Viral meningitis: Management, prognosis, and prevention in children
- Cecilia Di Pentima, MD
Cecilia Di Pentima, MD
- Director of Pediatric Infectious Diseases
- Goryeb Children's Hospital, Atlantic Health System
- Professor, Department of Pediatrics, Thomas Jefferson University
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
The management, prognosis, and prevention of viral meningitis in children will be discussed here. The epidemiology, pathogenesis, clinical manifestations, diagnosis, and differential diagnosis are discussed separately. (See "Viral meningitis: Epidemiology, pathogenesis, and etiology in children" and "Viral meningitis: Clinical features and diagnosis in children".)
OVERVIEW OF APPROACH
Viral meningitis may be suspected on the basis of epidemiologic data, clinical features, and initial cerebrospinal (CSF) studies, but clinical features cannot reliably differentiate viral from bacterial meningitis; the CSF profiles of bacterial and viral meningitis overlap considerably (table 1) [1,2]. The diagnosis of viral meningitis requires negative CSF culture for routine bacterial pathogens and positive identification of a viral pathogen in the CSF or other patient samples. (See "Viral meningitis: Clinical features and diagnosis in children", section on 'Diagnosis'.)
Pending results of CSF cultures and virologic studies, the results of the initial evaluation can be used to make a provisional diagnosis of bacterial meningitis, viral meningitis, or unclear etiology (table 1). The provisional diagnosis is one of several considerations in the initial management.
Indications for hospitalization may include [3,4]:
●Ill-appearance or signs of encephalitis (eg, altered mental status, behavior, or personality; motor or sensory deficits; speech or movement disorders; hemiparesis; flaccid paralysis; paresthesias; seizures) (see "Acute viral encephalitis in children: Clinical manifestations and diagnosis", section on 'Clinical features' and "Paraneoplastic and autoimmune encephalitis")
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- OVERVIEW OF APPROACH
- Suspected bacterial meningitis
- Suspected viral meningitis
- Unclear etiology
- - Repeat LP
- SUPPORTIVE CARE
- EMPIRIC THERAPY
- Empiric antibiotics
- - Choice of agent
- - Duration of therapy
- Empiric antivirals
- - Duration
- SPECIFIC THERAPY
- PERSISTENT SYMPTOMS
- Personal protection
- Infection control
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS