Key Treatment

Adjunctive dexamethasone is recommended for children and infants with H. influenzae type b meningitis, but not if they have already received antibiotics (Tunkel et al., 2004) (SOR: A). In adults, adjunctive dexamethasone is recommended for pneumococcal meningitis (Tunkel et al., 2004) (SOR: B).

Viral Meningitis Viral meningitis manifests similar to bacterial meningitis, although its course is rarely aggressive. The diagnostic process and examination are similar to those for bacterial meningitis. Viral meningitis is usually caused by enteroviruses, HSV, mumps virus, and HIV. Along with the signs of meningitis, signs that suggest a viral etiology include genital lesions (HSV-2), diarrhea, or a maculopapular rash (enteroviruses). Diagnosis is made by the history, examination, and CSF results. Early in the course, the CSF might show predominantly neutrophils that can resemble bacterial meningitis. Treatment is symptomatic. Suppressive therapy should be offered to patients with recurrent HSV meningitis.

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