McGill Fiona, Griffiths Michael J, Solomon Tom
aInstitute of Infection and Global Health, University of Liverpool bNational Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, University of Liverpool cRoyal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool dLeeds Teaching Hospitals NHS Trust, Leeds eAlderhey Children's NHS Foundation Trust fThe Walton Centre NHS Foundation Trust, Liverpool, UK.
Curr Opin Infect Dis. 2017 Apr;30(2):248-256. doi: 10.1097/QCO.0000000000000355.
The purpose of this review is to give an overview of viral meningitis and then focus in on some of the areas of uncertainty in diagnostics, treatment and outcome.
Bacterial meningitis has been declining in incidence over recent years. Over a similar time period molecular diagnostics have increasingly been used. Because of both of these developments viral meningitis is becoming relatively more important. However, there are still many unanswered questions. Despite improvements in diagnostics many laboratories do not use molecular methods and even when they are used many cases still remain without a proven viral aetiology identified. There are also no established treatments for viral meningitis and the one potential treatment, aciclovir, which is effective in vitro for herpes simplex virus, has never been subjected to a clinical trial.
Viruses are in increasingly important cause of meningitis in the era of declining bacterial disease. The exact viral aetiology varies according to age and country. Molecular diagnostics can not only improve the rate of pathogen detection but also reduce unnecessary antibiotics use and length of hospitalization. Further research is required into treatments for viral meningitis and the impact in terms of longer term sequelae.
本综述旨在概述病毒性脑膜炎，然后重点关注诊断、治疗及预后方面的一些不确定领域。
近年来细菌性脑膜炎的发病率一直在下降。在相似的时间段内，分子诊断方法的使用越来越多。由于这两个方面的发展，病毒性脑膜炎正变得相对更为重要。然而，仍有许多问题未得到解答。尽管诊断有所改善，但许多实验室并未采用分子方法，即便采用了分子方法，仍有许多病例无法确定病毒病因。病毒性脑膜炎也没有既定的治疗方法，一种潜在的治疗药物阿昔洛韦，虽在体外对单纯疱疹病毒有效，但从未进行过临床试验。
在细菌性疾病发病率下降的时代，病毒是脑膜炎日益重要的病因。确切的病毒病因因年龄和国家而异。分子诊断不仅可以提高病原体检测率，还能减少不必要的抗生素使用及住院时间。需要对病毒性脑膜炎的治疗方法及其对长期后遗症的影响进行进一步研究。
