Other important diagnoses must be excludedBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39458.446551.3A (Published 17 January 2008) Cite this as: BMJ 2008;336:110
The crucial aspect in viral meningitis is to consider non-viral causes of aseptic meningitis and is not mentioned in the review by Logan and MacMahon.1 Of these, tuberculous meningitis and partly treated bacterial meningitis are most relevant. There are many others—for example, leptospirosis, drug related meningitis, and parameningeal brain abscess—presenting as aseptic meningitis before focal signs have developed. The findings from cerebrospinal fluid in all these conditions can be similar, even identical, to those found in viral meningitis. The authors mention various advantages in making a positive viral identification. Its real importance is in helping to exclude these non-viral illnesses. Many of them carry a serious prognosis and require immediate treatment.
Competing interests: None declared.