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Most people are familiar with the rare and deadly form of meningitis caused by a bacterial infection. However, there is another and milder form of inflammation of the meninges in which a virus is the cause. This form is far more common, but less well known. While bacterial meningitis affects between 100 and 200 people a year in Denmark, more than twice as many people contract viral meningitis, most commonly caused by enterovirus and herpes simplex virus 2. 

Although the viral infection resolves quickly and rarely costs lives, ten per cent of those affected experience a prolonged aftermath with so-called brain fog. Patients suffer from headaches, extreme fatigue and difficulty concentrating, likely caused by an overactive immune system. The after-effects eventually subside, but can lead to more than six months of sick leave. And doctors lack both the knowledge, treatment options and clinical guidelines. 

This is the background for the research project that consultant physician and PhD Jacob Bodilsen from the Department of Infectious Diseases at Aalborg University Hospital has now received support for from the Lundbeck Foundation. 

"Viral meningitis is the most common form of meningitis and at the same time the one we know least about. There are some very basic questions we have been debating for years, and now we can finally resolve them," says Jacob Bodilsen. 

About the patients, he explains that they are young — on average 32 years old — often with young children and in the middle of a career. 

"They are used to pushing themselves, but find that their brain struggles to keep up — they become mentally exhausted and need a great deal of rest. It affects their studies, their work and their social lives." 

The project, which will involve 500 patients from across the country, is divided into three parts. In the first part, the researchers will investigate the role of the immune system by, among other things, analyzing blood and cerebrospinal fluid — particularly in women, who most often experience severe disease progression.

"It is probably because women have a stronger inflammatory response. We see the same with vaccines. We want to find out, among other things, what role sex hormones play, and how those with the strong response fare compared to the others. There may be a treatment option in regulating the immune response," he explains. 

The second part concerns the long-term effects. 

"We will systematically document what happens when the brain becomes fatigued, and also look at whether there is a link between after-effects and an underlying tendency towards depression or anxiety." 

The third part concerns the drug Aciclovir, which is prescribed to around 16 per cent of patients whose meningitis is caused not by enterovirus but by herpes simplex virus 2. 

"This drug has been used for 50 years to reduce the intensity of symptoms, but we do not know whether it works. My impression is that it does not, but we have no documentation. So now we will investigate it." 

The grant is more than welcome, as Jacob Bodilsen believes this patient group has been overlooked for years. 

"Patients are treated very differently because our knowledge and understanding of the disease is limited. The fact that we can now finally move forward in this field and perhaps identify new treatment options is a huge milestone for me, and very rewarding,” he says.