Other important diagnoses must be excluded

doi:10.1136/bmj.39458.446551.3A

BMJ 2008;336:110 (19 January), doi:10.1136/bmj.39458.446551.3A

Letters

Diagnosing viral meningitis

Other important diagnoses must be excluded

The first 100% of the full text of this article appears below.

The crucial aspect in viral meningitis is to consider non-viralcauses of aseptic meningitis and is not mentioned in the reviewby Logan and MacMahon.¹ Of these, tuberculous meningitis andpartly treated bacterial meningitis are most relevant. Thereare many others—for example, leptospirosis, drug relatedmeningitis, and parameningeal brain abscess—presentingas aseptic meningitis before focal signs have developed. Thefindings from cerebrospinal fluid in all these conditions canbe similar, even identical, to those found in viral meningitis.The authors mention various advantages in making a positiveviral identification. Its real importance is in helping to excludethese non-viral illnesses. Many of them carry a serious prognosisand require immediate treatment.