From the Guidelines
Adenovirus meningitis in pediatric patients should be managed with supportive care, focusing on symptom management and close monitoring for potential complications, as there are no specific antiviral treatments approved for this condition. The management of adenovirus meningitis involves adequate hydration, fever control with acetaminophen (10-15 mg/kg/dose every 4-6 hours) or ibuprofen (5-10 mg/kg/dose every 6-8 hours), and pain management 1. Hospitalization may be necessary for severe cases to monitor for complications and provide IV fluids. While most cases resolve without specific intervention within 7-10 days, close monitoring is essential as adenovirus meningitis can occasionally lead to more serious neurological complications.
Key Considerations
- Diagnosis typically involves cerebrospinal fluid analysis showing pleocytosis with lymphocyte predominance, normal glucose, and mildly elevated protein, along with PCR testing to identify adenovirus.
- Prevention measures include good hand hygiene, avoiding close contact with infected individuals, and proper disinfection of surfaces, as adenovirus is highly contagious and can spread through respiratory droplets and fecal-oral routes.
- Parents should seek immediate medical attention if their child shows signs of increased intracranial pressure such as persistent vomiting, altered consciousness, or seizures.
Clinical Characteristics
The clinical characteristics of pediatric meningitis, as outlined in a study 1, highlight the importance of considering various symptoms, including fever, vomiting, altered mental status, headache, neck stiffness, seizures, and focal neurologic deficits, in the diagnosis and management of adenovirus meningitis. However, it is crucial to note that these characteristics may not be specific to adenovirus meningitis and can be seen in other types of meningitis as well.
Treatment Approach
The treatment approach for adenovirus meningitis should prioritize supportive care, with a focus on managing symptoms and preventing complications, rather than relying on specific antiviral treatments. This approach is supported by the lack of approved antiviral treatments for adenovirus meningitis and the importance of close monitoring for potential complications.
From the Research
Adenovirus Meningitis in Pediatrics
- Adenovirus infection is common in childhood and is generally associated with self-limited disease 2.
- However, in some cases, adenovirus infection can cause severe disease, including meningitis, particularly in immunocompromised patients 3, 4, 5.
- The treatment of adenovirus infections is controversial, but cidofovir is considered the drug of choice for severe adenovirus infections 2, 3, 4.
- A study found that cidofovir was successful in treating a case of fulminant adenovirus infection associated with lymphopenia and multiple organ failure in a previously healthy child 2.
- Another study reported a case of disseminated adenovirus infection accompanied by hemophagocytic syndrome and meningitis in an allogeneic hematopoietic stem cell transplantation recipient, which was successfully treated with cidofovir 4.
- Adenovirus meningoencephalitis is a rare but significant condition, particularly in immunocompromised patients, and its involvement in meningoencephalitis remains unclear 5.
- A study found that the frequency of adenovirus central nervous system infection was 1.08%, predominating in female patients with a predisposing condition, and presented with adenovirus encephalitis 5.
Diagnosis and Treatment
- The diagnosis of adenovirus meningitis can be challenging, and it is essential to distinguish it from bacterial meningitis, which requires prompt antibiotic treatment 6.
- Inflammatory markers, such as procalcitonin, in the serum and cerebrospinal fluid may help distinguish between bacterial meningitis and viral meningitis 6.
- Cidofovir is considered the drug of choice for severe adenovirus infections, but its use is not universally accepted, and further study is warranted to determine its potential role in treating severe adenovirus infections in immunocompetent children 2, 3, 4.