Viral Meningitis and Encephalitis in Kids

Many people, including some medical professionals, use the words meningitis and encephalitis synonymously.  That's not quite accurate.  The word meningitis means an inflammation of the tissues surrounding the brain (the meninges).  Encephalitis is inflammation of the brain itself. It is true that sometimes both come together-- a meningoencephalitis.

Inflammation of the brain or meninges can be caused by bacteria, viruses, fungi, or even as a drug reaction.

 Of these, viral meningitis is probably most common. 

In kids, viral meningitis or encephalitis usually impacts those less than one year old or between 5 to ten years of age.  It’s most common from spring into autumn.  Most viruses that end up damaging the central nervous system initially infect the lungs or gastrointestinal tract, and spread to the central nervous system through the lymphatic system.

Many different viruses can be responsible for a meningitis or encephalitis.  The most common culprits are enteroviruses, including coxsackie and echoviruses.  EV71, the agent of hand-foot-mouth disease, is one of the most significant causes.  While this is especially true in Asia, sporadic cases have also been reported in the US and Europe.  The polio virus, better known for causing paralysis, can also instead cause a meningitis, though this is now rare thanks to vaccination.  Herpes simplex (HSV) is another potential cause—while potentially very serious, it is also treatable if caught early on.

  For this reason, most physicians will begin treatment as soon as the possibility of the virus is considered, rather than waiting for confirmation. 

Viral meningitis can be difficult to diagnose, especially in small children.  Unlike adults, kids may not be able to describe their symptoms well (if at all).

  Furthermore, infants will often behave strangely just as part of being a child. Many symptoms of meningitis can overlap with other diseases—for example, temperature changes, being less active, and not eating well can indicate a wide array of problems.  For this reason, and because their immune system is not fully developed, it has become protocol in many emergency departments to do a lumbar puncture on any infant less than 90 days old who come in with signs of infection.  This allows doctors to check the cerebrospinal fluid (CSF), not only to find out about a viral meningitis, but to rule out a bacterial meningitis, which can be even more serious and also more readily treated. 

While waiting on results from a lumbar puncture, then, most physicians will provide antibiotics to treat both bacteria and some viruses.  Many viruses do not respond to drugs—in this case, the only resort is to watch and wait while keeping the child as safe and comfortable as possible under the circumstances.  Fortunately, such viruses usually resolve on their own without serious consequences if medical support is provided.

  This is in stark consequences with bacterial meningitis, in which delayed treatment can have fatal consequences.  If no bacteria grow out from the CSF after 24 to 48 hours,  antibiotics can be discontinued.

Children can be made more comfortable by letting them rest where it is quiet and relatively dimly lit.  Tylenol should be given for headache, pain or fever.  Intravenous fluids can be given if the child is too lethargic to swallow safely and is becoming dehydrated. 

Most children with viral meningitis make a complete recovery.  Sometimes the meningitis is accompanied by an encephalitis, which increases the odds of further complications.  For example, enteroviral infections sometimes cause changes in the white matter of the brain, with an increased risk of developmental delay or seizures.  While the majority of such children tend to do well, it’s a good idea to ensure they have access to a specialist in child development to ensure they are developing normally.   


Cecilia Di Pentima, Viral meningitis: Management, prognosis, and prevention in children, Up-To-Date, June 2015, Accessed July 2015

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