Summary
Definition
History and exam
Key diagnostic factors
- rapid onset of illness
- fever
- irritability
- leg pain
- seizures
- neck pain
- headache
- confusion
- altered consciousness
- hypotension
- pallor or mottled skin
- rash
- cold hands and feet
- neck stiffness
- photophobia
- hypotonia
- high-pitched cry
- Kernig sign
- Brudzinski sign
- bulging fontanel
Other diagnostic factors
- lethargy
- poor appetite or feeding
- nausea or vomiting
- thirst
- coryza, sore throat, or cough
- respiratory distress
- tachycardia
Risk factors
- young age
- complement deficiency
- asplenia or hyposplenia
- residence in dormitory
- globulin deficiency
- close contact with invasive meningococcal infection
- household crowding
- recent move into a new community
- travel to a hyperendemic or epidemic area
- tobacco smoke exposure
- respiratory infection
- laboratory workers
- visiting bars/clubs
- kissing
Diagnostic investigations
1st investigations to order
- blood cultures
- CBC and differential
- electrolytes, Ca, Mg, glucose
- coagulation profile (prothrombin time, INR, activated PPT, fibrinogen, fibrin degradation products)
Investigations to consider
- Cerebrospinal fluid (CSF) Gram stain
- CSF cell count and differential
- CSF glucose, protein
- CSF culture
- antigen detection in CSF
- CXR
- 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
Treatment algorithm
Contributors
Authors VIEW ALL
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 VIEW ALL
Chief
Meningitis and Vaccine Preventable Disease Branch
CDC
Atlanta
GA
Disclosures
NM declares that she has no competing interests.
Professor of Pediatrics
SMIMER Hospital
Gujarat
India
Disclosures
VD declares that she has no competing interests.
Director
Clinical Epidemiology Unit
Marilia Medical School
Sao Paulo
Brazil
Disclosures
LOC declares that she has no competing interests.
Consultant in Infectious Diseases and Tropical Medicine
Hospital for Tropical Diseases
London
UK
Disclosures
KA declares that she has no competing interests.
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