Meanwhile, exclusion criteria were: (1) clinical symptoms of viral meningitis and routine, biochemical, and cytological examination of cerebrospinal fluid and (2) research on animal experiments.

The articles studied are currently published and the criteria included in this paper are: (1) the disease studied is viral meningitis (2) the subjects are human and (3) diagnostic techniques of etiology.

The keywords used to search for information were meningitis, virus, etiology, and diagnosis. This study was conducted using a comprehensive search of PubMed and Web of Science databases. Therefore, it is our aim to comprehensively analyze the existing etiological diagnostic techniques for viral meningitis, hoping to provide some reference when clinicians track the cause of meningitis. After a systematic search of the literature, we found that there is currently no article that comprehensively and in detail discusses the etiological diagnostic techniques for viral meningitis. Therefore, choosing an optimally rapid and accurate method is of great importance. Moreover, EV-71 is difficult to detect from CSF and can usually be detected by polymerase chain reaction (PCR) from stool and throat swabs ( 22– 25). At the same time, high mutation rates of EVs ( 20) and long viral shedding times necessitate continued surveillance to identify changes in EV infection in the central nervous system and transmission of EVs ( 21). The viruses invaded the central nervous system mainly by three routes, the blood–brain barrier penetration, axonal transport and Trojan-Horse-Mediated entry, leaving different traces detectable by different methods ( 19). Early sample sizes were limited and virus concentrations were low, severely hindering accurate detection of pathogens by microscopy. Laboratory diagnostic methods include microscopic examination of clinical specimens, viral culture, serological studies, immunodetection of viral or viral antigens and even sequence reading of DNA or RNA ( 18). During the COVID pandemic, despite being reported, the incident rate of meningitis caused by SARS-CoV-2 seems extremely low. And others such as herpes simplex virus (HSV) and varicella-zoster virus (VZV) are also common pathogens causing this disease ( 15– 17), but mumps virus and influenza virus are relatively rare. The virus has more than 60 different subtypes, including poliovirus, coxsackievirus A, coxsackievirus B, and echovirus ( 12– 14).

Currently, the causative agent of viral meningitis is mainly human enterovirus (EV) ( 8– 11). For instance, it directly influences the host immune response to viral infection (such as innate immune response and adaptive immune response), or indirectly influences susceptibility to viral infection by affecting other factors such as age, sex and comorbidities, resulting in differences in disease severity and outcome. In addition, host genetic inheritance would also influence viral invasion ( 5– 7). It is common in immunocompromised people such as children and the elderly ( 3, 4). Viral meningitis is the most common infection of the central nervous system and is caused by viral invasion of the meninges ( 1, 2).

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