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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BUN: blood urea nitrogen; CBC: complete blood count; CNS: central nervous system; CRP: C-reactive protein; CSF: cerebrospinal fluid; CT: computed tomography; INR: international normalized ratio; IV: intravenous; LP: lumbar puncture; PT: prothrombin time; PTT: partial thromboplastin time; STAT: intervention should be performed emergently.
* The optimal use of dexamethasone in children with suspected meningitis is uncertain, 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 children with suspected community-acquired bacterial meningitis. In addition, it may be reasonable to use dexamethasone in older adolescent patients since dexamethasone is a recommended component of therapy for adult patients 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.Do you want to add Medilib to your home screen?