Acute viral meningitis -: Epidemiological, clinical and biological characteristics of 29 hospitalized patients

Objectives To further characterize the epidemiological, clinical, biological and therapeutic data concerning acute aseptic viral meningitis. Methods We studied, retrospectively, the dossiers of 29 patients hospitalized in 2000 for acute aseptic meningitis of viral origin. Results In the 7 days preceding hospitalization, a viral syndrome had appeared in 45 % of cases. On admission, mean body temperature was of 38.6degreesC +/- 0.6 and in 72 %, superior or equal to 38.5degreesC. The mean number of cells in the cephalo-spinal liquid (CSL) was of 188 +/- 304/mm(3) with 51 % of neutrophilic polynuclears and 44 % of lymphocytes. Mean cervico-spinal fluid protein level was of 0.71 +/- 0.3 g/l and glycorrhachia 3 +/- 0.4 mm/l. Mean total leukocyte concentration was of 9130 +/- 2803/mm(3). Mean C- reactive protein was of 20 +/- 29 mg/l, and in 86% of cases, inferior to 25 mg/l. Patients who underwent lumbar puncture, within the 72 hours following the appearance of the meningeal syndrome, exhibited statistically significant higher numbers of neutrophilic polynuclears in the CSL than in those in whom this examination was conducted after 72 hours (59% vs. 33%: p = 0.03). The delay before obtaining apyrexia was a mean of 1.4 days (33.9 +/- 17.6 hours). Patients who had been administered antibiotics for at least 24 hours (62%) exhibited CSL significantly richer in elements (247.3 +/- 375/mm(3) vs. 90.27 59.6/mm(3), p=0.049) with a greater proportion of neutrophilic polynuclears (61 +/- 34% vs. 34 +/- 29%; p=0.015) and longer hospitalization (3.67 +/- 1.6 vs. 2.64 +/- 1.1 days; p=0.028) than those who had not been treated. Conclusion This retrospective study demonstrates the difficulties that clinicians encounter in the emergency diagnosis and treatment of acute meningitis of presumed viral origin.