From the Guidelines
Viral meningitis generally has a favorable prognosis, with most patients making a complete recovery without long-term complications. The treatment for viral meningitis is mainly supportive, focusing on pain management and adequate hydration, as there are currently no treatments of proven benefit for most causes of viral meningitis 1.
Key Points to Consider
- Treatment should be supportive with analgesia and fluids if necessary, and antibiotics should be stopped once a viral diagnosis is made 1.
- Some clinicians treat herpes meningitis with aciclovir or valaciclovir, but there is no evidence to support this, and the potential risks should be weighed against the lack of evidence for efficacy 1.
- If there are any suggestions of encephalitis, intravenous aciclovir should be given for suspected HSV encephalitis, and the British Infection Association/Association of British Neurologists guidelines on the management of encephalitis should be followed 1.
- Recurrent episodes of lymphocytic meningitis, or Mollaret’s meningitis, are most often caused by HSV-2, but oral valaciclovir has not been shown to reduce recurrent HSV-2 meningitis in a placebo-controlled trial 1.
Management and Outcome
- Most patients can recover at home, though hospitalization may be necessary for severe cases, particularly in infants, elderly patients, or those with compromised immune systems.
- While rare, some patients may experience lingering symptoms like headaches, fatigue, or concentration difficulties for weeks or months after the acute illness.
- Prompt medical attention is still important to rule out bacterial meningitis, which requires immediate antibiotic treatment and has a more serious prognosis.
- The good prognosis relates to the virus's limited impact on the central nervous system compared to bacterial infections, which typically don't cause permanent neurological damage 1.
From the Research
Viral Meningitis Prognosis
- The prognosis for viral meningitis is generally good, with most cases resolving on their own without specific treatment 2, 3.
- However, some cases can be severe and require hospitalization, especially if the patient has a weakened immune system or is experiencing severe symptoms 4.
- The use of molecular diagnostics has improved the rate of pathogen detection, reducing unnecessary antibiotic use and length of hospitalization 3, 5.
- Early administration of antiviral drugs such as acyclovir, valaciclovir, or famciclovir can shorten the duration of an episode of aseptic meningitis, but there is no established treatment for viral meningitis 2, 5.
- Recurrent meningitis is less common, but can be caused by herpes simplex virus 2 in young adults, and daily prophylactic administration of antiviral drugs can reduce the frequency of future episodes 2.
Factors Affecting Prognosis
- Age and country of origin can affect the viral etiology of meningitis, with enteroviruses being the most common cause of viral meningitis worldwide 3, 6.
- The severity of symptoms, such as headache, photophobia, nuchal rigidity, and vomiting, can also impact the prognosis 4.
- The use of a prediction model for viral meningitis can help decrease hospitalization rates by identifying patients who can be safely discharged from the emergency department 4.
Future Directions
- Further research is needed to improve the diagnosis and management of viral meningitis, including the development of effective treatments and a better understanding of the pathogenesis of the disease 5, 6.
- Vaccination and proper skin protection against transmitting vectors can help prevent some cases of viral meningitis 3.