This is usually called aseptic meningitis, because of the absence of bacteria. Cultures still need to be taken in the event the patient has compromised reaction or the infection is still early. Antibiotics should usually not be initiated unless there is other evidence to suggest a bacterial infection. When suspecting aseptic meningitis, depending upon the setting, skin tests for TB, a chest x-ray, a reagin test for syphilis, fungal cultures, and India ink preparations should be done. Viruses are the most common cause of this picture in military age groups.
Treatment consists of supportive care, analgesics, hydration, and enteric isolation.
Preventive medicine technicians should look for spread of illness and pay particular attention to latrines, food service, and berthing areas. The spinal fluid shows a few hundred lymphocytes, moderate elevation of protein, a negative gram stain, and negative cultures. If there is a major medical treatment facility nearby, this patient must be transferred for evaluation and treatment. If there is currently an epidemic of typical viral meningitis at the command or in the community, it is reasonable to discontinue the patient's antibiotics, examine the patient every day and repeat their LP in 1 or 2 days for signs of infection. If the patient cannot be quickly referred to a treatment facility and if there is not a local outbreak of viral meningitis to account for the patient's illness, the GMO must contact an infectious disease specialist for consultation and start the patient on high doses of ceftriaxone or penicillin for 2 weeks.