Meningococcal disease

Last reviewed: 20 Feb 2023
Last updated: 06 Oct 2022



History and exam

Key diagnostic factors

  • rapid onset of illness
  • fever
  • irritability
  • leg pain
  • seizures
  • neck pain
  • headache
  • altered mental status
  • 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
More key diagnostic factors

Other diagnostic factors

  • lethargy
  • poor appetite or feeding
  • nausea or vomiting
  • thirst
  • coryza, sore throat, or cough
  • respiratory distress
  • tachycardia
Other diagnostic factors

Risk factors

  • young age
  • complement deficiency
  • use of eculizumab and ravulizumab
  • immunoglobulin deficiency
  • HIV infection
  • asplenia or hyposplenia
  • college attendance
  • close contact with invasive meningococcal infection
  • household crowding
  • travel to a hyperendemic or epidemic area
  • laboratory workers
  • tobacco smoke exposure
  • recent move into a new community
  • respiratory infection
  • visiting bars/clubs
  • kissing
More risk factors

Diagnostic investigations

1st investigations to order

  • blood cultures
  • CBC and differential
  • electrolytes, calcium, magnesium, phosphate, glucose
  • coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
More 1st investigations to order

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
More investigations to consider

Treatment algorithm


suspected meningitis

suspected meningococcal bacteremia


confirmed meningococcal meningitis

confirmed meningococcal bacteremia



Elisabeth Adderson, MD
Elisabeth Adderson

Associate Member

St. Jude Children's Research Hospital

Associate Professor of Pediatrics

University of Tennessee Health Sciences Center




EA declares that she has no competing interests.

Peer reviewers

Richard T. Ellison III, MD

Professor of Medicine, Microbiology & Physiological Systems

UMass Chan Medical School




RE declares that he has no competing interests.

  • Differentials

    • Streptococcus pneumoniae sepsis
    • Staphylococcus aureus sepsis
    • Streptococcus pyogenes sepsis
    More Differentials
  • Guidelines

    • Advisory Committee on Immunization Practices child and adolescent immunization schedule: recommendations for ages 18 years or younger, United States, 2022
    • Canadian immunization guide
    More Guidelines
  • Patient leaflets

    Meningitis and septicemia

    MenB (meningococcal group B) vaccine

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer