|Herpes Varicella-Zoster (Shingles) Infection
|Chickenpox Varicella Infection
|Varicella Cerebral Vasculopathy
|Herpes Zoster Ophthalmicus (HZO) Shingles
|Rubella (German Measles)
|Epstein-Barr Virus infection
| Cytomegalovirus (CMV) infections
| CMV retinitis infections
- Exclude encephalitis
- Commoner in Autumn and Summer
- Fever and signs of meningism
- Enteroviruses 77-90% usually in summer months in children
- Arboviral infection : occur in clusters. Tick exposure. Lyme disease. Test viral-specific CSF IgM
- HSV2 : can follow a genital infection
- VZV: associated chickenpox or shingles. HSV1 causes encephalitis and HSV2 viral meningitis
- HIV : At seroconversion or later. Cranial nerve palsies
- EBV: may follow infectious mononucleosis picture. IgM antibody.
- Mumps: may have orchitis. Seen in winter/spring. Males are more affected. Falling occurrence due to vaccination
- Lymphocytic choriomeningitis: in the autumn. Exposure to mice or their faeces. Rash, pulmonary changes, alopecia, orchitis, parotitis
- Measles, CMV infection
- Rash, Headache, fever, meningism, Kernig's positive
- Vomiting or diarrhoea, Neck stiffness is usually mild
- Frontal headache with pain moving eyes,
- Confusion and seizures suggest encephalitis
- Often occurs after genital lesions with HSV2
- Recurrent meningitis (Mollaret's meningitis)
- CSF - lymphocytes < 100 neutrophils and mild elevated protein and normal glucose. If there are lymphocytes and reduced glucose then consider fungal infection, listeria or tuberculosis or inflammatory causes such as sarcoid.
- CSF PCR may be done for CMV, EBV, VZV.
- HIV test where indicated
- CT to exclude abscess
- Bacterial meningitis, Brain abscess
- Cryptococcal meningitis
- Exclude bacterial meningitis. Aciclovir may be considered if HSV1/2 suspected. Most have a self-limiting infection and treatment is symptomatic.
- Take advice regarding starting HAART if HIV meningitis.
- Prognosis is good for nearly all patients though some symptoms may persist for months such as headache and lethargy. In neonates and infants, there have been suggestions of intellectual impairment