Viral meningitis
Summary
Definition
History and exam
Key diagnostic factors
- headache
- nausea and vomiting
- photophobia
- neck stiffness
- fever
Other diagnostic factors
- rash
- Kernig sign
- Brudzinski sign
Risk factors
- infants and young children
- young adults
- older people
- summer and fall
- exposure to mosquito or tick vector
- unvaccinated for mumps
- use of swimming pools and ponds
- immunosuppression
- exposure to rodents
Diagnostic investigations
1st investigations to order
- CSF microscopy
- CSF Gram stain
- CSF bacterial culture
- CSF protein
- CSF glucose
- CSF PCR for enteroviruses
- CSF PCR for herpes viruses
- HIV serology/HIV reverse transcriptase (RT)-PCR
Investigations to consider
- CT/MRI head
- EEG
- CSF viral culture
Emerging tests
- CSF C-reactive protein (CRP)
- serum and CSF procalcitonin
- CSF lactate
Treatment algorithm
possible bacterial meningitis
confirmed viral agent, other than HSV, varicella zoster, or CMV
HSV or varicella zoster confirmed causative agent
CMV confirmed causative agent
recurrent viral meningitis
Contributors
Expert advisers
John Williams, MRCP, DTM&H
Consultant
The James Cook University Hospital
Middlesbrough
UK
Declarações
JW declares that he has no competing interests.
Agradecimentos
Dr John Williams would like to gratefully acknowledge Dr David Chadwick, a previous contributor to this topic.
Declarações
DC is an author of a reference cited in this topic.
Revisores
Karen Roos, MD
John and Nancy Nelson Professor of Neurology
Indiana University School of Medicine
Indianapolis
IN
Declarações
KR declares that she has no competing interests.
Vassiliki Syriopoulou, MD
Professor of Pediatrics
University of Athens
Aghia Sophia Children's Hospital
Athens
Greece
Declarações
VS declares that she has no competing interests.
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Referências
Principais artigos
McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.Texto completo Resumo
Centers for Disease Control and Prevention. About viral meningitis. Jan 2024 [internet publication].Texto completo
Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5 [Epub ahead of print].Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Meningitis, bacterial
- Encephalitis
- Encephalopathy (toxic/metabolic)
Mais Diagnósticos diferenciaisDiretrizes
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
Mais DiretrizesFolhetos informativos para os pacientes
Meningitis and septicemia
Lumbar puncture
More Patient information
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