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With uncommon exceptions, only supportive care with analgesics is essential for viral meningitis. Mainly because the clinical presentations of microbe and viral meningitis might be indistinguishable, laboratory studies from the cerebrospinal fluid are vital in differentiating these entities. Cerebrospinal fluid leukocyte pleocytosis (white blood cells within the cerebrospinal fluid) could possibly be the hallmark of meningitis. Microbe meningitis is normally characterized by neutrophilic pleocytosis (predominance of polymorphonuclear neutrophils from the cerebrospinal fluid). Typical causes of lymphocytic pleocytosis include viral infections (eg, enterovirus, West Nile virus), fungal infections (eg, cryptococcus in HIV-infected persons), and spirochetal infections (eg, neurosyphilis or Lyme neuroborreliosis).
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