Virus
- Enterovirus (most common)
- Herpes simplex virus (HSV 2 > 1)
- Human immunodeficiency virus (HIV)
- Varicella-zoster virus (VZV)
- CMV
- Mumps
- Encephalitis virus (arbovirus)
Nonpolio enteroviruses (echovirus, coxsackievirus, and enterovirus)
typically are seen in summer through fall and
account for more than 90% of all cases of viral meningitis
The percentage of PMN may be higher in early viral meningitis,
and in some cases, glucose levels may be decreased
HSV-2 meningitis can cause necrotizing encephalitis and neurologic deficits
Acyclovir 10 mg/kg IV if HSV encephalitis is suspected
Viral encephalitis : Brain parenchyma
Altered level of consciousness, focal weakness, or seizures
HSV-1 is responsible for most cases of HSV encephalitis;
HSV-2 frequently causes aseptic meningitis but is not usually
associated with development of encephalitis
Epstein-Barr virus, cytomegalovirus, and rabies, arboviral encephalitides
Most viruses reach the nervous system hematogenously during viremia
Rabies, HSV, and herpes zoster virus—reach the spinal cord then the brain
Consider encephalitis in patients exhibiting
behavioral changes, new psychiatric symptoms,
cognitive deficits, or seizures
Encephalitis show regional tropism
HSV involves limbic structures of the temporal and frontal lobes :
psychiatric features, memory disturbance, and aphasia.
Some arboviruses predominantly affect the basal ganglia,
causing choreoathetosis and parkinsonian movements.
Involvement of the brainstem nuclei that control swallowing leads to the
hydrophobic choking response characteristic of rabies encephalitis
HSV encephalitis, herpes zoster virus encephalitis : acyclovir
CMV encephalitis : ganciclovir
There are no known treatments for arbovirus encephalitis
Fungal CNS infections
Cryptococcus neoformans, followed by Coccidioides immitis
Aspergillus and Candida are most often
discovered in immunocompromised hosts.
Mucormycoses : diabetics
Significant elevations in opening pressure
are often seen in cryptococcal meningitis.
India ink staining and serum cryptococcal antigen testing
AFS and culture : TB
Liposomal amphotericin B is the agent of choice in cryptococcal meningitis.
Use fluconazole or itraconazole for C. immitis.
Treat Candida meningitis with liposomal amphotericin B
often combined with flucytosine
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