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]
Key Articles
Referenced Articles
Sign in to access our clinical decision support tools