1.) Are there any elements on H&P that make you suspect viral meningitis in adult patients? Do you LP all patients you suspect have viral meningitis?
2.) Does a “normal” CSF reassure you that the patient does not have bacterial meningitis?
3.) Do you use CSF lactate or other cytochemical markers to differentiate between viral and bacterial meningitis? Do you send anything beyond a standard meningitis panel for immunocompetent patients? When and what?
4.) When do you admit a patient, post-LP, who appears to have viral meningitis? What anti-microbial agents do you administer these patients, if any?
These are great questions. Since viral meningitis is so hard to cure, it would be good that all medical personal is properly educated about it. I have a friend that was sent home 2 times within a week, where symptoms of meningitis were replaced as a flu symptoms. When she finally went to hospital, she staid there for almost two weeks, and it took her 6 months to fully reover.
Thanks for your comment and for reading. All meningitis can be very difficult to diagnose. Viral meningitis is really many different disease entities, and we use it here as an umbrella term, to differentiate from the commonly much more serious bacterial meningitis.