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Viral Central Nervous System Infections in Children

By

Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Jun 2023
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  • Central nervous system (CNS) infections caused by viruses can cause meningitis and encephalitis.

  • Symptoms usually start with fever and can progress to irritability, refusal to eat, headache, neck stiffness, and sometimes seizures.

  • The diagnosis of viral central nervous system infections is based on a spinal tap.

  • Antiviral medications are usually not effective for most viruses that cause central nervous system infections, so children need to receive supportive measures (such as fluids and medications to control fever and pain).

  • Many infections are mild, but others are severe and can cause death.

Viruses Overview of Viral Infections A virus is composed of nucleic acid, either DNA or RNA, surrounded by a protein coat. It requires a living cell in which to multiply. A viral infection can lead to a spectrum of symptoms from... read more that cause central nervous system (brain and spinal cord) infections include herpesviruses (see also herpes simplex virus infections Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection... read more Herpes Simplex Virus (HSV) Infections ), arboviruses Arboviruses Arbovirus, arenavirus, and filovirus are viruses that are spread from animals to people and, with some viruses, from people to people. The animal involved depends on the type of virus. Many... read more , coxsackieviruses Overview of Enterovirus Infections Enteroviruses are a group of viruses. Enterovirus infections affect many parts of the body and may be caused by any of several different viral strains. Enterovirus infections may be caused by... read more Overview of Enterovirus Infections , echoviruses Overview of Enterovirus Infections Enteroviruses are a group of viruses. Enterovirus infections affect many parts of the body and may be caused by any of several different viral strains. Enterovirus infections may be caused by... read more Overview of Enterovirus Infections , and enteroviruses Overview of Enterovirus Infections Enteroviruses are a group of viruses. Enterovirus infections affect many parts of the body and may be caused by any of several different viral strains. Enterovirus infections may be caused by... read more Overview of Enterovirus Infections .

Meningitis is far more common among children than is encephalitis.

Viruses affect the central nervous system in two ways:

  • They can directly infect and destroy cells in the brain and spinal cord .

  • Certain viral infections elsewhere in the body can cause the immune system to attack and damage cells around the nerves.

Children acquire viral infections of the central nervous system through various routes. Newborns can develop herpesvirus infections through contact with infected secretions in the birth canal (see Herpes Simplex Virus (HSV) Infection in Newborns Herpes Simplex Virus (HSV) Infection in Newborns Herpes simplex virus infection usually causes only annoying, recurring blisters in healthy adults but can cause severe infection in newborns. Newborns may become infected at birth or after birth... read more Herpes Simplex Virus (HSV) Infection in Newborns ). Other viral infections are acquired by breathing air contaminated with virus-containing droplets exhaled by an infected person. Arbovirus infections are acquired from bites by infected insects.

Sometimes after a viral infection, children develop inflammation of the nerves in the brain and spinal cord called postinfectious encephalomyelitis or acute disseminated encephalomyelitis Acute Disseminated Encephalomyelitis (ADEM) Disorders that cause demyelination and have no known cause are called primary demyelinating disorders. Demyelination is the destruction of the tissues that wrap around nerves, called the myelin... read more . This disorder typically causes symptoms such as fever, a headache, nausea, and vomiting to occur a few weeks after children recover from the initial viral infection.

Symptoms of Viral CNS Infections in Children

The symptoms of viral meningitis Viral Meningitis Viral meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space) when it is caused... read more and encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more in older children and adolescents are similar to those in adults: fever, cough, muscle aches, vomiting, loss of appetite, and headache, followed by symptoms of meningitis (headache, fever, and a stiff neck) or of encephalitis (fever, headache, personality changes or confusion, seizures, paralysis or numbness and sleepiness).

The inability of infants to communicate directly makes it difficult to understand their symptoms. Usually, however, infants with central nervous system infections have some of the symptoms described below.

Viral central nervous system infections in newborns and infants usually begin with fever. Newborns may have no other symptoms and may initially not otherwise appear ill. Infants older than a month or so typically become irritable and fussy and refuse to eat. Vomiting is common. Sometimes the soft spot on top of a newborn's head (fontanelle) bulges when the newborn is upright, indicating an increase in pressure on the brain. Because irritation of the meninges is worsened by movement, an infant with meningitis may cry more, rather than calm down, when picked up and rocked. Some infants develop a strange, high-pitched cry.

An infection with herpes simplex virus, which is often concentrated in only one part of the brain, may lead to seizures or weakness appearing in only one part of the body. An infant with herpes simplex virus encephalitis may also have a rash on the skin, in the eyes, or in the mouth. The rash consists of red spots with fluid-filled blisters that crust over or scab before healing (see Herpes Simplex Virus (HSV) Infection in Newborns Symptoms Herpes simplex virus infection usually causes only annoying, recurring blisters in healthy adults but can cause severe infection in newborns. Newborns may become infected at birth or after birth... read more Symptoms ).

Postinfectious encephalomyelitis may cause many neurologic problems, depending on the part of the brain that is damaged. Children may have weakness of an arm or leg, vision or hearing loss, difficulty walking, a change in behavior, intellectual disability, or recurring seizures. Some of these symptoms are noticed right away. Other symptoms may not be noticed until later, for example, when the child has routine tests of hearing, vision, and/or intelligence. Often the symptoms resolve with time, but occasionally they are permanent.

Diagnosis of Viral CNS Infections in Children

  • Spinal tap (lumbar puncture)

Doctors are concerned about the possibility of meningitis or encephalitis in every newborn who has a fever, as well as in older infants and children who have fever and are irritable or otherwise not acting normally.

To make the diagnosis of meningitis or the diagnosis of encephalitis, doctors do a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more Spinal Tap (lumbar puncture) to obtain cerebrospinal fluid (CSF, the liquid that surrounds the brain and spinal cord) for laboratory analysis. In viral infections, the number of white blood cells is increased in the CSF, but no bacteria are seen. Polymerase chain reaction (PCR) Polymerase chain reaction (PCR) Genetic diagnostic technologies are scientific methods that are used to understand and evaluate an organism's genes. (See also Genes and Chromosomes.) Genes are segments of deoxyribonucleic... read more techniques are available to more quickly identify herpesviruses and enteroviruses in the CSF.

Blood tests that detect antibodies against viruses in samples of CSF may be done, but these tests usually take days to complete.

Did You Know...

  • Antibiotics cannot be used to treat viral infections, but antiviral medications can be used to treat some viral infections.

Treatment of Viral CNS Infections in Children

  • Keeping the infant comfortable

  • Medications for fever or seizures

  • For postinfectious encephalomyelitis, corticosteroids or other treatments

Most children require only supportive care. That is, they need to be kept warm and given plenty of fluids and medications to treat any fever or seizures.

Antiviral drugs Antiviral drugs A virus is composed of nucleic acid, either DNA or RNA, surrounded by a protein coat. It requires a living cell in which to multiply. A viral infection can lead to a spectrum of symptoms from... read more are not effective for most central nervous system infections. However, infections caused by herpes simplex virus can be treated with acyclovir given by vein.

Postinfectious encephalomyelitis may be treated with corticosteroids given by vein and plasma exchange Plasma exchange In apheresis, blood is removed from a person and then returned after substances are removed from it. Apheresis can be used to Obtain healthy blood components from a donor to transfuse to a person... read more or immune globulin. Immune globulin is given by vein and consists of antibodies obtained from the blood of people with a normal immune system.

Prognosis for Viral CNS Infections in Children

Prognosis varies greatly with the type of infection. Many types of viral meningitis and encephalitis are mild, and the child recovers quickly and completely. Other types are severe.

Brain infection with herpes simplex virus is particularly grave. Without treatment, about 50% of newborns with encephalitis caused by herpes simplex virus die. More than half of those who survive have severe neurologic problems. If the untreated herpes infection involves other parts of the body as well as the brain, the death rate is as high as 85%. Treatment with acyclovir decreases the death rate and increases the percentage of children who develop normally.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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