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Unraveling Viral Meningitis During Pregnancy A Rare but Resolvable Medical Challenge

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by

Vishnu
in

Introduction

Viral meningitis, though typically self limiting, can present a diagnostic dilemma during pregnancy due to overlapping symptoms with more severe conditions like bacterial meningitis. A recently reported case by Roseingrave and Lalchandani sheds light on the clinical approach and outcomes of viral meningitis in a pregnant patient.
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Case Summary

  • A 34-year-old woman, 26+5 weeks pregnant, presented with fever, headache, photophobia, and a recent history of flu like illness.
  • Initial tests showed elevated white blood cells and CRP levels; lumbar puncture confirmed meningitis through CSF analysis.
  • She was treated empirically for bacterial meningitis and HSV encephalitis until CSF PCR tested positive for enteroviral RNA, confirming viral meningitis.
  • The patient improved without complications and was discharged after six days, with a successful full-term vaginal delivery at 41 weeks.

Diagnostic Approach & Clinical Insights

  • Lumbar puncture remains the cornerstone of diagnosis, helping to distinguish between bacterial and viral causes.
  • Key investigations included:
    • Serum inflammatory markers
    • Blood cultures
    • Brain imaging (CT)
    • CSF analysis (cell count, glucose, protein)
    • Multiplex real-time PCR
  • Despite initial severity, no adverse fetal or neonatal outcomes were observed, reinforcing the typically benign course of enteroviral meningitis in pregnancy.

Broader Clinical Implications

The Centers for Disease Control and Prevention (CDC) emphasize that accurate and timely pathogen identification is essential to reduce unnecessary antimicrobial use and avoid misdiagnosis of meningitis types. This is particularly critical in pregnancy, where maternal and fetal risks must be balanced. The CDC also supports the use of PCR diagnostics in evaluating central nervous system infections for improved clinical outcomes.

Further Reading and Resources

Conclusion & Key Takeaways

  • Viral meningitis in pregnancy is rare, but requires a high index of suspicion due to overlapping symptoms with more dangerous conditions.
  • Timely lumbar puncture and PCR testing are vital for accurate diagnosis and targeted treatment.
  • Prognosis is favorable when diagnosed early, and supportive care is usually sufficient.

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