Last reviewed: 23 Aug 2023
Last updated: 16 Nov 2022
Summary
Definition
History and exam
Key diagnostic factors
- headache
- nausea and vomiting
- photophobia
- neck stiffness
- fever
More key diagnostic factors
Other diagnostic factors
- rash
- Kernig sign
- Brudzinski sign
Other diagnostic factors
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
More risk factors
Diagnostic investigations
1st investigations 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
More 1st investigations to order
Investigations to consider
- CT/MRI head
- EEG
- CSF viral culture
More investigations to consider
Emerging tests
- CSF C-reactive protein (CRP)
- serum and CSF procalcitonin
- CSF lactate
Treatment algorithm
INITIAL
possible bacterial meningitis
ACUTE
confirmed viral agent, other than HSV, varicella zoster, or CMV
HSV or varicella zoster confirmed causative agent
CMV confirmed causative agent
ONGOING
recurrent viral meningitis
Contributors
Authors
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. 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.
Differentials
- Meningitis, bacterial
- Encephalitis
- Encephalopathy (toxic/metabolic)
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 leaflets
Meningitis and septicemia
Lumbar puncture
More Patient leaflets
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