Table 1.

Distinctive etiological, clinical, epidemiological, complications, and diagnostic elements of pediatric viral and bacterial meningitis: Comparative presentation.

	PVM	PBM	References
Etiology	The most commonly reported viral causes of PVM include: • Enteroviruses (EVs): mainly CV-A, CV-B, EV-A71, EV-B69, EV-B73, and EV-D68. • HPeV. • Herpesviruses including HSV-1, HSV-2, VZV, EBV, CMV, HHV-6. • Influenza viruses (type A and B). • Arboviruses including WNFV, JEV, YFV, DENV, EEEV, CHIKV, LACV. • Mumps virus. • LMCV.	Several bacterial organisms were known to cause meningitis (septic meningitis) in children, including Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitides, Escherichia coli, group B Streptococcus agalactiae, Staphylococcus aureus, Listeria monocytogenes, Mycobacterium tuberculosis, and Pasteurella multocida.	(7, 27–69)
Clinical features	Generally, the clinical phenotypes of PVM and the course of the illness depend on the causative virus. Unless complicated, PVM cases had usually manifested benign or asymptomatic course. Primary non-specific symptoms, including fever, headache, neck stiffness, malaise, anorexia, fatigue, and vomiting, were noted. In critical cases, meningeal signs, including photophobia, myalgia, cough, sore throat, nuchal rigidity, and skin rash, were also observed.	Pediatric BM has been encountered as a more severe and fatal condition than PVM. Antibiotics therapy significantly reduced the infection risk and severity. The characteristic signs of PBM include sudden onset of fever, headache, and meningismus. Among the severe and hospitalized cases, coma, ICP, seizures, shock, and deaths were reported.	(20, 66, 70–72)
Epidemiology	Some factors and correlates for PVM epidemiology were highlighted in many studies. These included; the causative virus, seasonality, age, gender, immune status of the child, infectivity, morbidity, and CFR. Conclusively, PVM was known to have higher infectivity and morbidity rates but fewer mortalities than BM.	The incidence and prevalence rates of BM were noted to peak among young children and the elderly. Formerly, high CFRs of BM were reported. However, antibiotics to treat the disease augmented with the worldwide use of bacterial vaccines (such as Streptococcus pneumoniae, Neisseria meningitides, and Haemophilus influenza) significantly reduced the incidence and fatalities of BM among pediatric patients, with the peak incidence in young children and the elderly.	(1, 7, 11, 53, 66, 73–85)
Complications	PVM complications were uncommon to occur. However, some short and long-term neurological consequences were reported. Neuropathological disorders (such as shock and seizures), behavioral consequences (such as sensorineural hearing loss), and Neuropsychological complications (such as sleep disturbances) were observed in PVM patients. Other complications, including meningoencephalitis, myocarditis, pericarditis, acute flaccid paralysis, rhombencephalitis, and deaths, were also mentioned in multiple case reports.	Rational and appropriate application of antibiotics and other therapies were known to limit the occurrence of neurological complications among PBM patients. BM was confirmed as the primary cause of global neurological disabilities among neonates. ICP, stroke, and seizures are the most commonly known complications of BM in children.	(27, 30, 31, 85–92)
Diagnosis	Clinical presentations, physical examinations, virus isolation, serological testing, biochemistry findings, and pleocytosis are suggestive. Molecular detection is definitive for the etiological diagnosis of PVM.	Lumbar puncture for bacterial culture was always recommended to diagnose BM. Gram staining and cultures were the essential tools for BM diagnosis. Cells counts and glucose and protein levels were used as differential diagnostic factors with PVM.	(54, 57, 70, 76–78, 93–97)

CFR, Case fatality rate; CHIKV, Chikungunya virus; CMV, Cytomegalovirus; CV, Coxsackievirus; DENV, Dengue virus; EBV, Epstein Barr virus; EEEV, Eastern equine encephalitis virus; EVs, Enteroviruses; HHV-6, Human herpesvirus 6; HPeV, Human parechovirus; HSV-1,-2, Herpes simplex virus-1,-2; ICP, Intracranial pressure; JEV, Japanese encephalitis virus; LACV, La Crosse virus; LMCV, Lymphocytic choriomeningitis virus; PBM, Pediatric bacterial meningitis; PVM, Pediatric viral meningitis; VZV, Varicella zoster virus; WNFV, West Nile fever virus; YFV, Yellow fever virus.