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Last reviewed: 21 Jul 2025
Last updated: 22 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • cefaleia
  • rigidez de nuca
  • febre
  • estado mental alterado
  • confusão
  • fotofobia
  • vômitos
  • convulsões
  • hipotermia (lactentes)
  • irritabilidade (lactentes)
  • letargia (lactentes)
  • baixa aceitação alimentar (lactentes)
  • apneia (lactentes)
  • deficit neurológico focal
  • movimento ocular anormal
  • paralisia facial
  • problemas de equilíbrio/deficiência auditiva
  • fontanela abaulada em lactentes

Other diagnostic factors

  • choro em tom agudo (lactentes)
  • erupção cutânea
  • papiledema
  • sinal de Kernig
  • sinal de Brudzinski

Risk factors

  • ≤5 ou ≥65 anos de idade
  • aglomerações
  • exposição a patógenos
  • lactentes não imunizados
  • imunodeficiência
  • câncer
  • estado de asplenia/hiposplênico
  • defeitos anatômicos cranianos
  • implantes cocleares
  • infecção contígua
  • tabagismo

Diagnostic tests

1st tests to order

  • contagem celular do líquido cefalorraquidiano (LCR) e diferencial
  • proteína do líquido cefalorraquidiano (LCR)
  • glicose do líquido cefalorraquidiano (LCR)
  • coloração de Gram do líquido cefalorraquidiano (LCR)
  • cultura do líquido cefalorraquidiano (LCR)
  • detecção de antígeno no líquido cefalorraquidiano (LCR)
  • hemocultura
  • hemograma completo e diferencial
  • proteína C-reativa
  • eletrólitos, cálcio (Ca), magnésio (Mg), glicose
  • perfil de coagulação (tempo de protrombina, razão normalizada internacional [INR], tempo de tromboplastina parcial [TTP] ativada, fibrinogênio, produtos de degradação da fibrina)
  • tomografia computadorizada (TC) do crânio
  • reação em cadeia da polimerase

Tests to consider

  • ressonância nuclear magnética (RNM) de crânio
  • Doppler transcraniano
  • procalcitonina sérica

Emerging tests

  • proteína ligante de heparina (PLH)
  • testes rápidos de antígeno no líquido cefalorraquidiano (LCR)
  • sequenciamento metagenômico de nova geração (mNGS)

Treatment algorithm

Contributors

Authors

Rodrigo Hasbun, MD, MPH

Professor of Medicine

UT Health Mc Govern Medical School

Houston

TX

Disclosures

RH has received research support and personal fees from Biomeriaux. RH is an author of references cited in this topic.

Omaima El Tahir, MD

PhD Candidate

Department of Pediatric infectious Diseases and Immunology, AI&II

Amsterdam UMC, Vrije Universiteit Amsterdam

Amsterdam

The Netherlands

Disclosures

OET declares that she has no competing interests.

Acknowledgements

Dr Rodrigo Hasbun and Omaima El Tahir would like to gratefully acknowledge Dr Marceline Tutu van Furth, previous contributor to this topic.

Disclosures

AMTvF declares that she has no competing interests.

Peer reviewers

Catherine Derber, MD

Professor

Department of Medicine

Eastern Virginia Medical School

Norfolk

VA

Disclosures

CD declares that she has no competing interests.

Guy Thwaites, MA, MBBS, PhD, MRCP, FRCPath

Wellcome Trust Clinical Research Fellow

Centre for Molecular Microbiology and Infection

Imperial College London

London

UK

Disclosures

GT declares that he has no competing interests.

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

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

Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. Abstract

Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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