Viral meningitis with reduced CSF sugar is seen in
**Core Concept**
Viral meningitis is an inflammatory condition of the meninges, primarily caused by viral infections. The cerebrospinal fluid (CSF) analysis in viral meningitis typically shows a lymphocytic pleocytosis, with normal glucose levels.
**Why the Correct Answer is Right**
In viral meningitis, the glucose levels in the CSF are usually preserved because the viruses do not directly invade the brain parenchyma or the CSF-producing cells. The inflammation and cellular response to the viral infection lead to the release of cytokines and chemokines, which attract lymphocytes into the CSF, resulting in a lymphocytic pleocytosis. The glucose levels in the CSF are maintained because the viruses do not directly affect the glucose transport mechanisms in the CSF.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because bacterial meningitis typically presents with reduced CSF glucose levels due to the direct invasion of bacteria into the CSF, which leads to the consumption of glucose by the bacterial cells and the host's inflammatory response.
**Option B:** This option is incorrect because tuberculous meningitis can present with reduced CSF glucose levels, but it is not the most characteristic feature of viral meningitis.
**Option C:** This option is incorrect because fungal meningitis can also present with reduced CSF glucose levels, but it is not a typical feature of viral meningitis.
**Option D:** This option is incorrect because parasitic meningitis can present with various CSF abnormalities, but reduced CSF glucose levels are not a characteristic feature of viral meningitis.
**Clinical Pearl / High-Yield Fact**
In viral meningitis, the CSF analysis typically shows a lymphocytic pleocytosis with normal glucose levels, and the presence of viral particles or viral nucleic acids in the CSF can be confirmed by PCR or other molecular techniques.
**Correct Answer: B. Tuberculous meningitis**