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Meningococcal disease

Last reviewed: 2 Apr 2025
Last updated: 11 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • rapid onset of illness and rapid deterioration
  • fever
  • leg pain
  • seizures
  • neck pain and stiffness
  • paresis
  • headache
  • photophobia
  • altered mental status
  • altered consciousness
  • focal neurological deficit including cranial nerve involvement and abnormal pupils
  • hypotension
  • shock
  • toxic/moribund state
  • pallor or mottled skin
  • rash
  • cold hands and feet
  • hypotonia
  • high-pitched cry
  • Kernig sign
  • Brudzinski sign
  • bulging fontanel
Full details

Other diagnostic factors

  • irritability
  • lethargy
  • muscle ache/joint pain
  • poor appetite or feeding
  • nausea or vomiting
  • thirst
  • coryza, sore throat, or cough
  • respiratory distress
  • tachycardia
Full details

Risk factors

  • young age
  • complement deficiency
  • use of eculizumab and ravulizumab
  • immunoglobulin deficiency
  • HIV infection
  • asplenia or hyposplenia
  • college 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
Full details

Diagnostic tests

1st tests to order

  • blood cultures
  • CBC and differential
  • electrolytes, calcium, magnesium, phosphate, glucose
  • coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
Full details

Tests to consider

  • cerebrospinal fluid (CSF) Gram stain
  • CSF cell count and differential
  • CSF glucose, protein
  • CSF culture
  • antigen detection in CSF
  • chest x-ray
  • 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
  • polymerase chain reaction
Full details

Treatment algorithm

INITIAL

suspected meningitis

suspected meningococcal bacteremia

ACUTE

confirmed meningococcal meningitis

confirmed meningococcal bacteremia

Contributors

Authors

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

Professor of Medicine, Microbiology & Physiological Systems

UMass Chan Medical School

Worcester

MA

Disclosures

RE declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication].Full text

Mbaeyi SA, Bozio CH, Duffy J, et al; Centers for Disease Control and Prevention. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020 Sep 25;69(9):1-41.Full text  Abstract

van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Streptococcus pneumoniae sepsis
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  • Guidelines

    • Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management
    • Management of suspected and confirmed bacterial meningitis in Canadian children older than 2 months of age
    More Guidelines
  • Patient information

    Meningitis and septicemia

    MenB (meningococcal group B) vaccine

    More Patient information
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