Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- headache
- photophobia
- neck stiffness
- fever
- nausea and vomiting
Other diagnostic factors
- rash
- Kernig's sign
- Brudzinski's sign
Risk factors
- infants and young children
- young adults
- older people
- summer and autumn
- exposure to mosquito or tick vector
- unvaccinated for mumps
- use of swimming pools and ponds
- immunosuppression
- exposure to rodents
Diagnostic investigations
1st investigations to order
- blood cultures
- FBC and differential
- C-reactive protein (CRP)
- serum procalcitonin
- serum urea, creatinine, and electrolytes
- blood gases
- blood glucose
- CSF microscopy
- CSF Gram stain
- CSF bacterial culture
- CSF protein
- CSF glucose
- CSF lactate
- CSF, stool and throat swab PCR for viral pathogens
- HIV serology/HIV reverse transcriptase (RT)-PCR
Investigations to consider
- CT/MRI head scan
Emerging tests
- CSF procalcitonin
Treatment algorithm
suspected meningitis, unknown aetiology
confirmed viral meningitis
recurrent viral meningitis
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.
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
- Bacterial meningitis (adults)
- Bacterial meningitis (children)
- Encephalitis
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
More GuidelinesPatient information
Lumbar puncture
More Patient information
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