病毒性脑(膜)炎是一种严重威胁公共卫生的中枢神经系统炎症性疾病。尽管病史、症状体征、常规检测、影像学，以及分子诊断技术的不断改进等对病毒性脑(膜)炎诊断具有至关重要的作用，但其仍然受到技术、检测试剂、样本类型、检测时间窗口等因素的限制，且须根据不同的临床特征选择合适的诊断技术。仍有40%～60%的患者难以明确病因，进行及时、准确的诊断是开展针对性适当治疗的基石。60%～80%的病毒性脑(膜)炎患者首次就诊发生在基层医疗机构，而基层医院因技术条件所限，确诊率低于20%，因此制定规范化的病因学诊断路径，实行分级诊断策略尤为必要。在基层医院条件有限的情况下，通过详细询问病史、全面体格检查及基本实验室检查初步确定诊断方向；根据疑似病因，通过聚合酶链反应(polymerase chain reaction，PCR)等常规分子生物学技术进行病原体初筛；在PCR结果阴性或不可行时，考虑应用如宏基因组二代测序(metagenomic next-generation sequencing，mNGS)的非靶向广覆盖技术；建立多学科团队诊疗模式及临床诊疗网络以提高确诊率，改善患者的临床结局。随着检测技术的进步和人工智能的应用，病毒性脑(膜)炎诊断将更准确。

Viral encephalitis/meningitis is a severe inflammatory disease of the central nervous system that poses a significant threat to public health. Despite the crucial role played by medical history, symptoms, routine tests and imaging in its diagnosis, and continuous improvements in molecular diagnostic techniques, limitations including technical limitations, assay variability, sample types, and detection time windows still constrain its diagnosis. Moreover, the selection of appropriate diagnostic techniques depends on different clinical features, leaving 40% to 60% of patients with an unclear etiology. Timely and accurate diagnosis is fundamental for initiating targeted and appropriate treatment. Sixty to eighty percent of patients with viral encephalitis initially seek medical attention at primary healthcare institutions. However, due to technical constraints, the diagnostic rate in these institutions is below 20%. Therefore, establishing a standardized diagnostic pathway based on etiology and implementing a tiered diagnostic strategy are particularly necessary. In situations where resources are limited at primary healthcare institutions, the preliminary diagnosis can be established by detailed inquiry into medical history, comprehensive physical examination, and basic laboratory tests. Based on the suspected etiology, routine molecular biology techniques such as polymerase chain reaction (PCR) can be employed for initial pathogen screening. In cases whose PCR results are negative or not feasible, non-targeted broad-coverage techniques like metagenomic next-generation sequencing (mNGS) should be considered. The establishment of a multidisciplinary team for diagnosis and treatment, along with the creation of clinical diagnostic and treatment networks, are essential to enhance the diagnostic rate and improve clinical outcomes. With advancements in diagnostic technologies and the application of artificial intelligence, the diagnosis of viral encephalitis is expected to become more precise.