Summary
Definition
History and exam
Key diagnostic factors
- headache
- altered mental status
Other diagnostic factors
- fever
- diarrhea and abdominal pain
- generalized malaise
- flu-like symptoms in pregnancy
- poor feeding (neonates)
- meningismus
- cranial nerve deficits
- cerebellar signs
- focal neurologic signs
- seizures
- hypotension
- intrapartum fever
- bleeding diathesis with hemorrhage
- cardiac murmur
Risk factors
- exposure to contaminated food
- age >45-50 years
- pregnancy
- neonates
- immunocompromised states
- impaired stomach acidification
Diagnostic tests
1st tests to order
- CBC
- urine pregnancy test
- blood cultures
- brain MRI
- brain CT
- cerebrospinal fluid (CSF) analysis
Tests to consider
- prothrombin time (PT) and PTT
- D-dimer
- placenta and amniotic fluid culture
- cervical swab culture
- meconium Gram stain and culture
- Listeria serology
- food analysis
- stool culture
- polymerase chain reaction of blood
- other stool analyses
- electroencephalogram
- echocardiography
Emerging tests
- meningitis/encephalitis panel
Treatment algorithm
gastroenteritis
systemic infection: not gastroenteritis, not meningitis/meningoencephalitis
meningitis/meningoencephalitis
Contributors
Authors
Petros M. Karsaliakos, MD, FRCP, MSc
Honorary Clinical Senior Lecturer
Glasgow University
Consultant in General Medicine
Queen Elizabeth University Hospital
NHS GGC
Scotland
Disclosures
PMK declares that he has no competing interests.
Eleftherios Mylonakis, MD, PhD, FIDSA
Charles C.J. Carpenter Professor of Infectious Disease
Chief, Infectious Diseases Division
Rhode Island Hospital and The Miriam Hospital
Alpert Medical School of Brown University
Assistant Dean for Outpatient Investigations
Professor of Molecular Microbiology and Immunology
Brown University
Providence
RI
Disclosures
EM is an author of several references cited in this topic.
Peer reviewers
Josiah D. Rich, MD, MPH
Professor of Medicine and Community Health
Brown University
Providence
RI
Disclosures
JDR declares that he has no competing interests.
Alistair Leonord, MBChB, BSc, MRCPath, MD, DTM&H
Professor
Infection and Immunity
Consultant Microbiologist
Bacteriology Dept
Southern General Hospital
Glasgow
UK
Disclosures
AL declares that he has no competing interests.
Differentials
- Other bacterial meningitides
- Other brain abscesses
- Viral gastroenteritis
More DifferentialsGuidelines
- Listeria (Listeriosis)
- ACOG Committee Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes
More Guidelines
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