Expert Opinion :
Not every meningitis is bacterial meningitis and not every low sugar meningitis is again bacterial meningitis. Infact low sugar may also be seen in viral meningitis apart from tuberculous meningitis and fungal meningitis. The commonest cause of meningitis is viral and then followed by bacterial and tuberculosis. Viral meningitis usually presents with fever, multiple episodes of seizures (with normal sensorium) and lymphocytic predominance on CSF examination. Hence viral meningitis is also called as aseptic meningitis. Bacterial meningitis presents with fever, toxicity, vomiting and is associated with high CSF cell count (initially polymorphs and later lymphocytic). In this child, the duration of disease has only been for 6 hours, CSF shows lymphocytes and child has not received any antibiotics before CSF examination. Thus, it is suggestive of viral meningitis. Through CSF sugar is low; it may be seen with viral infections. In this child, CT brain was normal. CSF culture and latex were negative and CSF PCR was positive for enterovirus. Thus antibiotics are not required and one needs to assess every low sugar meningitis for the cause.