Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review

Abstract

Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.

Análise epidemiológica dos casos de meningite em crianças no Brasil dos anos 2010 a 2020

“…As manifestações clínicas primárias incluem sintomas gripais comuns, cefaleia, fotofobia, febre, rigidez da nuca, mialgia e fadiga. A gravidade desses sintomas depende da idade do paciente e são mais graves entre bebês e crianças (Al-Qahtani et al, 2022).…”

“…A meningite é uma inflamação das meninges do cérebro e da medula espinhal causada por agentes infecciosos e não infecciosos. Os agentes infecciosos que causam meningite incluem vírus, bactérias e fungos (Al-Qahtani et al, 2022). A meningite do sistema nervoso central, que acomete as meninges, em especial o espaço subaracnóideo.…”

Case report: Clinical and virological characteristics of aseptic meningitis caused by a recombinant echovirus 18 in an immunocompetent adult

“…Meningitis is inflammation of the meninges characterized by an abnormal number of white blood cells (WBC) in cerebrospinal fluid (CSF) with few or no focal neurological findings or brain abnormalities on imaging and accompanied by the acute onset of fever, headache, and neck stiffness ( 1 , 2 ). Infectious agents, including viruses, bacteria, and fungi, are the most common causes of meningitis ( 3 ). Viral meningitis is associated with the acute onset of meningeal symptoms and fever, pleocytosis of the cerebrospinal fluid, and no growth on routine bacterial cultures, usually affecting young children ( 1 , 4 ).…”

“…Viral meningitis is associated with the acute onset of meningeal symptoms and fever, pleocytosis of the cerebrospinal fluid, and no growth on routine bacterial cultures, usually affecting young children ( 1 , 4 ). Many viruses have been shown to cause viral meningitis, such as enteroviruses (EVs), parechovirus, herpesviruses, influenza viruses, arboviruses, and coronaviruses, and viral etiology varies according to age and country ( 3 ).…”

Progress in etiological diagnosis of viral meningitis

“…For instance, it directly influences the host immune response to viral infection (such as innate immune response and adaptive immune response), or indirectly influences susceptibility to viral infection by affecting other factors such as age, sex and comorbidities, resulting in differences in disease severity and outcome. Currently, the causative agent of viral meningitis is mainly human enterovirus (EV) (8)(9)(10)(11). The virus has more than 60 different subtypes, including poliovirus, coxsackievirus A, coxsackievirus B, and echovirus (12)(13)(14).…”