Summary
Definition
History and exam
Key diagnostic factors
- headache
- nausea and vomiting
- photophobia
- neck stiffness
- fever
Other diagnostic factors
- rash
- Kernig sign
- Brudzinski sign
Risk factors
- infants and young children
- young adults
- older people
- summer and fall
- exposure to mosquito or tick vector
- unvaccinated for mumps
- use of swimming pools and ponds
- immunosuppression
- exposure to rodents
Diagnostic tests
1st tests to order
- CSF microscopy
- CSF Gram stain
- CSF bacterial culture
- CSF protein
- CSF glucose
- CSF PCR for enteroviruses
- CSF PCR for herpes viruses
- HIV serology/HIV reverse transcriptase (RT)-PCR
Tests to consider
- CT/MRI head
- EEG
- CSF viral culture
Emerging tests
- CSF C-reactive protein (CRP)
- serum and CSF procalcitonin
- CSF lactate
Treatment algorithm
possible bacterial meningitis
confirmed viral agent, other than HSV, varicella zoster, or CMV
HSV or varicella zoster confirmed causative agent
CMV confirmed causative agent
recurrent viral meningitis
Contributors
Expert advisers
John Williams, MRCP, DTM&H
Consultant
The James Cook University Hospital
Middlesbrough
UK
Disclosures
JW declares that he has no competing interests.
Acknowledgements
Dr John Williams would like to gratefully acknowledge Dr David Chadwick, a previous contributor to this topic.
Disclosures
DC is an author of a reference cited in this topic.
Peer reviewers
Karen Roos, MD
John and Nancy Nelson Professor of Neurology
Indiana University School of Medicine
Indianapolis
IN
Disclosures
KR declares that she has no competing interests.
Vassiliki Syriopoulou, MD
Professor of Pediatrics
University of Athens
Aghia Sophia Children's Hospital
Athens
Greece
Disclosures
VS declares that she has no competing interests.
References
Key articles
McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.Full text Abstract
Centers for Disease Control and Prevention. About viral meningitis. Jan 2024 [internet publication].Full text
Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5 [Epub ahead of print].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
- Meningitis, bacterial
- Encephalitis
- Encephalopathy (toxic/metabolic)
More DifferentialsGuidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
More GuidelinesPatient information
Meningitis and septicemia
Lumbar puncture
More Patient information
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