Last reviewed: September 2018
Last updated: September  2018

Summary

Definition

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
  • facial palsy
  • balance problems/hearing impairment
  • bulging fontanelle in infants

Other diagnostic factors

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

Risk factors

  • ≤5 or ≥65 years of age
  • crowding
  • exposure to pathogens
  • non-immunised infants
  • immunodeficiency
  • cancer
  • asplenia/hyposplenic state
  • contiguous infection
  • cranial anatomical defects
  • cochlear implants

Diagnostic investigations

1st investigations to order

  • cerebrospinal fluid (CSF) cell count and differential
  • CSF protein
  • CSF glucose
  • CSF Gram stain
  • CSF culture
  • antigen detection in CSF
  • blood culture
  • FBC and differential
  • CRP
  • electrolytes, calcium (Ca), magnesium (Mg), glucose
  • coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
  • CT head
  • PCR
Full details

Investigations to consider

  • MRI head
  • serum procalcitonin
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

A. Marceline Tutu van Furth

Professor in Pediatric Infectious Diseases

Vrije Universiteit Medical Center

Amsterdam

The Netherlands

Disclosures

AMTvF declares that she has no competing interests.

PhD Candidate

Pediatric Infectious Diseases and Immunogenetics

Vrije Universiteit Medical Center

Amsterdam

The Netherlands

Disclosures

OET 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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