Summary
Definition
History and exam
Key diagnostic factors
- fever
- vomiting/nausea
- irritable/unsettled
- headache
- altered mental state
- neck stiffness
- photophobia
- seizures
- focal neurological deficit including cranial nerve involvement and abnormal pupils
- rash
- shock
- raised intracranial pressure
- back rigidity
- bulging fontanelle
- Kernig’s sign
- Brudzinksi’s sign
- apnoea
- rapid deterioration
- hypotension
- cold peripheries
- toxic/moribund state
- paresis
- presence of risk factors
Other diagnostic factors
- unusual skin colour
- lethargy
- ill appearance
- refusing food/drink
- muscle ache/joint pain
- respiratory distress or breathing difficulty
- chills/shivering
- diarrhoea, abdominal pain/distension
- sore throat/coryza or other ear, nose, and throat symptoms/signs
Risk factors
- young age
- complement deficiency
- use of eculizumab and ravulizumab
- immunoglobulin deficiency
- HIV infection
- asplenia or hyposplenia
- university attendance
- close contact with invasive meningococcal infection
- household crowding
- travel to a hyperendemic or epidemic area
- laboratory workers
- tobacco smoke exposure
- recent move into a new community
- respiratory infection
- visiting bars/clubs
- kissing
Diagnostic investigations
1st investigations to order
- blood gases (including lactate)
- glucose
- full blood count
- procalcitonin (or CRP)
- coagulation profile
- blood cultures
- PCR for Neisseria meningitidis
- urea, electrolytes and creatinine, serum calcium, ionised magnesium (Mg2+), ionised phosphate (PO4-)
- liver function tests
- cross-match (children)
- CFS PCR for Neisseria meningitidis and Streptococcus pneumoniae
- PCR for Streptococcus pneumoniae (adults)
- CSF white blood cell count and examination
- CSF total protein concentration
- CSF glucose concentration
- CSF microscopy, Gram stain, culture and sensitivities
- CSF lactate (adults)
- throat swab for culture
Investigations to consider
- cranial CT
- complement deficiency (children)
- serum HIV (adults)
Treatment algorithm
suspected bacterial meningitis: presenting in hospital
suspected meningococcal sepsis: presenting in hospital
suspected meningococcal disease (meningitis or sepsis): presenting in the community
confirmed or probable bacterial meningitis (including meningococcal meningitis)
confirmed or probable meningococcal disease
Contributors
Expert advisers
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Flight Doctor
Greater Sydney Area
Helicopter Emergency Medical Service
New South Wales
Australia
Disclosures
AA declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Elisabeth Adderson, MD
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
Robert Taylor, MBChB, MRCP(UK), MRCP(London), DipMedTox, DipTher PGDME, FHEA FRCEM
Acute Hospital Sub Dean (Cornwall)
Honorary Clinical Senior Lecturer
Consultant Emergency Physician
The Knowledge Spa
Royal Cornwall Hospital
Truro
UK
Disclosures
RT declares that he has no competing interests.
Brian Angus, BSc, MBChB, DTM&H, FRCP, MD, FFTM
Consultant in Infectious Diseases
Clinical Tutor in Medicine and Associate Professor and Reader in Infectious Diseases
University of Oxford
Director
Oxford Centre for Clinical Tropical Medicine and Global Health
Oxford
UK
Disclosures
BA declares that he has no competing interests.
Editors
Susan Mayor
Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Streptococcus pneumoniae sepsis
- Staphylococcus aureus sepsis
- Streptococcus pyogenes sepsis
More DifferentialsGuidelines
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
- Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management
More GuidelinesCalculators
Glasgow Coma Scale
More CalculatorsVideos
Diagnostic lumbar puncture in adults: animated demonstration
More videosPatient information
Meningitis and septicaemia
MenB (meningococcal group B) vaccine
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer