Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • rapid onset of illness
  • fever
  • irritability
  • high-pitched cry
  • leg pain
  • seizures
  • neck pain
  • headache
  • confusion
  • altered consciousness
  • hypotension
  • pallor or mottled skin
  • rash
  • cold hands and feet
  • neck stiffness
  • Kernig sign
  • Brudzinski sign
  • bulging fontanel
  • photophobia
  • hypotonia

Other diagnostic factors

  • lethargy
  • poor appetite or feeding
  • nausea or vomiting
  • thirst
  • coryza, sore throat, or cough
  • respiratory distress
  • tachycardia

Risk factors

  • young age
  • complement deficiency
  • asplenia or hyposplenia
  • residence in dormitory
  • globulin deficiency
  • close contact with invasive meningococcal infection
  • household crowding
  • recent move into a new community
  • travel to a hyperendemic or epidemic area
  • tobacco smoke exposure
  • respiratory infection
  • laboratory workers
  • visiting bars/clubs
  • kissing

Diagnostic investigations

1st investigations to order

  • blood cultures
  • CBC and differential
  • electrolytes, Ca, Mg, glucose
  • coagulation profile (prothrombin time, INR, activated PPT, fibrinogen, fibrin degradation products)
Full details

Investigations to consider

  • Cerebrospinal fluid (CSF) Gram stain
  • CSF cell count and differential
  • CSF glucose, protein
  • CSF culture
  • antigen detection in CSF
  • CXR
  • CT head
  • Gram stain of non-CSF body fluid
  • culture of non-CSF body fluid
  • immunohistochemical staining of skin lesion biopsy
  • echocardiography
  • joint x-ray
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Elisabeth Adderson

Associate Member

St. Jude Children's Research Hospital

Associate Professor of Pediatrics

University of Tennessee Health Sciences Center

Memphis

TN

Disclosures

EA declares that she has no competing interests.

Peer reviewers VIEW ALL

Chief

Meningitis and Vaccine Preventable Disease Branch

CDC

Atlanta

GA

Disclosures

NM declares that she has no competing interests.

Professor of Pediatrics

SMIMER Hospital

Gujarat

India

Disclosures

VD declares that she has no competing interests.

Director

Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo

Brazil

Disclosures

LOC declares that she has no competing interests.

Consultant in Infectious Diseases and Tropical Medicine

Hospital for Tropical Diseases

London

UK

Disclosures

KA declares that she has no competing interests.

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