Highlights & Basics
- Viral meningitis is typically self-limited with no serious sequelae.
- Infants, immunocompromised patients, and those infected with herpes viruses or arboviruses are more likely to have complications.
- It is important to distinguish viral meningitis from bacterial meningitis, which is associated with significant morbidity and mortality and requires urgent treatment.
- Early diagnosis of viral meningitis may allow antibiotics to be stopped and patients to be discharged from the hospital.
Quick Reference
- History & Exam - Key Factors 
- Other Factors 
 
- Diagnostics Tests 
- Treatment Options 
Definition
Epidemiology
Etiology
Pathophysiology
Citations
- 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.[Abstract][Full Text] 
- Centers for Disease Control and Prevention. Viral meningitis. May 2021 [internet publication].[Full Text] 
- 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:ciae104.[Abstract][Full Text] 
- 1. Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician. 2017 Sep 1;96(5):314-22.[Abstract] 
- 2. Sawyer MH. Enterovirus infections: diagnosis and treatment. Pediatr Infect Dis J. 1999 Dec;18(12):1033-9.[Abstract] 
- 3. 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.[Abstract][Full Text] 
- 4. Centers for Disease Control and Prevention. Viral meningitis. May 2021 [internet publication].[Full Text] 
- 5. Dagan R, Jenista JA, Menegus MA. Association of clinical presentation, laboratory findings, and virus serotypes with the presence of meningitis in hospitalized infants with enterovirus infection. J Pediatr. 1988 Dec;113(6):975-8.[Abstract] 
- 6. Agency for Healthcare Research and Quality. Meningitis-related hospitalizations in the United States, 2006. Statistical brief 57. July 2008 [internet publication].[Full Text] 
- 7. Hammer SM, Connolly KJ. Viral aseptic meningitis in the United States: clinical features, viral etiologies and differential diagnosis. Curr Clin Top Infect Dis. 1992;12:1-25.[Abstract] 
- 8. Lee KY, Burgner D, Lee HS, et al. The changing epidemiology of pediatric aseptic meningitis in Daejeon, Korea from 1987 to 2003. BMC Infect Dis. 2005 Nov 2;5:97.[Abstract][Full Text] 
- 9. Michos AG, Syriopoulou VP, Hadjichristodoulou C, et al. Aseptic meningitis in children: analysis of 506 cases. PLoS One. 2007 Aug 1;2(7):e674.[Abstract][Full Text] 
- 10. Rotbart HA, Brennan PJ, Fife KH. Enterovirus meningitis in adults. Clin Infect Dis. 1998 Oct;27(4):896-8.[Abstract] 
- 11. Khetsuriani N, Lamonte-Fowlkes A, Oberst S, et al. Enterovirus surveillance - United States, 1970-2005. MMWR Surveill Summ. 2006 Sep 15;55(8):1-20.[Abstract][Full Text] 
- 12. Nash D, Mostashari F, Fine A, et al. The outbreak of West Nile virus infection in the New York City area in 1999. N Engl J Med. 2001 Jun 14;344(24):1807-14.[Abstract][Full Text] 
- 13. Bystritsky RJ, Chow FC. Infectious meningitis and encephalitis. Neurol Clin. 2022 Feb;40(1):77-91.[Abstract] 
- 14. McGill F, Griffiths MJ, Bonnett LJ, et al. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infect Dis. 2018 Sep;18(9):992-1003.[Abstract][Full Text] 
- 15. Jimenez-Caballero PE, Servia M, Mondejar-Marin B, et al. Mumps meningitis: a case mix in a neurology department [in Spanish]. Rev Neurol. 2005 Apr 1-15;40(7):420-2.[Abstract] 
- 16. Kohil A, Jemmieh S, Smatti MK, et al. Viral meningitis: an overview. Arch Virol. 2021 Feb;166(2):335-45.[Abstract][Full Text] 
- 17. Centers for Disease Control and Prevention. West Nile virus. June 2022 [internet publication].[Full Text] 
- 18. McJunkin JE, de los Reyes EC, Irazuzta JE. La Crosse encephalitis in children. N Engl J Med. 2001 Mar 15;344(11):801-7.[Abstract][Full Text] 
- 19. Chadwick DR. Viral meningitis. Br Med Bull. 2006 Feb 10;75-76:1-14.[Abstract][Full Text] 
- 20. Bergstrom T, Vahlne A, Alestig K, et al. Primary and recurrent herpes simplex virus type 2-induced meningitis. J Infect Dis. 1990 Aug;162(2):322-30.[Abstract] 
- 21. Abedi GR, Watson JT, Pham H, et al. Enterovirus and human parechovirus surveillance - United States, 2009-2013. MMWR Morb Mortal Wkly Rep. 2015 Sep 4;64(34):940-3.[Abstract][Full Text] 
- 22. Abedi GR, Watson JT, Nix WA, et al. Enterovirus and parechovirus surveillance - United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):515-8.[Abstract][Full Text] 
- 23. Hauri AM, Schimmelpfennig M, Walter-Domes M, et al. An outbreak of viral meningitis associated with a public swimming pond. Epidemiol Infect. 2005 Apr;133(2):291-8.[Abstract] 
- 24. Halliday E, Winkelstein J, Webster AD. Enteroviral infections in primary immunodeficiency (PID): a survey of morbidity and mortality. J Infect. 2003 Jan;46(1):1-8.[Abstract] 
- 25. Marzouk O, Thomson AP, Sills JA, et al. Features and outcome in meningococcal disease presenting with maculopapular rash. Arch Dis Child. 1991 Apr;66(4):485-7.[Abstract][Full Text] 
- 26. Sukhai RN, Munneke R. Enteroviral meningitis with a petechial rash in three children. Eur J Pediatr. 2002 Apr;161(4):226-7.[Abstract] 
- 27. O'Sullivan CE, Aksamit AJ, Harrington JR, et al. Clinical spectrum and laboratory characteristics associated with detection of herpes simplex virus DNA in cerebrospinal fluid. Mayo Clin Proc. 2003 Nov;78(11):1347-52.[Abstract] 
- 28. Hasbun R, Abrahams J, Jekel J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001 Dec 13;345(24):1727-33.[Abstract][Full Text] 
- 29. 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:ciae104.[Abstract][Full Text] 
- 30. Vuorinen T, Vainionpaa R, Hyypia T. Five years' experience of reverse-transcriptase polymerase chain reaction in daily diagnosis of enterovirus and rhinovirus infections. Clin Infect Dis. 2003 Aug 1;37(3):452-5.[Abstract][Full Text] 
- 31. Boivin G. Diagnosis of herpes virus infections of the central nervous system. Herpes. 2004 Jun;11(Suppl 2):A48-A56.[Abstract] 
- 32. American Society for Clinical Pathology. Thirty five things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2022 [internet publication].[Full Text] 
- 33. Sakushima K, Hayashino Y, Kawaguchi T, et al. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. J Infect. 2011 Apr;62(4):255-62.[Abstract] 
- 34. Huy NT, Thao NT, Diep DT, et al. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. Crit Care. 2010 Dec 31;14(6):R240.[Abstract][Full Text] 
- 35. Levy M, Wong E, Fried D. Diseases that mimic meningitis: analysis of 650 lumbar punctures. Clin Pediatr. 1990 May;29(5):254-5, 258-61.[Abstract] 
- 36. Perez Mendez C, Ona Navarro M, Ballesteros Garcia S, et al. Enteroviral meningitis. Clinical and laboratory findings in a series of 60 children [in Spanish]. An Esp Pediatr. 2001 Jul;55(1):11-4.[Abstract] 
- 37. Attia J, Hatala R, Cook DJ, et al. Does this adult patient have acute meningitis? JAMA. 1999 Jul 14;282(2):175-81.[Abstract] 
- 38. Uchihara T, Tsukagoshi H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache. 1991 Mar;31(3):167-71.[Abstract] 
- 39. Puxty JAH, Fox RA, Horan MA. The frequency of physical signs usually attributed to meningeal irritation in elderly patients. J Am Geriatr Soc. 1983 Oct;31(10):590-2.[Abstract] 
- 40. Bernit BE, de Lamballerie X, Zandotti C, et al. Prospective investigation of a large outbreak of meningitis due to Echovirus 30 during summer 2000 in Marseilles, France. Medicine (Baltimore). 2004 Jul;83(4):245-53.[Abstract] 
- 41. Negrini B, Kelleher KJ, Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics. 2000 Feb;105(2):316-9.[Abstract] 
- 42. Spanos A, Harrell FE Jr, Durack DT. Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. JAMA. 1989 Nov 17;262(19):2700-7.[Abstract] 
- 43. Sawyer MH, Holland D, Aintablian N, et al. Diagnosis of enteroviral central nervous system infection by polymerase chain reaction during a large community outbreak. Pediatr Infect Dis J. 1994 Mar;13(3):177-82.[Abstract] 
- 44. Yerly S, Gervaix A, Simonet V, et al. Rapid and sensitive detection of enteroviruses in specimens from patients with aseptic meningitis. J Clin Microbiol. 1996 Jan;34(1):199-201.[Abstract][Full Text] 
- 45. Gerdes LU, Jorgensen PE, Nexo E, et al. C-reactive protein and bacterial meningitis: a meta-analysis. Scand J Clin Lab Invest. 1998 Aug;58(5):383-93.[Abstract] 
- 46. Jereb M, Muzlovic I, Hojker S, et al. Predictive value of serum and cerebrospinal fluid procalcitonin levels for the diagnosis of bacterial meningitis. Infection. 2001 Aug;29(4):209-12.[Abstract] 
- 47. Atallah CJ, Panossian VS, Atallah NJ, et al. Extra-pulmonary applications of procalcitonin: an updated literature review. Expert Rev Mol Diagn. 2022 May;22(5):537-44.[Abstract] 
- 48. Henry BM, Roy J, Ramakrishnan PK, et al. Procalcitonin as a serum biomarker for differentiation of bacterial meningitis from viral meningitis in children: evidence from a meta-analysis. Clin Pediatr (Phila). 2016 Jul;55(8):749-64.[Abstract] 
- 49. Vikse J, Henry BM, Roy J, et al. The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis. Int J Infect Dis. 2015 Sep;38:68-76.[Abstract][Full Text] 
- 50. Bihan K, Weiss N, Théophile H, et al. Drug-induced aseptic meningitis: 329 cases from the French pharmacovigilance database analysis. Br J Clin Pharmacol. 2019 Nov;85(11):2540-46.[Abstract][Full Text] 
- 51. Nannini S, Koshenkova L, Baloglu S, et al. Immune-related aseptic meningitis and strategies to manage immune checkpoint inhibitor therapy: a systematic review. J Neurooncol. 2022 May;157(3):533-50.[Abstract][Full Text] 
- 52. Wang N, Bertalan MS, Brastianos PK. Leptomeningeal metastasis from systemic cancer: Review and update on management. Cancer. 2018 Jan 1;124(1):21-35.[Abstract][Full Text] 
- 53. Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. Surg Neurol Int. 2013;4(suppl 4):S265-88.[Abstract][Full Text] 
- 54. de Gans J, van der Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002 Nov 14;347(20):1549-56.[Abstract][Full Text] 
- 55. van de Beek D, de Gans J, McIntyre P, et al. Steroids in adults with acute bacterial meningitis: a systematic review. Lancet Infect Dis. 2004 Mar;4(3):139-43.[Abstract] 
- 56. Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405.[Abstract][Full Text] 
- 57. Chaudhuri A, Martinez-Martin P, Kennedy PG, et al; EFNS Task Force. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul;15(7):649-59.[Abstract] 
- 58. National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication].[Full Text] 
- 59. Bergstrom T, Alestig K. Treatment of primary and recurrent herpes simplex virus type 2 induced meningitis with acyclovir. Scand J Infect Dis. 1990;22(2):239-40.[Abstract] 
- 60. Aurelius E, Franzen-Röhl E, Glimåker M, et al. Long-term valacyclovir suppressive treatment after herpes simplex virus type 2 meningitis: a double-blind, randomized controlled trial. Clin Infect Dis. 2012 May;54(9):1304-13.[Abstract] 
- 61. Wilfert CM, Thompson RJ Jr, Sunder TR, et al. Longitudinal assessment of children with enteroviral meningitis during the first 3 months of life. Pediatrics. 1981 Jun;67(6):811-5.[Abstract] 
- 62. Bedford H, de Louvais J, Halket S, et al. Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ. 2001 Sep 8;323(7312):533-6.[Abstract][Full Text] 
- 63. Hudson JA, Broad J, Martin NG, et al. Outcomes beyond hospital discharge in infants and children with viral meningitis: A systematic review. Rev Med Virol. 2020 Mar;30(2):e2083.[Abstract] 
- 64. Chang LY, Huang LM, Gau SS, et al. Neurodevelopment and cognition in children after enterovirus 71 infection. N Engl J Med. 2007 Mar 22;356(12):1226-34.[Abstract][Full Text] 
