This article was originally published in Portuguese on Medscape .
Bacteria and viruses are the leading causes of community-acquired meningitis. Bacterial meningitis is associated with high morbidity and mortality, and prompt treatment with appropriate antibiotics is essential to optimize outcomes. Early diagnosis is therefore crucial for selecting patients who need antibiotics. On the other hand, the course of viral meningitis is generally benign, and there is usually no specific antimicrobial treatment required. Distinguishing between viral and bacterial causes of meningitis can be challenging; therefore, many patients receive empiric antibiotic treatment.
Etiology
The most common etiologic agents of community-acquired bacterial meningitis are shown in the following table.
| Newborns |
Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes |
| age 2 and younger |
Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae |
| age 3-49 |
S pneumoniae, N meningitidis |
| age 50+ |
S pneumoniae, N meningitidis, and L monocytogenes |
Among the etiologic agents of viral meningitis, the non-polio enteroviruses (Echovirus 30, 11, 9, 6, 7, 18, 16, 71, 25; Coxsackie B2, A9, B1, B3, B4) are the most common, responsible for more than 85% of cases. Other viruses potentially responsible for meningitis include the herpes simplex virus (HSV), primarily type 2, and flavivirus (such as the Dengue virus).
Clinical Presentation
The clinical presentation of bacterial meningitis is more severe than that of viral meningitis.
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COMMENTARY
How Do We Distinguish Between Viral and Bacterial Meningitis?
Renan Domingues, MD, PhD; Fernando Brunale, MD, PhD; Carlos Giafferi, MD; Carlos Senne, MD
April 25, 2022
This article was originally published in Portuguese on Medscape .
Bacteria and viruses are the leading causes of community-acquired meningitis. Bacterial meningitis is associated with high morbidity and mortality, and prompt treatment with appropriate antibiotics is essential to optimize outcomes. Early diagnosis is therefore crucial for selecting patients who need antibiotics. On the other hand, the course of viral meningitis is generally benign, and there is usually no specific antimicrobial treatment required. Distinguishing between viral and bacterial causes of meningitis can be challenging; therefore, many patients receive empiric antibiotic treatment.
Etiology
The most common etiologic agents of community-acquired bacterial meningitis are shown in the following table.
Among the etiologic agents of viral meningitis, the non-polio enteroviruses (Echovirus 30, 11, 9, 6, 7, 18, 16, 71, 25; Coxsackie B2, A9, B1, B3, B4) are the most common, responsible for more than 85% of cases. Other viruses potentially responsible for meningitis include the herpes simplex virus (HSV), primarily type 2, and flavivirus (such as the Dengue virus).
Clinical Presentation
The clinical presentation of bacterial meningitis is more severe than that of viral meningitis.
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Cite this: How Do We Distinguish Between Viral and Bacterial Meningitis? - Medscape - Apr 25, 2022.