After-effects of viral meningitis in adults

Transcription

1 After-effects of viral meningitis in adults Dr Fiona McGill NIHR Doctoral Research Fellow Liverpool Brain Infections Group, Liverpool Specialist Registrar Infectious Diseases/Medical Microbiology

2 Meningitis Often caused by infection Bacteria Viruses Fungi, parasites

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4 What is a virus? Viruses Very small (10nm-300nm) Live inside cells Difficult to grow in a lab Bacteria Larger can be seen with a normal microscope (1000nm) Most grow easily given the right conditions Can live out with cells

5 Viral Meningitis - causes Lots! Enteroviruses Same family as poliovirus Gut bug Can be fatal in very young children Spread by poor hygeine Outbreaks Seasonal

6 Herpesviruses Herpes simplex virus type 2 Spread sexually often asymptomatically Very few have current/history of genital disease Amount of people infected worldwide with HSV-2 is increasing Can recur (most don t!) Can occur with a first infection, or several years after infection Varicella Zoster virus Chickenpox/Shingles Often occurs without rash Can occur at time of first infection or as a reactivation

7 Others Arboviruses Arthropod Borne Viruses Not present in UK but are in Europe/USA Think of in travellers Toscana Virus, West Nile Virus, Tick Borne Encephalitis Mumps HIV Causes an aseptic meningitis Normally at time of first infection Can occur later in disease Other herpes viruses EBV, CMV, HSV-1, HHV-6/7

8 Viral Meningitis is a benign and self limiting condition then I noticed that I was forgetful and I kept checking things, and forget something or somebody's name or something, and it has just gradually got worse and you keep, I really do I am one of them people that convince myself and say no, no it's, that is not, I am alright you know that's fine, but now I am getting to the point I know, I am not, exaggerating and I am definitely not erm... you know making it up, I think I have suffered a bit of memory loss through it sometimes I you know when you can't get a word out, but you want to say something, and then you know when you want to do something but then you forget what it is, even now I occasionally still do get right sided frontal headache it is not bad, and I don t need to take painkillers but I am aware that it is not quite back to normal erm

9 Sequelae Headache/symptoms EV meningitis 11 days to resolution of headache, men achieve headache resolution quicker, less likely to achieve resolution if headache severe to start with 15% of EV patients had a headache that persisted for > 21 days (Desmond et al; ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, July 2006, p ) Cognitive problems Mild cognitive impairment Visual memory and cognitive speed (Sittinger et al; J Neurol (2002) 249 : ) Executive and visuo-constructive functions (Schmidt et al; Brain (2006), 129, ) Recurrences Fatigue Poor sleep (Schmidt et al; J Neurol Neurosurg Psychiatry 2006;77: ) Chronic Fatigue Syndrome (Hotopf; J Neurol Neurosurg Psychiatry : ) Costs $ per episode (Parasuraman; Pharmacoeconomics 2001; 19 (1): 3-12, Khetsuriani; Neuroepidemiology 2003;22: ) $1.3billion over a 5 year period (Khetsuriani; Neuroepidemiology 2003;22: )?Psychosocial

10 What are the after effects of viral meningitis in adults in the UK? Meningitis NW Study/ UK Meningitis study Recruits patients who are 16 and over with suspected meningitis In 45 hospitals throughout the UK Funded by Meningitis Research Foundation and the NIHR Primary aim was to identify incidence and aetiology of viral meningitis in the UK Secondary aims include longer term outcomes of VM

11 Symptoms - conclusions Symptoms persist throughout the 3 weeks after admission especially headache and neck stiffness Symptoms potentially last longer in those where no pathogen is identified Limitations Lots of missing data Self reported questionnaire Limited returns (possibly because it is still quite early on and patients still feel pretty rotten).

12 Conclusions Some patients with viral meningitis appear to have significant problems at least up to a year following their acute illness Difficult to know if this is a reflection of the meningitis per se or the viral illness (problems in the unhealthy control group as well) Similar levels of problems to survivors of bacterial meningitis Self-reported questionnaires we don t know what we don t know! May provide some useful tools to use in future treatment trials

13 Acknowledgements Meningitis NW/UK Meningitis Steering Committee Chief Investigator: Prof Tom Solomon Chair : Dr Alastair Miller Dr Guleed Adan Dr Laura Bonnett Ms Alison Gummery Dr Alan Haycox Dr Antony Martin Brain Infections UK Staff All PI s, Co-investigators and research nurses at all sites All the patients