Summary
Definition
History and exam
Key diagnostic factors
- rapid onset of illness and rapid deterioration
- fever
- leg pain
- seizures
- neck pain and stiffness
- 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
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
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
Diagnostic tests
1st tests to order
- blood cultures
- CBC and differential
- electrolytes, calcium, magnesium, phosphate, glucose
- coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
Tests 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
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication].Full text
Mbaeyi SA, Bozio CH, Duffy J, et al; Centers for Disease Control and Prevention. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020 Sep 25;69(9):1-41.Full text Abstract
van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Streptococcus pneumoniae sepsis
- Staphylococcus aureus sepsis
- Streptococcus pyogenes sepsis
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- Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management
- Management of suspected and confirmed bacterial meningitis in Canadian children older than 2 months of age
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Meningitis and septicemia
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