Clinical findings |
Infants – Fever, hypothermia, bulging fontanel, lethargy, irritability, seizures, respiratory distress, poor feeding, vomiting. |
Older children – Fever, headache, photophobia, meningismus, nausea/vomiting, confusion, lethargy, irritability. |
Evaluation |
Laboratory testing – Initial laboratory testing should include (STAT):
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Lumbar puncture (LP):
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Neuroimaging (eg, head CT):
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Management |
Supportive care:
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Antimicrobial therapy – Antibiotic therapy should be initiated immediately following the LP if the clinical suspicion for meningitis is high:
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STAT: intervention should be performed emergently; CBC: complete blood count; CRP: C-reactive protein; BUN: blood urea nitrogen; PT: prothrombin time; INR: international normalized ratio; PTT: partial thromboplastin time; LP: lumbar puncture; CT: computed tomography; CSF: cerebrospinal fluid; CNS: central nervous system; IV: intravenous.
* The use of dexamethasone in children with suspected meningitis is controversial, and expert opinions varies. UpToDate's author would administer dexamethasone only to children who are known or highly suspected to have H. influenzae (Hib) at the time the LP is performed (a fairly uncommon scenario). Other experts would administer dexamethasone to all young children (age ≥6 weeks to ≤5 years old) with community-acquired meningitis and to children with sickle cell disease or asplenia with suspected bacterial meningitis. The 2021 Red Book statement on dexamethasone use in pneumococcal meningitis also acknowledges that expert opinion differs on this issue. Evidence supporting the efficacy of dexamethasone in reducing the risk of hearing loss in children with meningitis is most clearly established for infections caused by Hib. For other bacterial pathogens (eg, pneumococcus, meningococcus), the efficacy of dexamethasone is uncertain. For further details, refer to UpToDate topics on bacterial meningitis in children and the use of dexamethasone and other measures to prevent neurologic complications of pediatric bacterial meningitis.