Last reviewed: November 2017
Last updated: May  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • headache
  • neck stiffness
  • fever
  • altered mental status
  • confusion
  • focal neurological deficit
  • abnormal eye movement
  • bulging fontanelle in infants
  • photophobia
  • vomiting
  • seizures
  • hypothermia (infants)
  • irritability (infants)
  • lethargy (infants)
  • poor feeding (infants)
  • apnoea (infants)

Other diagnostic factors

  • high-pitched cry (infants)
  • rash
  • papilloedema
  • Kernig's sign
  • Brudzinski's sign

Risk factors

  • ≤5 years of age
  • ≥60 years of age
  • male gender
  • low socio-economic status
  • crowding
  • exposure to pathogens
  • non-immunised infants
  • immunosuppression
  • asplenia
  • contiguous infection
  • cranial anatomical defects
  • cochlear implants
  • sickle cell disease

Diagnostic investigations

1st investigations to order

  • CSF cell count and differential
  • CSF protein
  • CSF glucose
  • CSF Gram stain
  • CSF culture
  • antigen detection in CSF
  • blood culture
  • CT head
Full details

Emerging tests

  • CRP
  • serum procalcitonin
  • PCR
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

A. Marceline van Furth

Professor in Pediatric Infectious Diseases

Vrije Universiteit Medical Center

Amsterdam

The Netherlands

Disclosures

AMvF declares that she has no competing interests.

Peer reviewers VIEW ALL

Wellcome Trust Clinical Research Fellow

Centre for Molecular Microbiology and Infection

Imperial College London

London

UK

Disclosures

GT declares that he has no competing interests.

Assistant Professor

Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine

The Johns Hopkins University

Baltimore

MD

Disclosures

WZ declares that she has no competing interests.

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