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Meningococcal disease

最后审阅: 18 Aug 2025
最后更新: 11 Mar 2025

小结

定义

病史和体格检查

关键诊断因素

  • 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
完整详情

其他诊断因素

  • irritability
  • lethargy
  • muscle ache/joint pain
  • poor appetite or feeding
  • nausea or vomiting
  • thirst
  • coryza, sore throat, or cough
  • respiratory distress
  • tachycardia
完整详情

危险因素

  • 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
完整详情

诊断性检查

首要检查

  • blood cultures
  • CBC and differential
  • electrolytes, calcium, magnesium, phosphate, glucose
  • coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
完整详情

需考虑的检查

  • 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
完整详情

治疗流程

初步治疗

suspected meningitis

suspected meningococcal bacteremia

急症处理

confirmed meningococcal meningitis

confirmed meningococcal bacteremia

撰稿人

作者

Elisabeth Adderson, MD
Elisabeth Adderson

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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
    More Differentials
  • Guidelines

    • 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
    More Guidelines
  • Patient information

    Meningitis and septicemia

    MenB (meningococcal group B) vaccine

    More Patient information
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