Last reviewed: 5 Oct 2024
Last updated: 03 May 2024
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, 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
Richard T. Ellison III, MD
Professor of Medicine, Microbiology & Physiological Systems
UMass Chan Medical School
Worcester
MA
Disclosures
RE declares that he has no competing interests.
Differentials
- Streptococcus pneumoniae sepsis
- Staphylococcus aureus sepsis
- Streptococcus pyogenes sepsis
More DifferentialsGuidelines
- Advisory Committee on Immunization Practices adult immunization schedule: recommendations for ages 19 years or older, United States, 2024
- Advisory Committee on Immunization Practices child and adolescent immunization schedule: recommendations for ages 18 years or younger, United States, 2024
More GuidelinesPatient information
Meningitis and septicemia
MenB (meningococcal group B) vaccine
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