Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- headache
- photophobia
- neck stiffness
- fever
- nausea and vomiting
Other diagnostic factors
- rash
- Kernig's sign
- Brudzinski's sign
Risk factors
- infants and young children
- young adults
- older people
- summer and autumn
- exposure to mosquito or tick vector
- unvaccinated for mumps
- use of swimming pools and ponds
- immunosuppression
- exposure to rodents
Diagnostic investigations
1st investigations to order
- blood cultures
- FBC and differential
- C-reactive protein (CRP)
- serum procalcitonin
- serum urea, creatinine, and electrolytes
- blood gases
- blood glucose
- CSF microscopy
- CSF Gram stain
- CSF bacterial culture
- CSF protein
- CSF glucose
- CSF lactate
- CSF, stool and throat swab PCR for viral pathogens
- HIV serology/HIV reverse transcriptase (RT)-PCR
Investigations to consider
- CT/MRI head scan
Emerging tests
- CSF procalcitonin
Treatment algorithm
suspected meningitis, unknown aetiology
confirmed viral meningitis
recurrent viral meningitis
Contributors
Expert advisers
John Williams, MRCP, DTM&H
Infectious Diseases 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
Alex Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Consultant in Emergency Medicine
Royal London Hospital
Consultant, Physician Response Unit
Barts Health NHS Trust/London Air Ambulance
London
UK
Disclosures
AA declares that he has no competing interests.
Fiona McGill, MRCP, DTMH, DipHIVMed
Clinical Lecturer
Institute of Infection and Global Health
University of Liverpool
Liverpool
UK
Disclosures
FM is on the Meningitis Research Foundation’s Medical Advisory Group, has lectured on national and international events on meningitis and has developed a review for ‘clinical medicine’ on viral meningitis and encephalitis.
Editors
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Differentials
- Bacterial meningitis (adults)
- Bacterial meningitis (children)
- Encephalitis
More DifferentialsGuidelines
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
More GuidelinesPatient information
Lumbar puncture
More Patient information
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