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Viral meningitis.

K R Ratzan

    The Medical Clinics of North America
    |March 1, 1985
    PubMed
    Summary

    Differentiating viral meningitis from bacterial meningitis relies on cerebrospinal fluid (CSF) analysis and clinical judgment. Early CSF findings like polymorphonuclear leukocytes and low glucose can indicate viral meningitis, guiding treatment decisions.

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    Area of Science:

    • Neurology
    • Infectious Diseases
    • Virology

    Background:

    • Viral meningitis is a form of aseptic meningitis syndrome requiring differentiation from bacterial meningitis.
    • Enteroviruses are the most common cause of aseptic meningitis in the United States, exhibiting seasonal incidence patterns.
    • Cerebrospinal fluid (CSF) analysis is crucial for diagnosis, with initial findings potentially including polymorphonuclear leukocytes and low glucose levels.

    Purpose of the Study:

    • To highlight the importance of distinguishing viral meningitis from bacterial meningitis through CSF examination and clinical assessment.
    • To discuss the diagnostic criteria and etiological agents of viral meningitis, particularly enteroviral infections.
    • To emphasize the clinical significance of identifying specific viral pathogens for optimizing patient management and treatment.

    Main Methods:

    • Analysis of cerebrospinal fluid (CSF) characteristics, including cell counts (polymorphonuclear leukocytes vs. mononuclear cells) and glucose levels.
    • Clinical judgment based on patient presentation and examination findings.
    • Diagnostic approaches for specific viral agents such as enteroviruses, herpes simplex virus (HSV), varicella-zoster virus, and arboviruses, including viral isolation and serologic testing.

    Main Results:

    • Initial CSF in viral meningitis may show polymorphonuclear leukocytes and low glucose, especially in enteroviral infections.
    • A shift from neutrophils to mononuclear cells in CSF suggests viral meningitis.
    • Herpes simplex virus type 2 (HSV-2) is associated with meningitis, while HSV-1 is linked to meningoencephalitis. Serologic tests are useful for diagnosing infections caused by herpes simplex, varicella-zoster, LCM, and arboviruses.

    Conclusions:

    • Accurate diagnosis of viral meningitis is essential to avoid unnecessary antimicrobial therapy and shorten hospital stays.
    • Understanding CSF profiles and employing appropriate diagnostic tests aids in identifying the causative viral agent.
    • Specific viral diagnoses, like enteroviral infections, rely on viral isolation and antibody response, while other viral infections can be diagnosed serologically.

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