Last reviewed: June 2018
Last updated: October  2017



History and exam

Key diagnostic factors

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


Authors VIEW ALL

A. Marceline van Furth

Professor in Pediatric Infectious Diseases

Vrije Universiteit Medical Center


The Netherlands


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




GT declares that he has no competing interests.

Assistant Professor

Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine

The Johns Hopkins University




WZ declares that she has no competing interests.

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