obsolete echovirus meningitis

Echovirus Meningitis: A Rare but Serious Condition

Echovirus meningitis, also known as enteroviral meningitis, is a rare but serious condition caused by the echovirus, a type of enterovirus. This viral infection affects the membranes surrounding the brain and spinal cord, leading to inflammation and potentially life-threatening complications.

Symptoms and Clinical Differences

The symptoms of echovirus meningitis can vary in severity and may include:

• Headache (100%)
• Photophobia (87.5%)
• Nausea (67.5%) [2]
• Lethargy, drowsiness, personality changes, seizures, paresis, and coma [4]

In contrast to other aseptic meningitis cases, echovirus meningitis tends to affect younger patients and may have a rather benign clinical course [11].

Epidemiology and Outbreaks

Echoviruses are a group of viruses that primarily affect children and can cause upper respiratory tract infections, laryngotracheitis, and epidemic conjunctivitis [5]. Meningitis caused by echovirus 30 has been reported in several outbreaks worldwide, including Germany (2013), Bulgaria (2012), Finland (2009-2010), and China (2014) [10].

Risk Factors

Household members of ill day care centre children are 15 times more likely to have met the case definition for enteroviral illness than those of non-ill day care centre children [13]. Contact with an ill household member, day care attendance, and other factors can increase the risk of echovirus infection.

Diagnosis and Treatment

The diagnosis of echovirus meningitis is based on clinical symptoms and laboratory parameters such as clear cerebrospinal fluid (CSF) with an abnormal number of white blood cells [6]. There is no specific treatment for echovirus meningitis, but supportive care and antiviral medications may be administered to manage symptoms and prevent complications.

References

[1] Not provided in the context. [2] Symptoms included headache (100%), photophobia (87.5%), and nausea (67.5%) [2]. [4] Symptoms include lethargy, drowsiness, personality changes, seizures, paresis, and coma [4]. [5] Echoviruses are a group of viruses that primarily affect children and can cause upper respiratory tract infections, laryngotracheitis, and epidemic conjunctivitis [5]. [6] Meningitis is inflammation of the meninges characterized by an abnormal number of white blood cells (WBC) in cerebrospinal fluid (CSF) [6]. [10] Meningitis caused by echovirus 30 has been reported in several outbreaks worldwide, including Germany (2013), Bulgaria (2012), Finland (2009-2010), and China (2014) [10]. [11] Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18) [11]. [13] Household members of ill day care centre children are 15 times more likely to have met the case definition for enteroviral illness than those of non-ill day care centre children [13].

Early Signs and Symptoms

The early signs and symptoms of echovirus meningitis can be similar to those of other viral infections, making it challenging to diagnose in its initial stages. According to various sources [3][4], the following symptoms may be present:

• Sudden high fever
• Stiff neck
• Bad headache
• Nausea or vomiting
• Confusion or trouble concentrating
• Seizures

These symptoms can develop over several hours or days, and it's essential to seek medical attention immediately if they are suspected.

Additional Symptoms in Babies

In infants under 2 years old, the symptoms may be different from those experienced by adults. Some signs of echovirus meningitis in babies include:

• Bulging "soft spot" (fontanelle) on baby's head
• Poor eating

These symptoms can be subtle and may not always be immediately apparent.

Other Symptoms

In some cases, the symptoms of echovirus meningitis can progress to more severe conditions. These may include:

• Lethargy or drowsiness
• Personality changes
• Seizures
• Paresis (partial paralysis)
• Coma

It's crucial to seek medical attention immediately if any of these symptoms are suspected.

Rash and Skin Symptoms

In some cases, echovirus meningitis can cause a rash or skin symptoms. These may include:

• Petichial rash (small, pinpoint spots on the skin)
• Sore throat
• Chest pain

These symptoms can be similar to those experienced in other viral infections, making diagnosis challenging.

Important Note

Echovirus meningitis is a serious condition that requires immediate medical attention. If any of these symptoms are suspected, it's essential to seek help from a qualified healthcare professional as soon as possible.

References:

[1] Meningitis: Signs and Symptoms of Infection (Source 2) [2] Takeaways (Source 3) [3] Meningitis signs and symptoms in babies (Source 4) [4] Echovirus-9 causes a petichial rash that is often confused with meningococcemia. When the CNS is involved, aseptic meningitis develops. (Source 14)

Diagnostic Tests for Obsolete Echovirus Meningitis

Echovirus meningitis, a type of viral meningitis caused by echoviruses, was once a significant public health concern in the early 2000s. While it is still possible to contract this infection, the incidence has decreased significantly due to improvements in hygiene and vaccination efforts.

Historical Diagnostic Methods

In the past, diagnostic tests for echovirus meningitis were limited. According to search results [1], a prospective study of adults admitted to a regional infectious disease unit in 2001 found that clinical features such as fever, headache, and neck stiffness were common among patients with echovirus meningitis.

Laboratory Tests

The following laboratory tests were used to diagnose echovirus infections:

• Blood cultures: A blood sample was taken from the patient's arm to check for signs of infection [5].
• PCR (Polymerase Chain Reaction) testing: This molecular method was increasingly available in the early 2000s and can provide rapid and accurate diagnoses for bacterial meningitis, including echovirus infections [11, 12].

Other Diagnostic Methods

In addition to laboratory tests, other diagnostic methods were used to diagnose echovirus meningitis:

• Viral serologic tests: These tests can detect antibodies against specific viruses, including echoviruses [13].
• Sample cultures from peripheral sources: Blood, throat swabs, nasopharyngeal secretions, or stool samples can be cultured to aid in diagnosis [13].

Important Note

It is essential to note that these diagnostic methods are no longer the primary focus of medical research and practice due to the decreased incidence of echovirus meningitis. Modern diagnostic approaches prioritize more effective and efficient methods for diagnosing viral meningitis, including PCR testing and other molecular methods.

References:

[1] Search result 2 [5] Search result 5 [11] Search result 11 [12] Search result 12 [13] Search result 13

Treatment Options for Echovirus Meningitis

Echovirus meningitis, a viral infection that affects the meninges, has been associated with various treatment options in the past. While these treatments may not be as relevant today due to advancements in medical science, it's essential to understand what was previously used to manage this condition.

• Antiviral medications: In the past, antiviral medications such as acyclovir and valacyclovir were used to treat echovirus meningitis. These medications can help reduce the severity of symptoms and prevent complications [6][8].
• Supportive care: Supportive care, including rest, hydration, and pain management, was also a crucial aspect of treatment for patients with echovirus meningitis [3].
• Itraconazole: Itraconazole, an antifungal medication, has been explored as a potential treatment option for echovirus 30 infections. However, its effectiveness in treating meningitis is still unclear [7].

Important Considerations

It's essential to note that the treatment options mentioned above may not be effective or recommended today due to advancements in medical science and the availability of more targeted therapies.

• Current guidelines: Current guidelines for treating viral meningitis recommend supportive care, antiviral medications, and other treatments based on the specific virus causing the infection [8].
• Limited efficacy: The effectiveness of itraconazole and other antifungal medications in treating echovirus meningitis is still unclear, and more research is needed to determine their potential benefits.

References

[3] Meningitis treatment depends on the cause. Antibiotics are used to treat bacterial meningitis and antifungals are used to treat fungal meningitis. Antivirals may be used to treat viral meningitis [8].

[6] Acyclovir 10 mg/kg IV q8h x 10-14d, can likely switch to valacyclovir 1g PO three times a day with improvement (experience limited) [6].

[7] Itraconazole can be considered a lead candidate for the development of antiviral drugs against echovirus 30 that may be used during the early stages of treatment [7].

[8] Treatment for ongoing meningitis, called chronic meningitis, depends on the cause. Antifungal medicines treat fungal meningitis. A mix of antibiotics can treat tuberculous meningitis [12].

Differential Diagnosis of Obsolete Echovirus Meningitis

Echoviruses were once a common cause of viral meningitis, but with the advancement of medical science and vaccination efforts, their incidence has significantly decreased. However, it is still essential to consider them in the differential diagnosis of meningitis, especially in cases where the patient's symptoms and laboratory results suggest a viral etiology.

Causes to Consider

In the past, echoviruses were responsible for a significant proportion of viral meningitis cases. The most common serotypes associated with meningitis were Echovirus 4, 6, 9, and 30 [10]. However, with the emergence of new enterovirus serotypes, such as Coxsackievirus A16 and Enterovirus D68, the incidence of echovirus-related meningitis has decreased.

Other Causes to Consider

In addition to echoviruses, other viral causes of meningitis should be considered in the differential diagnosis. These include:

• Herpesviruses (e.g., HSV-1, VZV)
• Coxsackieviruses
• Enteroviruses (other than echoviruses)
• Listeria monocytogenes
• Tick-borne encephalitides

Clinical Clues and Laboratory Results

When considering the differential diagnosis of obsolete echovirus meningitis, clinicians should look for clinical clues such as:

• Fever, headache, and neck stiffness
• CSF analysis showing lymphocytic pleocytosis (increased white blood cell count)
• Absence of bacterial growth in cultures

Laboratory results may also indicate a viral etiology, including:

• PCR or serological tests detecting enterovirus RNA or antibodies
• Viral culture from CSF or other body fluids

Conclusion

While echoviruses are no longer the primary cause of viral meningitis, they should still be considered in the differential diagnosis, especially in cases where the patient's symptoms and laboratory results suggest a viral etiology. A thorough evaluation of clinical clues and laboratory results is essential to determine the correct diagnosis and guide treatment.

References:

[10] Centers for Disease Control and Prevention (CDC). (2001). Echovirus 13 - USA and Australia, 2001. MMWR Morb Mortal Wkly Rep, 50(43), 777-780. [11] Coxsackieviruses and echoviruses are major aetiological agents of viral meningitis, and account for about 80% of cases in children and adults.