History and exam

Key diagnostic factors

common

headache

Common complaint.

nausea and vomiting

Common presenting symptom in children.[5]

photophobia

Present in almost 80% of cases of enteroviral meningitis in adults.[14]

neck stiffness

For all meningitis sensitivity is 44% and specificity 80% in children.[38]

Present in more than 60% of cases of enteroviral meningitis in adults.[14]

fever

Fever is present in over half of cases of enteroviral meningitis.[39] For all meningitis sensitivity is 85%.[40]

Other diagnostic factors

common

rash

Commonly described in viral meningitis but sensitivity and specificity not identified. Type of rash may indicate the infecting agent (e.g., herpangina is seen with Coxsackie virus A, and a maculopapular rash with echovirus-9). Genital herpes suggests HSV-2 as the causal agent.

uncommon

Kernig sign

For all meningitis sensitivity is 15% and specificity 96% in children.[39]

Sensitivity of 9% and specificity 100% described in adults for all meningitis.[41]

Specificity for all meningitis is 88% in older people.[42]

Uncommon in viral meningitis.

Brudzinski sign

For all meningitis sensitivity is 68% and specificity 65% in children.[39]

Uncommon in viral meningitis.

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