Introduction:
Aseptic meningitis is a general term that describes the inflammation of the lining of the brain called the meninges. The meninges are divided into three thin layers: the outer dura mater, the middle arachnoid mater, and the inner pia mater. These layers serve as a cushion and shock absorber, protecting the brain from mechanical injuries or assaults. Therefore, any inflammation of these layers of the brain can lead to meningitis. The inflammation can be due to several factors, such as bacterial infection, referred to as bacterial meningitis. If meningitis is due to causes other than the bacterial origin, then it is called aseptic meningitis. Viruses are the most common cause of aseptic meningitis, and viral meningitis is more common than bacterial meningitis.
What Is the Incidence of Aseptic Meningitis?
Aseptic meningitis can occur in individuals of all ages. However,
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It occurs in 11 in 100,000 people.
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The highest incidence is seen in children less than five years of age.
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Males are more likely to get infected than females in a ratio of 2:1.
Who Is at High Risk?
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School-going children are at high risk of contracting the virus leading to meningitis.
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Immunocompromised individuals.
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Presence of any debilitating diseases such as HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency disease syndrome).
What Causes Aseptic Meningitis in Children?
Meningitis is primarily caused due to bacterial or viral infections in the cerebrospinal fluid. Aseptic meningitis is caused due to viral infections that are comparatively less severe than bacterial meningitis. The etiology can be categorized into two for better understanding.
Infectious Meningitis: It is caused due to viruses, bacteria, fungi, and parasites. The predominant ones are viruses.
The viral organisms responsible for aseptic meningitis are
The bacteria associated with aseptic meningitis are:
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Mycoplasma pneumoniae.
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Mycobacterium tuberculosis.
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Treponema pallidum.
The fungi responsible for causing this condition are:
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Candida.
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Cryptococcus neoformans.
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Histoplasma capsulatum.
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Coccidioides immitis.
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Blastomyces dermatitidis.
Parasites are also responsible for aseptic meningitis. They are:
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Toxoplasma gondii.
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Neurocysticercosis.
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Trichinosis.
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Hartmannella.
Non-infectious Meningitis:
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Systemic Diseases: Systemic diseases can also cause meningitis, such as sarcoidosis, Behcet's disease, Sjogren syndrome, and systemic lupus erythematosus.
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Drug-induced Aseptic Meningitis: Certain drugs such as non-steroidal anti-inflammatory drugs, antibiotics such as Sulfonamides, Penicillins, and intravenous immunoglobulins might cause aseptic meningitis.
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Neoplastic Meningitis: Sometimes, the cancer metastasis can also result in inflammation of the tissues of the brain.
Other Causes:
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Syphilis.
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Pediatric tuberculosis.
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Infections that occur secondary to vaccinations.
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Lyme’s disease.
What Are the Signs and Symptoms?
The symptoms may vary according to the cause of the condition. Generally, aseptic meningitis due to bacterial origin tends to be more severe with serious complications. Aseptic meningitis due to viruses is less severe with rare complications. The affected people recover very soon, within a week or two. Most often, the symptoms are similar to the common cold and flu.
The common presentations seen are:
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Fever with chills.
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Body aches. The headaches tend to be pulsating, intense, and throbbing in nature.
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Sensitivity to light.
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Decreased appetite with vomiting.
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Lethargy and fatigue.
The symptoms that are encountered in toddlers and infants are:
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Irritability, crying.
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Fever.
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Drowsiness and tiredness.
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Poor appetite.
When to Seek a Doctor for Help?
If the child has any of the following symptoms, then immediately seek a doctor’s help to prevent any serious complications:
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Seizures.
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Stiffness of the neck.
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Persistent headaches.
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Altered mental health, confusion, and disorientation.
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High fever.
What Are the Other Similar Conditions?
The symptoms of aseptic meningitis are similar to other viral infections, and often the symptoms overlap with other conditions such as:
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Urinary tract infections.
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Pneumoniae also presents with fever and body aches.
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Viral encephalitis.
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Atypical migraine.
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Hydrocephalus.
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Amebic meningoencephalitis.
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Measles and mumps.
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Pediatric tuberculosis.
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Reye’s syndrome.
How to Diagnose Aseptic Meningitis?
Since the clinical features may appear similar, diagnostic tests are performed to prevent misdiagnosis. The diagnostic tests performed are:
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Complete Blood Count: To determine the platelet count and erythrocyte sedimentation rate, immunoglobulin M and immunoglobulin G for enterovirus infections, etc.
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Lumbar Puncture: Cerebrospinal fluid is collected, and the microscopic examination is done to rule out the presence of bacterial growth, bacterial PCR (polymerase chain reactions), N. meningitidis, S. pneumoniae, and H. influenza.
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C-Reactive Proteins: An increased value of C-reactive proteins above 80 is suggestive of bacterial meningitis.
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Blood Glucose Levels: It compares the glucose levels in the blood and cerebrospinal fluid. In the case of meningitis, glucose levels in the cerebrospinal fluid remain elevated.
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Blood Culture: It assesses the presence of bacterial meningitis.
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Throat Swabs: A sterile cotton bud probe is inserted into the throat and rubbed over the surfaces to obtain the samples. It is generally indicated to identify the causative microorganisms.
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Interleukin-6 and Interleukin-12: High levels of interleukin 6 (IL-6) and interleukin-12 (IL-12) are seen in bacterial meningitis. This feature helps to distinguish between bacterial and viral meningitis.
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Head Ultrasound: As computed tomography scans are recommended in neonates and infants, an ultrasound of the head is performed. It provides adequate information about the disease condition.
How to Treat Aseptic Meningitis in the Pediatric Population?
Aseptic meningitis in pediatric individuals is initially treated supportively. Further consultations are done with pediatricians, infectious disease specialists, and neurologists, and then the treatment is planned accordingly. Emergency treatment is rendered in case of seizures, and if the patient is unconscious, they are immediately transferred to the intensive care unit for further assessments.
Medications:
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Antibiotics: If bacterial meningitis is suspected, Cephalosporins such as Cefotaxime, Ceftriaxone, and Vancomycin can be administered.
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Antiviral Therapy: Acyclovir is recommended in cases of aseptic meningitis due to viral microorganisms.
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Anti-Tubercular Drugs: In some instances, tuberculous meningitis may also be present. In such cases, an antitubercular regimen is supplemented to prevent complications and shorten the course of tuberculosis infection. Drugs used are Isoniazid, Rifampin, Pyrazinamide, Ethambutol, and Streptomycin. The second line of drugs used is Ethionamide, Cycloserine, and Capreomycin.
What Are the Possible Complications?
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If seizures are not treated promptly, it may lead to a condition called status epilepticus.
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If bacterial meningitis is not treated properly, it can result in permanent hearing loss.
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Encephalitis (inflammation of the brain).
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Mental regressions.
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Cranial nerve palsies.
Conclusion:
The mainstay should be focused on limiting the exposure of the child to viral infections and droplet infections acquired from sick people. Therefore it is better to keep the child away from sick people at home. Personal hygiene is essential. Parents and caretakers should always wash their hands with soap and water or use an alcohol-based hand rub while handling the children. Children should also be educated to wash their hands regularly after playing or any outdoor activities. Always keep track of the vaccinations to be given to the child as they help to prevent any serious infections.
