Differentiation between purulent meningitis and viral meningitis

Written by Zhang Hui
Neurology
Updated on September 21, 2024
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Purulent meningitis and viral meningitis are different diseases. Purulent meningitis is caused by bacterial infection of the meninges. Viral meningitis is caused by viral invasion of the meninges. Generally, purulent meningitis is more severe, and patients may exhibit symptoms of systemic toxin poisoning, such as high fever, nausea, vomiting, sickly appearance, and general weakness. The symptoms of viral meningitis are relatively mild, and the fever is not particularly severe. Another important differentiation is based on the analysis of cerebrospinal fluid. In viral meningitis, the lumbar puncture shows that the white blood cell count is below 1000*10^6/L, and the levels of sugar and chloride are generally normal or slightly low, with protein usually mildly elevated. In purulent meningitis, the cerebrospinal fluid shows a significant increase in white blood cell count, even reaching from 1000*10^6/L to 10000*10^6/L; the protein content is significantly increased, the sugar content is markedly decreased, and chloride levels are reduced. Additionally, bacteria can be found in the cerebrospinal fluid and blood cultures in purulent meningitis, whereas viral meningitis cerebrospinal fluid cultures do not show bacteria.

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Written by Zhang Hui
Neurology
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Differences between Viral Meningitis and Tuberculous Meningitis

Virial meningitis and tuberculous meningitis sometimes require additional differentiation in clinical practice because their treatment plans are significantly different. Virial meningitis has a relatively abrupt onset and is caused by a viral infection, generally having a good prognosis. Patients with tuberculous meningitis usually exhibit symptoms of tuberculosis toxicity such as low fever, night sweats, and fatigue before the onset of the disease. Commonly, other forms of tuberculosis can be identified, such as pulmonary tuberculosis or intestinal tuberculosis. An important diagnostic tool for differentiation is the lumbar puncture. In viral meningitis, the lumbar puncture pressure is generally not particularly high, whereas in tuberculous meningitis, the lumbar puncture pressure is very high, reaching over 400 mm of water column. Additionally, the cerebrospinal fluid (CSF) in tuberculous meningitis is yellowish, and its protein levels are significantly elevated, as are its white blood cell counts, typically ranging from 50 to 500 × 10^6/L. In tuberculous meningitis, the levels of glucose and chloride in the cerebrospinal fluid are significantly decreased, especially chloride, which is a prominent indicator for diagnosing tuberculous meningitis. In contrast, such clear changes are not observed in the lumbar puncture for viral meningitis. Another aspect to consider is the treatment response; if antiviral treatment is ineffective, the possibility of tuberculous meningitis should be considered.

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Written by Zhang Hui
Neurology
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Meningitis examination methods

The examination methods for meningitis mainly include several types. The first is the lumbar puncture examination, which is a very important diagnostic tool. Through lumbar puncture, one can observe the cerebrospinal fluid (CSF) pressure, its color, and perform laboratory tests on the CSF to examine biochemical properties and cell count changes. Additionally, it is possible to culture pathogens from the cerebrospinal fluid, which is of great auxiliary value in the diagnosis and differential diagnosis of meningitis. Secondly, patients with meningitis also need to undergo physical examinations. If signs of meningeal irritation are found during the physical examination, it also indicates meningitis. Thirdly, patients may need to undergo enhanced Magnetic Resonance Imaging (MRI) of the brain. If the meningitis lesions are severe, meningeal enhancement can be seen.

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Written by Han Shun Li
Pulmonology
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Does meningitis cause headaches?

Meningitis is an inflammation of the meninges caused by pathogenic microorganisms, such as bacteria, tuberculosis bacteria, viruses, fungi, etc., which can all cause meningitis. Common symptoms of meningitis include fever, headache, nausea, vomiting, etc., thus patients with meningitis do experience headaches. Moreover, headache is one of the most common symptoms in patients with meningitis. Often, patients suffering from headaches will experience symptoms of nausea and vomiting, which is frequently projectile, and in many cases, the headache can be alleviated after vomiting.

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Written by Han Shun Li
Pulmonology
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What is meningitis?

Meningitis is predominantly an inflammation that occurs in the meninges and can extend to the brain parenchyma. It is generally caused by pathogenic microorganisms, including common pathogens such as bacteria, fungi, viruses, tuberculosis bacteria, etc. The most common symptoms include fever, headache, nausea, vomiting, stiff neck, etc. More severe cases can present with convulsions, disturbances of consciousness, or even coma. The condition can be mild or severe, and if not treated promptly, it can be fatal in serious cases.

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Written by Han Shun Li
Pulmonology
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Is meningitis serious?

Meningitis is a common infectious disease of the central nervous system. Patients with meningitis often experience symptoms such as fever, headache, nausea, vomiting, and neck stiffness. As the disease progresses, they may also experience seizures, motor disorders, disturbed consciousness, coma, and other conditions, with severe cases posing a risk to life. Many patients can still have sequelae after recovery, such as speech impairments, hemiplegia, and decreased intelligence. Therefore, meningitis is a very serious disease, and patients should actively cooperate with doctors for treatment after becoming ill.