Last reviewed: 26 Aug 2021
Last updated: 21 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • headache
  • neck stiffness
  • fever
  • altered mental status
  • confusion
  • photophobia
  • vomiting
  • seizures
  • hypothermia (infants)
  • irritability (infants)
  • lethargy (infants)
  • poor feeding (infants)
  • apnea (infants)
  • focal neurologic deficit
  • abnormal eye movement
  • facial palsy
  • balance problems/hearing impairment
  • bulging fontanel in infants

Other diagnostic factors

  • high-pitched cry (infants)
  • rash
  • papilledema
  • Kernig sign
  • Brudzinski sign

Risk factors

  • age ≤5 or ≥65 years
  • crowding
  • exposure to pathogens
  • nonimmunized infants
  • immunodeficiency
  • cancer
  • asplenia/hyposplenic state
  • cranial anatomic defects
  • cochlear implants
  • contiguous infection
  • smoking

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
  • CBC and differential
  • CRP
  • electrolytes, calcium (Ca), magnesium (Mg), glucose
  • coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
  • CT head
  • polymerase chain reaction (PCR)

Treatment algorithm

Contributors

Authors

A. Marceline Tutu van Furth, MD, PhD, MBA
A. Marceline Tutu van Furth

Professor in Pediatric Infectious Diseases

Department of Pediatric infectious Diseases and Immunology, AI&II

Amsterdam UMC, Vrije Universiteit Amsterdam

Amsterdam

The Netherlands

Disclosures

AMTvF declares that she has no competing interests.

Omaima El Tahir, MD

PhD Candidate

Department of Pediatric infectious Diseases and Immunology, AI&II

Amsterdam UMC, Vrije Universiteit Amsterdam

Amsterdam

The Netherlands

Disclosures

OET declares that she has no competing interests.

Peer reviewers

Guy Thwaites, MA, MBBS, PhD, MRCP, FRCPath

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.

Wendy Ziai, MD, MPH

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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