Viral meningitis: current issues in diagnosis and treatment

McGill, Fiona^a,b,c,d; Griffiths, Michael J.^a,b,e; Solomon, Tom^a,b,c,f

^aInstitute of Infection and Global Health, University of Liverpool

^bNational Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, University of Liverpool

^cRoyal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool

^dLeeds Teaching Hospitals NHS Trust, Leeds

^eAlderhey Children's NHS Foundation Trust

^fThe Walton Centre NHS Foundation Trust, Liverpool, UK

Correspondence to Fiona McGill, MBChB, University of Liverpool Institute of Infection and Global Health, Liverpool, UK. Tel: +0 151 795 9606; fax: +0 151 795 5528; e-mail:[email protected]

Current Opinion in Infectious Diseases30(2):p 248-256, April 2017. |DOI:10.1097/QCO.0000000000000355

Abstract

Purpose of review

The purpose of this review is to give an overview of viral meningitis and then focus in on some of the areas of uncertainty in diagnostics, treatment and outcome.

Recent findings

Bacterial meningitis has been declining in incidence over recent years. Over a similar time period molecular diagnostics have increasingly been used. Because of both of these developments viral meningitis is becoming relatively more important. However, there are still many unanswered questions. Despite improvements in diagnostics many laboratories do not use molecular methods and even when they are used many cases still remain without a proven viral aetiology identified. There are also no established treatments for viral meningitis and the one potential treatment, aciclovir, which is effectivein vitro for herpes simplex virus, has never been subjected to a clinical trial.

Summary

Viruses are in increasingly important cause of meningitis in the era of declining bacterial disease. The exact viral aetiology varies according to age and country. Molecular diagnostics can not only improve the rate of pathogen detection but also reduce unnecessary antibiotics use and length of hospitalization. Further research is required into treatments for viral meningitis and the impact in terms of longer term sequelae.