Can rhinovirus cause viral meningitis, especially in young children, immunocompromised individuals, or those with underlying medical conditions?

Can Rhinovirus Cause Viral Meningitis?

Yes, rhinovirus can cause viral meningitis, though it is extremely rare and represents an uncommon manifestation of this typically upper respiratory pathogen.

Evidence for Rhinovirus-Associated CNS Disease

The literature documents that rhinovirus can involve the central nervous system, though this occurs very infrequently:

• Only two cases of rhinovirus-associated CNS involvement had been reported in the literature prior to 2019, consisting of one case of meningitis and one case of sepsis-like illness 1
• A 2019 case report documented a 2-year-old child with rhinovirus A detected in both throat swab and cerebrospinal fluid, presenting with acute encephalitis/encephalopathy and cerebellitis—the first reported case of this presentation 1
• The virus was confirmed in the CSF using molecular techniques, establishing direct CNS involvement rather than systemic illness alone 1

Clinical Context and Typical Rhinovirus Presentations

While rhinovirus can theoretically cause meningitis, it is far more commonly associated with:

• Respiratory illness: Rhinovirus primarily causes upper respiratory tract infections and bronchiolitis, particularly in infants under 12 months of age 2
• Serious lower respiratory disease: Among 48 hospitalized pediatric patients with rhinovirus, bronchiolitis was the most frequent diagnosis, with 86% of patients being less than 12 months old 2
• Sepsis-like presentations: Nine patients in one series were diagnosed with suspected sepsis, though rhinovirus was the identified pathogen 2

Comparison to Common Viral Meningitis Pathogens

The rarity of rhinovirus meningitis becomes clear when compared to established causes:

• Enteroviruses are the most common cause of viral meningitis in children and young adults, accounting for the bulk of aseptic meningitis cases 3, 4
• Herpes simplex virus type 2 is the most common cause of recurrent viral meningitis in young adults 3
• The seasonal pattern of aseptic meningitis largely reflects enteroviral infections, not rhinovirus 4

Clinical Implications and Diagnostic Considerations

When evaluating patients with suspected viral meningitis:

• Do not routinely test for rhinovirus in CSF unless other common viral pathogens have been excluded and there is strong clinical suspicion with concurrent respiratory symptoms 1, 5
• Molecular diagnostic techniques have improved pathogen detection rates and can identify unusual causes like rhinovirus when specifically sought 1, 5
• Young infants with rhinovirus presenting with fever and altered mental status may warrant lumbar puncture given the documented cases of CNS involvement, though bacterial causes remain far more likely 2

Important Caveats

• The extremely low incidence means rhinovirus should not be high on the differential diagnosis for viral meningitis in immunocompetent patients 1
• Most rhinovirus infections in hospitalized children represent respiratory disease or complications of underlying illness, not primary CNS infection 2
• Further research using molecular techniques is needed to better understand the true incidence and pathophysiology of rhinovirus-associated CNS disease 1