BMJ  2008;336:36-40 (5 January), doi:10.1136/bmj.39409.673657.AE

Clinical review

Viral meningitis

¹ Infection and Immunology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH

The first 150 words of the full text of this article appear below.

Viral meningitis is common and often goes unreported. In the absence of a lumbar puncture, viral and bacterial meningitis cannot be differentiated with certainty, and all suspected cases should therefore be referred. Lumbar puncture and analysis of cerebrospinal fluid may be done primarily to exclude bacterial meningitis, but identification of the specific viral cause is itself beneficial. Viral diagnosis informs prognosis, enhances care of the patient, reduces the use of antibiotics, decreases length of stay in hospital, and can help to prevent further spread of infection. Over the past 20 years, vaccination policies, the HIV epidemic, altered sexual behaviour, and increasing travel have altered the spectrum of causative agents. In this review we outline the changing epidemiology, discuss key clinical topics, and illustrate how identification of the specific viral cause is beneficial. Neonatal meningitis may be a component of perinatal infection and is not covered here.

Summary points Bacterial and viral meningitis . . . [Full text of this article]

Definitions

Sources and selection criteria

How common is viral meningitis?

What causes it?

Box 1 Viral meningitis: causes to consider^{1 3 9}
All patients
Unvaccinated/incomplete vaccination course
Immunocompromised host
Travel history
Contact with rodent droppings or urine

What is the initial approach to the patient?

Box 2 Approach to the patient
History
Examination
Imaging before lumbar puncture?

How is it diagnosed?

Enteroviruses

Who gets it?
Clinical features and management

Herpes simplex viruses (HSV-2, HSV-1)

Who gets it?
Clinical features and management

Varicella zoster virus

Human immunodeficiency virus

Mumps

Case studies
Patient 1
Patient 2
Additional educational resources
Information for patients

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