Is it easy to tell clinically whether meningitis in a child is due to a bacterial or viral infection?

No. Therefore, all cases of clinical meningitis must initially be managed as if they are bacterial meningitis until the cause of the meningitis is identified. However, children with viral meningitis are often not as severely ill as children with bacterial meningitis. Only the findings on the lumbar puncture enable one to tell whether the infection is viral or bacterial.

Children with viral meningitis usually improve rapidly after a lumbar puncture and have fewer complications. The management is supportive and antibiotics can be stopped once the results of the lumbar puncture exclude bacterial meningitis. Tuberculous meningitis also has a similar presentation and must be distinguished on lumbar puncture and other investigations.

It is not possible to distinguish between viral and bacterial meningitis on clinical examination alone.

In viral meningitis most cells in the CSF are lymphocytes, the CSF glucose is normal and the Gram stain and culture are negative for bacteria.

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