Last reviewed: 20 Feb 2023
Last updated: 06 Oct 2022
Summary
Definition
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
INITIAL
suspected meningitis
suspected meningococcal bacteremia
ACUTE
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
Richard T. Ellison III, MD
Professor of Medicine, Microbiology & Physiological Systems
UMass Chan Medical School
Worcester
MA
Disclosures
RE declares that he has no competing interests.
Differentials
- Streptococcus pneumoniae sepsis
- Staphylococcus aureus sepsis
- Streptococcus pyogenes sepsis
More DifferentialsGuidelines
- Advisory Committee on Immunization Practices child and adolescent immunization schedule: recommendations for ages 18 years or younger, United States, 2022
- Canadian immunization guide
More GuidelinesPatient leaflets
Meningitis and septicemia
MenB (meningococcal group B) vaccine
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