

“If it turns out that if it’s not bacterial meningitis, treatment with steroids could potentially do some harm,” says Litman. When test results rule out bacterial meningitis, steroids are typically stopped. Some doctors are also concerned that steroids could decrease the penetration of antibiotics into the fluid around the brain and spinal cord where bacteria reside, but not all experts agree about this.

But, depending on the patient, meningitis treatment with steroids may be warranted.

“From my perspective, the benefits of using steroids outweigh the potential risks, especially if given for a short period of time,” says Litman. Research on the use steroids to treat meningitis is continuing at a number of medical centers around the country.