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Properly interpreted tests can make cerebrospinal fluid (CSF) a key tool in the diagnosis of a variety of diseases. Data on cerebrospinal fluid (CSF) samples submitted to the Trust Virology Laboratory (Sheffield, UK) from April 2004 through April 2007 were reviewed. White blood cell differential may be misleading early in the course of meningitis, because more than 10 percent of cases with bacterial infection will have an initial lymphocytic predominance and viral meningitis may initially be dominated by neutrophils. Enterovirus infection was the most common cause of viral meningitis in immunocompetent adults in this study. When this happens, CSF findings may resemble those of viral meningitis, but antibiotic treatment may need to be continued until there is definitive positive evidence of a viral cause (e. Bacterial meningitis and viral encephalitis are two life-threatening causes of infection and inflammation within the central nervous system (CNS).
Typical features of HSV-2 meningitis are headache, fever, stiff neck, and lymphocytic pleocytosis in the CSF.

CSF findings in bacterial meningitis may mimic those found in viral meningitis (particularly early on).
When an LP is performed, four tubes of CSF, each containing about 1mL of fluid, should be obtained and sent to the laboratory for analysis. The improved pharmacokinetic profiles and simpler dosing regimens of oral valaciclovir (1, 000 mg three times daily for 7 days) or famciclovir (250 mg or 500 mg three times daily) have led to their use instead of aciclovir (800 mg five times daily) as the preferred treatment.
The CSF analysis shows elevated opening pressure, elevated protein, low glucose (hypoglycorrhachia) , cloudy fluid and a positive Gram stain.
The diagnosis of herpes simplex meningitis was made at the time of the fourth episode by a positive PCR for herpes simplex virus infection in the cerebrospinal fluid. Symptoms include fever, headache, and altered mental status, often accompanied by seizures or focal neurologic deficits. Herpes simplex encephalitis (HSE) is a life-threatening consequence of herpes simplex virus (HSV) infection of the central nervous system (CNS).

Characteristics include usually normal opening pressure, slightly increased protein and normal glucose (glucose is below normal for bacterial meningitis). Polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) is the diagnostic method of choice for HSE, but negative results need to be interpreted in the context of the patient’s clinical presentation and the timing of the CSF sampling. In contrast to aseptic viral meningitis, neuropsychiatric symptoms often predominate in encephalitis, for example, anomia, hallucinations, psychosis, personality changes, and agitation. Herpes infection of the CNS, especially with HSV-2, can also cause both monophasic and recurrent aseptic meningitis, as well as myelitis or radiculitis.
The cerebrospinal fluid profile in acute viral encephalitis is indistinguishable from aseptic meningitis.

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