Most cases of viral meningitis occur in children and young adults. It can occur throughout the year, but is most prevalent in the warm summer and fall months. 2, rapid onset, usually a few hours. Clinical manifestations: fever, temperature up to 38-40°C, headache, mild mental disturbances such as drowsiness, lethargy or irritability, photophobia and pain during eye movements and myalgia are common complaints. Cervical tonicity and meningeal irritation may also be present, but are easily overlooked in the early stages. Rarely, mental confusion, rigidity or coma may occur. 4. Certain signs and symptoms are most often seen with specific viruses and help in pathogenic diagnosis. The rash is mostly seen with enteroviruses, mostly non-itchy erythema and papules, confined to the head and neck, more common in children. group A coxsackieviruses may also have gray blister-like herpetic pharyngitis at the pharyngeal mucosa. Pleuritic pain, brachial plexus neuritis, endocarditis, myocarditis, and orchitis are characteristic of group B coxsackievirus infections. Mumps and orchitis are characteristic of mumps virus infection, and it should be noted that orchitis is not limited to mumps virus infection, but can also be seen in group B coxsackievirus infection, infectious mononucleosis and lymphocytic choroid plexus meningitis. 5, cerebrospinal fluid examination: as a basis for confirming the diagnosis. Cerebrospinal fluid pressure is normal or mildly elevated. The appearance is colorless and clear. The cell count is elevated, 10-500/mm3. The cell classification is mainly lymphocytes, but in some cases early, it may also show prominent polymorphonuclear leukocytes, in which case the cerebrospinal fluid should be rechecked after 24-48 hours. In the case of viral meningitis, the leukocytes in the cerebrospinal fluid clearly change from polymorphonuclear to mononuclear, but the total number of cells, proteins and sugars do not change. The cerebrospinal fluid protein is mildly increased, and the sugar level is normal or mildly decreased. 6, determine the etiology: the virus can be isolated from the cerebrospinal fluid; IgM antibodies or viral antigens in the cerebrospinal fluid can be examined and detected in the serum of serum specimens in the acute and recovery periods. In recent years, immuno- and DNA-probe expansion techniques such as polymerase
chain reaction (PRC) to detect antigens has shown some promise. Treatment: 1. The key to treatment is early diagnosis in order to avoid unnecessary antimicrobial therapy. The vast majority of viral meningitis does not require an exact etiologic diagnosis because of its benign, self-limiting course. The main treatment for viral meningitis is symptomatic treatment, supportive therapy and prevention of comorbidities, such as bed rest, lowering body temperature; maintaining water and electrolyte balance, and supporting nutrition. 3, antiviral drugs: can shorten the course of the disease and reduce symptoms. However, only the early application of DNA inhibiting drugs is effective, such as acyclic guanosine (acyclovir) for the treatment of herpes simplex meningitis. Intravenous high-dose immunoglobulin can relieve chronic enterovirus meningitis. 4. a potentially serious comorbidity is the syndrome of poor antidiuretic hormone secretion. the clinical manifestations of SIADH are water retention, intracellular and extracellular expansion of water volume, and dilutional hyponatremia. Patients typically gain 3 kg of body weight without edema. Treatment should limit fluid intake to 800 to 1000 mL/mm2 per day. in addition, the fluid lost due to fever should be replaced.