Resumo
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- cefaleia
- fotofobia
- rigidez de nuca
- febre
- náuseas e vômitos
Other diagnostic factors
- erupção cutânea
- sinal de Kernig
- sinal de Brudzinski
Risk factors
- lactentes e crianças pequenas
- adultos jovens
- idosos
- verão e outono
- exposição a vetores mosquito ou carrapato
- não vacinado contra caxumba
- uso de piscinas e lagoas
- imunossupressão
- exposição a roedores
Diagnostic tests
1st tests to order
- hemoculturas
- hemograma completo e diferencial
- proteína C-reativa
- procalcitonina sérica
- ureia sérica, creatinina e eletrólitos
- gasometria
- glicose sanguínea
- microscopia do LCR
- coloração de Gram do líquido cefalorraquidiano (LCR)
- cultura bacteriana do LCR
- nível de proteína no LCR
- glicose no LCR
- lactato no LCR
- PCR de LCR, fezes e swab de garganta para patógenos virais
- sorologia para vírus da imunodeficiência humana (HIV)/transcriptase reversa do HIV (RT)-PCR
Tests to consider
- tomografia computadorizada (TC)/ressonância nuclear magnética (RNM) do crânio
Emerging tests
- Procalcitonina no LCR
Treatment algorithm
suspeita de meningite, etiologia desconhecida
Meningite viral confirmada
meningite viral recorrente
Contributors
Expert advisers
John Williams, MRCP, DTM&H
Infectious Diseases Consultant
The James Cook University Hospital
Middlesbrough
UK
Disclosures
JW declares that he has no competing interests.
Acknowledgements
Dr John Williams would like to gratefully acknowledge Dr David Chadwick, a previous contributor to this topic.
Disclosures
DC is an author of a reference cited in this topic.
Peer reviewers
Alex Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Consultant in Emergency Medicine
Royal London Hospital
Consultant, Physician Response Unit
Barts Health NHS Trust/London Air Ambulance
London
UK
Disclosures
AA declares that he has no competing interests.
Fiona McGill, MRCP, DTMH, DipHIVMed
Clinical Lecturer
Institute of Infection and Global Health
University of Liverpool
Liverpool
UK
Disclosures
FM is on the Meningitis Research Foundation’s Medical Advisory Group, has lectured on national and international events on meningitis and has developed a review for ‘clinical medicine’ on viral meningitis and encephalitis.
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
McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.Full text Abstract
McGill F, Griffiths MJ, Bonnett LJ, et al. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infect Dis. 2018 Sep;18(9):992-1003.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
- Meningite bacteriana (adultos)
- Meningite bacteriana (crianças)
- Encefalite
More DifferentialsGuidelines
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
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