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Meningococcal disease

Last reviewed: 30 Oct 2023
Last updated: 18 Jul 2023



History and exam

Key diagnostic factors

  • rapid onset of illness and rapid deterioration
  • fever
  • leg pain
  • seizures
  • neck pain and stiffness
  • back rigidity
  • paresis
  • headache
  • photophobia
  • altered mental status
  • altered consciousness
  • focal neurological deficit including cranial nerve involvement and abnormal pupils
  • hypotension
  • shock
  • toxic/moribund state
  • pallor or mottled skin
  • rash
  • cold hands and feet
  • hypotonia
  • high-pitched cry
  • Kernig sign
  • Brudzinski sign
  • bulging fontanel
More key diagnostic factors

Other diagnostic factors

  • irritability
  • lethargy
  • muscle ache/joint pain
  • 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.

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  • Patient leaflets

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