Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- cefaleia
- náuseas e vômitos
- fotofobia
- rigidez de nuca
- febre
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
- microscopia do LCR
- coloração de Gram do líquido cefalorraquidiano (LCR)
- cultura bacteriana do LCR
- nível de proteína no LCR
- glicose no LCR
- Reação em cadeia da polimerase para enterovírus no LCR
- Reação em cadeia da polimerase do LCR para herpesvírus
- 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
- eletroencefalograma (EEG)
- cultura viral do LCR
Emerging tests
- proteína C-reativa do LCR
- procalcitonina sérica e do LCR
- lactato no LCR
Treatment algorithm
possível meningite bacteriana
agente viral confirmado diferente do vírus do herpes simples (HSV), varicela-zóster ou citomegalovírus (CMV)
vírus do herpes simples (HSV) ou varicela-zóster confirmados como agentes causadores
citomegalovírus (CMV) confirmado como agente causador
meningite viral recorrente
Contributors
Authors
John Williams, MRCP, DTM&H
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. DC is an author of a reference cited in this topic.
Peer reviewers
Karen Roos, MD
John and Nancy Nelson Professor of Neurology
Indiana University School of Medicine
Indianapolis
IN
Disclosures
KR declares that she has no competing interests.
Vassiliki Syriopoulou, MD
Professor of Pediatrics
University of Athens
Aghia Sophia Children's Hospital
Athens
Greece
Disclosures
VS declares that she 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
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
Centers for Disease Control and Prevention. Viral meningitis. May 2021 [internet publication].Full text
Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.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
- Bacteriana, meningite
- Encefalite
- Encefalopatia (tóxica/metabólica)
More DifferentialsGuidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
More GuidelinesPatient information
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