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©2013 UpToDate ® Print Email Cerebrospinal fluid (CSF) patterns and diagnosis of viral meningitis in children Pathogen WBC (cells/mm3) RBC Glucose (mg/dL) Protein (mg/dL) Viral diagnosis Enterovirus 100-1000 None NL/SL↓ <160 Cell culture: NP, rectal, CSF; PCR: CSF Herpes simplex virus ~100 None or ↑ ~ ~100 or higher Cell culture: skin or mucosal lesion; PCR: CSF, blood Epstein Barr virus ↑ None NL ↑ PCR: CSF Serum serology Cytomegalovirus ↑ None ↓ ↑ Cell culture and CSF PCR Lymphocytic choriomeningitis virus ↑ None NL/SL↓ NL/SL↑ Serology, cell culture and PCR Influenza NL/SL↑ None NL NL/SL↑ NP cell culture, antigen testing and PCR CSF PCR Arboviruses <200 None NL ↑ Serum and CSF serology testing Cell culture: research laboratories WEE virus: PCR: CSF Eastern equine encephalitis 400-4000 Western equine encephalitis (WEE) ≤2000 West Nile virus <200 Up to 900 St. Louis encephalitis virus <200 ~200 NL: normal; SL: slightly; NP: nasopharyngeal aspirate; CSF: cerebrospinal fluid; PCR: polymerase chain reaction; ↓: decrease; ↑: increase. Data from: Feigin RD, Shackelford PG. Value of repeat lumbar puncture in the differential diagnosis of meningitis. N Engl J Med 1973; 289:571. Negrini B, Kelleher KJ, Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics 2000; 105:316. Rotbart HA. Viral meningitis. Semin Neurol 2000; 20:277. Sawyer MH. Enterovirus infections: diagnosis and treatment. Pediatr Infect Dis J 1999; 18:1033. Simko JP, Caliendo AM, Hogle K, Versalovic J. Differences in laboratory findings for cerebrospinal fluid specimens obtained from patients with meningitis or encephalitis due to herpes simplex virus (HSV) documented by detection of HSV DNA. Clin Infect Dis 2002; 35:414.