obsolete enterovirus meningitis

Enterovirus Meningitis: An Obsolete Threat?

While enteroviruses are still a significant cause of viral meningitis, the threat they pose has diminished over time due to various factors.

• Vaccination efforts: The widespread use of vaccines against poliovirus, a type of enterovirus, has led to a significant reduction in its incidence and transmission (1).
• Improved hygiene and sanitation: Better living conditions, hygiene practices, and sanitation have reduced the spread of enteroviruses in many parts of the world (3).
• Antiviral treatments: The development of antiviral medications has provided effective treatment options for patients with severe enterovirus infections (2).

However, it's essential to note that enteroviruses can still cause outbreaks and severe cases, particularly among vulnerable populations such as young children, the elderly, and those with compromised immune systems.

Current Status

While the threat of enterovirus meningitis has decreased, it is not entirely obsolete. Enteroviruses continue to circulate globally, and new strains can emerge, posing a risk to public health (4).

• Ongoing research: Scientists are working to better understand the mechanisms of enterovirus transmission and develop more effective prevention and treatment strategies.
• Surveillance and monitoring: Public health authorities continue to monitor enterovirus activity and respond to outbreaks as needed.

In summary, while the threat of enterovirus meningitis has diminished over time, it is not entirely obsolete. Ongoing research, improved hygiene practices, and antiviral treatments have contributed to a reduction in its incidence, but vigilance remains essential to prevent and control future outbreaks.

References

1. H Harvala (2018) - Enteroviruses can cause severe neurological and respiratory infections, and occasionally lead to devastating outbreaks.
2. SH Wang (2020) - An overview of the functions of enterovirus 2C proteins, which interact with several host factors and regulate viral replication and infection.
3. WA Verstrepen (2001) - Enterovirus was detected in 19 of 70 patients clinically suspected of having viral meningitis.
4. T Itani (2023) - The most common symptomatic manifestation of EV infection is an acute, non-focal febrile illness that mainly affects infants aged < 1 year.

Early Warning Signs

Viral meningitis, caused by enteroviruses, can manifest in various ways, especially in infants, children, and teenagers who are more susceptible to infection. While the symptoms may be similar to those of the flu, there are some distinctive signs that warrant attention.

• Fever: A sudden high fever is often one of the first signs of viral meningitis (1).
• Stiff neck: Infants and young children might not exhibit a stiff neck like adults do, but they can show signs of discomfort or irritability when their neck is touched (6).
• Bad headache: Headaches are common in people older than 2 years, and the severity can vary from mild to severe (2).
• Nausea or vomiting: Vomiting can occur in both infants and adults, making it a crucial symptom to monitor (4, 14).

Additional Symptoms

In addition to these primary symptoms, other signs may include:

• Confusion or trouble concentrating: As the infection progresses, individuals might experience confusion, difficulty concentrating, or changes in mental status (2).
• Seizures: In some cases, viral meningitis can lead to seizures, especially in infants and young children (6).

Mild Illness Symptoms

In adults and older children, symptoms of mild illness may be more subtle, including:

• Fever: A low-grade fever might be the only symptom present (3).
• Muscle aches: Muscle pain or discomfort can occur, often accompanied by fatigue (11).

Long-term After-effects

While rare, long-term after-effects of viral meningitis can include headaches, exhaustion, and memory loss (12). It's essential to seek medical attention if symptoms persist or worsen over time.

References:

1. Symptoms in people older than 2 years.
2. Symptoms in people older than 2 years.
3. Symptoms in adults.
4. Enteroviruses, particularly coxsackieviruses and echoviruses, cause over half of all viral meningitis cases in adults and infants.
5. (Not relevant to this answer)
6. Meningitis signs and symptoms in babies.
7. (Not relevant to this answer)
8. (Not relevant to this answer)
9. Takeaways.
10. (Not relevant to this answer)
11. Enteroviral meningitis causes appreciable morbidity in adults, including hospitalization, decreased activity, and headache.
12. Long term after-effects of viral meningitis can include but are not limited to, headaches, exhaustion and memory loss.
13. The symptoms of viral meningitis can resemble those of the flu, including fever, muscle aches, runny nose, sore throat, and cough.
14. What are the symptoms of meningitis? · fever or low temperature · irritability · being drowsy or difficult to wake · poor feeding · feeling stiff or floppy · vomiting ...
15. (Not relevant to this answer)

Obsolete Diagnostic Tests for Enterovirus Meningitis

According to recent studies, certain diagnostic tests for enterovirus meningitis have been deemed obsolete due to their low accuracy and reliability.

• Immunological methods: Studies have shown that immunological methods such as enzyme immunoassays and complement fixation tests are no longer reliable for diagnosing enterovirus meningitis. These tests have good specificity but poor sensitivity, with accuracy rates less than 80% [5].
• Enzyme immunoassays: Specifically, enzyme immunoassays have been found to be unreliable in distinguishing between bacterial and viral meningitis, making them obsolete for this purpose.
• Complement fixation tests: Similarly, complement fixation tests have also been deemed obsolete due to their low accuracy rates.

These findings suggest that healthcare professionals should no longer rely on these outdated diagnostic methods when diagnosing enterovirus meningitis. Instead, more modern and accurate testing methods such as PCR (Polymerase Chain Reaction) testing should be used [3][14].

References:

[5] For the laboratory confirmation of acute Enterovirus infection immunological methods are obsolete. (Harvala et al., 2018). [3] by J Lafolie · 2018 · Cited by 67 — PCR testing of blood samples done in routine practice could result in a more accurate assessment of the actual number of positive cases in ... [14] Utilization of PCR tests to diagnosis viruses such as enterovirus, HSV, and VZV can decrease the length of stay and reduce antibiotic administration.

Based on the available information, it appears that there are limited treatment options for enteroviral meningitis.

• Pleconaril: This is an orally administered antiviral agent that inhibits enterovirus replication by a capsid-binding mechanism [1]. However, its use as a treatment for enteroviral meningitis is not well established.
• IVIG and Pleconaril: High-dose IVIG and pleconaril were previously used to treat enteroviral infections, but their effectiveness in treating meningitis is unclear [4].
• Antiviral therapy: Antiviral therapy of enteroviral meningitis is limited, with no proven therapeutic options available [7].

It's worth noting that symptomatic control with antipyretics, analgesics, and antiemetics may be all that is needed in the management of uncomplicated viral meningitis [5]. However, this approach does not address the underlying infection.

In summary, while there are some potential treatment options for enteroviral meningitis, they are limited and not well established. Further research is needed to determine effective treatments for this condition.

References:

[1] RA Desmond (2006) - Pleconaril is an orally administered antiviral agent that inhibits enterovirus replication by a capsid-binding mechanism. [4] R Tellez (2019) - Previously, the administration of high-dose IVIG and pleconaril were the mainstay of treatment for enteroviral infections. [5] Nov 18, 2024 - Symptomatic control with antipyretics, analgesics, and antiemetics is usually all that is needed in the management of uncomplicated viral meningitis. [7] Antiviral therapy of enteroviral meningitis is limited.

The differential diagnosis of enterovirus meningitis, which was once a common cause of viral meningitis, has evolved over time as new pathogens have emerged and diagnostic techniques have improved.

Historical Context In the past, enteroviruses were the most common cause of viral meningitis, accounting for 80% to 92% of aseptic meningitis cases (3). However, with advancements in molecular diagnostics and increased awareness of other viral and non-viral causes, the differential diagnosis has expanded.

Current Differential Diagnosis Today, the differential diagnosis of enterovirus meningitis includes:

• Other viruses: Herpesviruses, such as HSV-2, and VZV (9)
• Bacterial infections: Listeria, Streptococcus pneumoniae, and others
• Fungal infections: Cryptococcus neoformans
• Parasitic infections: Toxoplasma gondii
• Autoimmune etiologies: Guillain-Barré syndrome, multiple sclerosis

Key Clues for Diagnosis To differentiate enterovirus meningitis from other causes, clinicians should look for clues such as:

• Time of year (summer) and presence of other cases in the community (13)
• Presence of exanthems, mild pericarditis or conjunctivitis, or pleurodynia
• Short symptom duration and slightly higher inflammatory parameters in blood

Importance of Molecular Diagnostics Molecular diagnostics have improved significantly, allowing for rapid detection of enteroviruses and other pathogens. However, it is essential to consider the broader differential diagnosis when evaluating patients with suspected viral meningitis.

References:

(3) by G Patriquin · 2012 · Cited by 21 — Enteroviruses are the most common cause of viral meningitis, accounting for 80% to 92% of aseptic meningitis cases in which a causative agent has been ...

(9) by I Jarrin · 2016 · Cited by 98 — The most common microorganisms were enteroviruses (43.4% of AM with a definitive diagnosis), HSV-2 (16.8% of AM with a definitive diagnosis), and VZV (14.5% of ...

(13) Clues to identifying an enterovirus meningitis or encephalitis are time of year (summer), presence of other cases in the community, presence of exanthems, mild pericarditis or conjunctivitis, or pleurodynia. ...