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
- use of eculizumab and ravulizumab
- immunoglobulin deficiency
- asplenia or hyposplenia
- college attendance
- close contact with invasive meningococcal infection
- household crowding
- recent move into a new community
- travel to a hyperendemic or epidemic area
- laboratory workers
- tobacco smoke exposure
- respiratory infection
- 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 PTT, 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
- chest x-ray
- 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
- polymerase chain reaction
Treatment algorithm
suspected meningitis
suspected meningococcal bacteremia
confirmed meningococcal meningitis
confirmed meningococcal bacteremia
Contributors
Authors
Elisabeth Adderson, MD

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
Nancy Messonnier, MD, PhD
Chief
Meningitis and Vaccine Preventable Disease Branch
CDC
Atlanta
GA
Disclosures
NM declares that she has no competing interests.
Vandana Desai, MD
Professor of Pediatrics
SMIMER Hospital
Gujarat
India
Disclosures
VD declares that she has no competing interests.
Lucieni Oliveira Conterno, MD, PhD
Director
Clinical Epidemiology Unit
Marilia Medical School
Sao Paulo
Brazil
Disclosures
LOC declares that she has no competing interests.
Katherine Ajdukiewicz, MRCP
Consultant in Infectious Diseases and Tropical Medicine
Hospital for Tropical Diseases
London
UK
Disclosures
KA declares that she has no competing interests.
Differentials
- Streptococcus pneumoniae sepsis
- Staphylococcus aureus sepsis
- Streptococcus pyogenes sepsis
More DifferentialsGuidelines
- Advisory Committee on Immunization Practices recommended adult immunization schedule for ages 19 years or older, United States, 2021
- Advisory Committee on Immunization Practices recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2021
More GuidelinesPatient leaflets
Meningitis and septicemia
MenB (meningococcal group B) vaccine
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer