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Meningitis

Last edited: 4/13/2026

Overview

Meningitis is inflammation of the meninges, the protective membranes covering the brain and spinal cord, often caused by bacterial, viral, or fungal infections, leading to severe neurological complications if untreated 47.

Diagnosis

  • Clinical Presentation: Fever, headache, neck stiffness, altered mental status 47.
  • Physical Examination: Kernig's and Brudzinski's signs 6.
  • Laboratory Tests: Cerebrospinal fluid (CSF) analysis showing pleocytosis, elevated protein, and decreased glucose 415.
  • Imaging: Lumbar puncture and neuroimaging (CT/MRI) if indicated for complications 28.
  • Diagnostic Criteria: Jolt accentuation test for headache sensitivity in emergency settings 4.

    • Management

  • Bacterial Meningitis:
    • - First-line Treatment: Intravenous antibiotics (e.g., ceftriaxone, vancomycin) tailored to suspected pathogens 7.
  • Viral Meningitis:
    • - Supportive Care: Symptomatic treatment, hydration, rest 4.
  • Adjunctive Therapies: Corticosteroids to reduce inflammation and improve outcomes in bacterial meningitis 7.

    • Special Populations

  • Pediatrics: Increased vigilance for delayed diagnosis and treatment, higher risk of complications 37.
  • Elderly: More likely to present with atypical symptoms, requiring thorough evaluation 7.
  • Comorbidities: Patients with immunodeficiencies or chronic diseases may require extended antibiotic courses 750.

    • Key Recommendations

  • Prompt Lumbar Puncture: Essential for accurate diagnosis and early initiation of appropriate treatment (Evidence: Strong 4).
  • Empirical Antibiotic Therapy: Initiate broad-spectrum antibiotics immediately in suspected bacterial meningitis until culture results are available (Evidence: Strong 7).
  • Corticosteroid Use: Consider corticosteroids in bacterial meningitis to reduce mortality and morbidity (Evidence: Moderate 7).
  • Vaccination: Administer meningococcal vaccines (MenACWY) to high-risk populations to prevent meningitis outbreaks (Evidence: Moderate 810).
  • Enhanced Surveillance and Reporting: Improve pharmacovigilance systems for adverse events following immunization to ensure vaccine safety (Evidence: Moderate 1013).

    • References

    1 Yota D, Massidi CE, Talisuna A, Tchikamgoua ON. Assessing the correlation between STAR health risk forecasts with actual health emergencies in West and Central Africa: a three-year analysis. Frontiers in public health 2025. link 2 Brotis AG, Churis I, Karvouniaris M. Local complications of adjunct intrathecal antibiotics for nosocomial meningitis associated with gram-negative pathogens: a meta-analysis. Neurosurgical review 2021. link 3 Weinstock MB, Jolliff H. High-Risk Medicolegal Conditions in Pediatric Emergency Medicine. Emergency medicine clinics of North America 2021. link 4 Iguchi M, Noguchi Y, Yamamoto S, Tanaka Y, Tsujimoto H. Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting. The Cochrane database of systematic reviews 2020. link 5 Shen H, Zhu C, Liu X, Ma D, Song C, Zhou L et al.. The etiology of acute meningitis and encephalitis syndromes in a sentinel pediatric hospital, Shenzhen, China. BMC infectious diseases 2019. link 6 Pietrzak K. Józef Brudziński (1874-1917). European neurology 2018. link 7 Tewabe T, Fenta A, Tegen A, Mezgebu M, Fentie T, Zeleke T. Clinical Outcomes and Risk Factors of Meningitis among Children in Referral Hospital, Ethiopia, 2016: A Retrospective Chart Review. Ethiopian journal of health sciences 2018. link 8 Griffiths M. Who should have the MenACWY vaccine?. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2016. link 9 . Meningitis: Know the Symptoms. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association 2016. link 10 Ateudjieu J, Stoll B, Nguefack-Tsague G, Yakum MN, Mengouo MN, Genton B. Incidence and types of adverse events during mass vaccination campaign with the meningococcal a conjugate vaccine (MENAFRIVAC™) in Cameroon. Pharmacoepidemiology and drug safety 2016. link 11 Diomandé FV, Yaméogo TM, Vannice KS, Preziosi MP, Viviani S, Ouandaogo CR et al.. Lessons Learned From Enhancing Vaccine Pharmacovigilance Activities During PsA-TT Introduction in African Countries, 2010-2013. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2015. link 12 Svider PF, Blake DM, Sahni KP, Folbe AJ, Liu JK, Baredes S et al.. Meningitis and legal liability: an otolaryngology perspective. American journal of otolaryngology 2014. link 13 Ateudjieu J, Stoll B, Nguefack-Tsague G, Tchangou C, Genton B. Vaccines safety; effect of supervision or SMS on reporting rates of adverse events following immunization (AEFI) with meningitis vaccine (MenAfriVac™): a randomized controlled trial. Vaccine 2014. link 14 Huy NT, Thao NT, Tuan NA, Khiem NT, Moore CC, Thi Ngoc Diep D et al.. Performance of thirteen clinical rules to distinguish bacterial and presumed viral meningitis in Vietnamese children. PloS one 2012. link 15 Perné A, Hainfellner JA, Womastek I, Haushofer A, Szekeres T, Schwarzinger I. Performance evaluation of the Sysmex XE-5000 hematology analyzer for white blood cell analysis in cerebrospinal fluid. Archives of pathology & laboratory medicine 2012. link 16 Ouandaogo CR, Yaméogo TM, Diomandé FV, Sawadogo C, Ouédraogo B, Ouédraogo-Traoré R et al.. Adverse events following immunization during mass vaccination campaigns at first introduction of a meningococcal A conjugate vaccine in Burkina Faso, 2010. Vaccine 2012. link 17 Appalaraju B, Parvathi S, Vijayalakshmi MA. Fatal fulminant Salmonella infantis meningitis with septicemia. The Journal of communicable diseases 2011. link 18 Wang SM, Ho TS, Shen CF, Wang JR, Liu CC. Echovirus 18 meningitis in southern Taiwan. The Pediatric infectious disease journal 2011. link 19 Allegro J, Papsin BC, Harrison RV, Campisi P. Acoustic analysis of voice in cochlear implant recipients with post-meningitic hearing loss. Cochlear implants international 2010. link 20 Kiefer AS, Gupta P, Kirmani S, Schwartz K, Henry N, Fischer PR. Treatment-resistant meningitis leading to the diagnosis of Currarino syndrome: a case report. The Pediatric infectious disease journal 2009. link 21 Fitch MT, Abrahamian FM, Moran GJ, Talan DA. Emergency department management of meningitis and encephalitis. Infectious disease clinics of North America 2008. link 22 Ewald AJ, McKeag DB. Meningitis in the athlete. Current sports medicine reports 2008. link 23 Fleury J, Picherot G, Cretolle C, Podevin G, David A, Caillon J et al.. Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis. Journal of perinatology : official journal of the California Perinatal Association 2007. link 24 Rubin L, Sprecher H, Kabaha A, Weber G, Teitler N, Rishpon S. Meningitis following spinal anesthesia: 6 cases in 5 years. Infection control and hospital epidemiology 2007. link 25 Ravishankar B, Mangala, Prakash GK, Shetty KJ, Ballal HS. Cerebral salt wasting syndrome in a patient with tuberculous meningitis. The Journal of the Association of Physicians of India 2006. link 26 Smallpage SJ. Meningitis: a new vaccine but parents still ignorant about the disease. The journal of family health care 2006. link 27 van Ramshorst GH, Lequin MH, Mancini GM, van de Ven CP. A case of split notochord syndrome: a child with a neuroenteric fistula presenting with meningitis. Journal of pediatric surgery 2006. link 28 Peterson MA, Abele J. Bedside ultrasound for difficult lumbar puncture. The Journal of emergency medicine 2005. link 29 Lynn W, Lightman S. Fever, headache, and visual blurring in a 17-year-old woman. PLoS medicine 2004. link 30 Wang VS, Tuch P, Wang CC. An unusual case of headache. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2003. link00159-0) 31 Koh TH, Ho S. Streptococcus bovis meningitis in a neonate with Ivemark syndrome. Scandinavian journal of infectious diseases 2002. link 32 Albayrak F, Memikoglu O, Kurt O, Cokca F, Birengel S, Tekeli E. A case of anthrax meningitis. Scandinavian journal of infectious diseases 2002. link 33 Pinn TG. Eosinophilic meningitis. An unusual cause of headache. Australian family physician 1999. link 34 Drummond DS, de Jong AL, Giannoni C, Sulek M, Friedman EM. Recurrent meningitis in the pediatric patient--the otolaryngologist's role. International journal of pediatric otorhinolaryngology 1999. link00022-1) 35 Frederiks JA, Koehler PJ. The first lumbar puncture. Journal of the history of the neurosciences 1997. link 36 Daya H, Amedofu G, Woodrow CJ, Agranoff D, Brobby G, Agbenyega T et al.. Assessment of cochlear damage after pneumococcal meningitis using otoacoustic emissions. Transactions of the Royal Society of Tropical Medicine and Hygiene 1997. link90063-8) 37 Jennings AL, Rothwell MP, Naysmith A. Epidural complications and a case of malignant meningitis. Palliative medicine 1997. link 38 Fernandes CM. Parenteral chlorpromazine and a meningitis headache. The Journal of emergency medicine 1995. link80024-7) 39 Martel N, Lee BC. Acquisition of heme iron by Neisseria meningitidis does not involve meningococcal transferrin-binding proteins. Infection and immunity 1994. link 40 Bennett MI, Tai YMA, Symonds JM. Staphylococcal meningitis following Synchromed intrathecal pump implant: a case report. Pain 1994. link90100-7) 41 Fairbanks VF, Folger WN. Cost containment, quality assurance, and physician microscopy of cerebrospinal fluid with normal cell counts. Analysis of 1,677 consecutive specimens. American journal of clinical pathology 1990. link 42 Corbetta LK, Danhauer JL, Prutting CA. A young meningitically deaf child with a cochlear implant: a case study. International journal of pediatric otorhinolaryngology 1990. link90332-l) 43 Waters K, Gillis J. Meningitis presenting as hypertension. Archives of disease in childhood 1987. link 44 Nadal D, Boltshauser E. Transient paraparesis following bacterial meningitis. Helvetica paediatrica acta 1987. link 45 Sozzi G, Marotta P, Piatti L. Vagoglossopharyngeal neuralgia with syncope in the course of carcinomatous meningitis. Italian journal of neurological sciences 1987. link 46 Dickie AS, Bremner DA, Wong PY, North JD, Robertson ID. Streptococcus suis bacteraemia. The New Zealand medical journal 1987. link 47 Shesser R. Headache caused by serious illness. Evaluation in an emergency setting. Postgraduate medicine 1987. link 48 Norris PG. Meningism following Salmonella virchow food poisoning. Postgraduate medical journal 1986. link 49 Lakhani M, Smith EA. Group B streptococcal meningitis in a diabetic adult. Postgraduate medical journal 1986. link 50 De Virgiliis S, Dessì S, Melis R, Cao A. Fatal Yersinia enterocolitica meningitis in thalassemia major. Bollettino dell'Istituto sieroterapico milanese 1984. link 51 Aärimaa T, Peltola H, Ruuskanen O. Pneumococcaemia complicated by meningitis. Archives of disease in childhood 1982. link 52 Jablokow VR, Kathuria S. Fatal meningitis due to Serratia marcescens after stapedectomy. Archives of otolaryngology (Chicago, Ill. : 1960) 1982. link 53 Swithinbank IM, Rake MO. A case of Mollaret's meningitis associated with a lymphoma. Postgraduate medical journal 1978. link 54 Mani RM, Kuruvila KC, Batliwala PM, Damle PN, Shirgaonkar GV, Soni RP et al.. Flavobacterium meningosepticum as an opportunist. Journal of clinical pathology 1978. link 55 Maller R, Frydén A, Nordström K, Anséhn S. Septicemia and meningitis caused by Fusobacterium aquatile. Scandinavian journal of infectious diseases 1978. link 56 Smith ER. An adult with haemophilus meningitis: case report. The New Zealand medical journal 1976. link 57 Pore RS, Chen J. Meningitis caused by Rhodotorula. Sabouraudia 1976. link

    Original source

    1. [1]
      Assessing the correlation between STAR health risk forecasts with actual health emergencies in West and Central Africa: a three-year analysis. — Yota D, Massidi CE, Talisuna A, Tchikamgoua ON Frontiers in public health (2025)
    2. [2]
      Local complications of adjunct intrathecal antibiotics for nosocomial meningitis associated with gram-negative pathogens: a meta-analysis. — Brotis AG, Churis I, Karvouniaris M Neurosurgical review (2021)
    3. [3]
      High-Risk Medicolegal Conditions in Pediatric Emergency Medicine. — Weinstock MB, Jolliff H Emergency medicine clinics of North America (2021)
    4. [4]
      Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting. — Iguchi M, Noguchi Y, Yamamoto S, Tanaka Y, Tsujimoto H The Cochrane database of systematic reviews (2020)
    5. [5]
      The etiology of acute meningitis and encephalitis syndromes in a sentinel pediatric hospital, Shenzhen, China. — Shen H, Zhu C, Liu X, Ma D, Song C, Zhou L et al. BMC infectious diseases (2019)
    6. [6]
      Józef Brudziński (1874-1917). — Pietrzak K European neurology (2018)
    7. [7]
      Clinical Outcomes and Risk Factors of Meningitis among Children in Referral Hospital, Ethiopia, 2016: A Retrospective Chart Review. — Tewabe T, Fenta A, Tegen A, Mezgebu M, Fentie T, Zeleke T Ethiopian journal of health sciences (2018)
    8. [8]
      Who should have the MenACWY vaccine? — Griffiths M Nursing standard (Royal College of Nursing (Great Britain) : 1987) (2016)
    9. [9]
      Meningitis: Know the Symptoms. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association (2016)
    10. [10]
      Incidence and types of adverse events during mass vaccination campaign with the meningococcal a conjugate vaccine (MENAFRIVAC™) in Cameroon. — Ateudjieu J, Stoll B, Nguefack-Tsague G, Yakum MN, Mengouo MN, Genton B Pharmacoepidemiology and drug safety (2016)
    11. [11]
      Lessons Learned From Enhancing Vaccine Pharmacovigilance Activities During PsA-TT Introduction in African Countries, 2010-2013. — Diomandé FV, Yaméogo TM, Vannice KS, Preziosi MP, Viviani S, Ouandaogo CR et al. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2015)
    12. [12]
      Meningitis and legal liability: an otolaryngology perspective. — Svider PF, Blake DM, Sahni KP, Folbe AJ, Liu JK, Baredes S et al. American journal of otolaryngology (2014)
    13. [13]
      Vaccines safety; effect of supervision or SMS on reporting rates of adverse events following immunization (AEFI) with meningitis vaccine (MenAfriVac™): a randomized controlled trial. — Ateudjieu J, Stoll B, Nguefack-Tsague G, Tchangou C, Genton B Vaccine (2014)
    14. [14]
      Performance of thirteen clinical rules to distinguish bacterial and presumed viral meningitis in Vietnamese children. — Huy NT, Thao NT, Tuan NA, Khiem NT, Moore CC, Thi Ngoc Diep D et al. PloS one (2012)
    15. [15]
      Performance evaluation of the Sysmex XE-5000 hematology analyzer for white blood cell analysis in cerebrospinal fluid. — Perné A, Hainfellner JA, Womastek I, Haushofer A, Szekeres T, Schwarzinger I Archives of pathology & laboratory medicine (2012)
    16. [16]
      Adverse events following immunization during mass vaccination campaigns at first introduction of a meningococcal A conjugate vaccine in Burkina Faso, 2010. — Ouandaogo CR, Yaméogo TM, Diomandé FV, Sawadogo C, Ouédraogo B, Ouédraogo-Traoré R et al. Vaccine (2012)
    17. [17]
      Fatal fulminant Salmonella infantis meningitis with septicemia. — Appalaraju B, Parvathi S, Vijayalakshmi MA The Journal of communicable diseases (2011)
    18. [18]
      Echovirus 18 meningitis in southern Taiwan. — Wang SM, Ho TS, Shen CF, Wang JR, Liu CC The Pediatric infectious disease journal (2011)
    19. [19]
      Acoustic analysis of voice in cochlear implant recipients with post-meningitic hearing loss. — Allegro J, Papsin BC, Harrison RV, Campisi P Cochlear implants international (2010)
    20. [20]
      Treatment-resistant meningitis leading to the diagnosis of Currarino syndrome: a case report. — Kiefer AS, Gupta P, Kirmani S, Schwartz K, Henry N, Fischer PR The Pediatric infectious disease journal (2009)
    21. [21]
      Emergency department management of meningitis and encephalitis. — Fitch MT, Abrahamian FM, Moran GJ, Talan DA Infectious disease clinics of North America (2008)
    22. [22]
      Meningitis in the athlete. — Ewald AJ, McKeag DB Current sports medicine reports (2008)
    23. [23]
      Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis. — Fleury J, Picherot G, Cretolle C, Podevin G, David A, Caillon J et al. Journal of perinatology : official journal of the California Perinatal Association (2007)
    24. [24]
      Meningitis following spinal anesthesia: 6 cases in 5 years. — Rubin L, Sprecher H, Kabaha A, Weber G, Teitler N, Rishpon S Infection control and hospital epidemiology (2007)
    25. [25]
      Cerebral salt wasting syndrome in a patient with tuberculous meningitis. — Ravishankar B, Mangala, Prakash GK, Shetty KJ, Ballal HS The Journal of the Association of Physicians of India (2006)
    26. [26]
      Meningitis: a new vaccine but parents still ignorant about the disease. — Smallpage SJ The journal of family health care (2006)
    27. [27]
      A case of split notochord syndrome: a child with a neuroenteric fistula presenting with meningitis. — van Ramshorst GH, Lequin MH, Mancini GM, van de Ven CP Journal of pediatric surgery (2006)
    28. [28]
      Bedside ultrasound for difficult lumbar puncture. — Peterson MA, Abele J The Journal of emergency medicine (2005)
    29. [29]
      Fever, headache, and visual blurring in a 17-year-old woman. — Lynn W, Lightman S PLoS medicine (2004)
    30. [30]
      An unusual case of headache. — Wang VS, Tuch P, Wang CC Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (2003)
    31. [31]
      Streptococcus bovis meningitis in a neonate with Ivemark syndrome. — Koh TH, Ho S Scandinavian journal of infectious diseases (2002)
    32. [32]
      A case of anthrax meningitis. — Albayrak F, Memikoglu O, Kurt O, Cokca F, Birengel S, Tekeli E Scandinavian journal of infectious diseases (2002)
    33. [33]
      Eosinophilic meningitis. An unusual cause of headache. — Pinn TG Australian family physician (1999)
    34. [34]
      Recurrent meningitis in the pediatric patient--the otolaryngologist's role. — Drummond DS, de Jong AL, Giannoni C, Sulek M, Friedman EM International journal of pediatric otorhinolaryngology (1999)
    35. [35]
      The first lumbar puncture. — Frederiks JA, Koehler PJ Journal of the history of the neurosciences (1997)
    36. [36]
      Assessment of cochlear damage after pneumococcal meningitis using otoacoustic emissions. — Daya H, Amedofu G, Woodrow CJ, Agranoff D, Brobby G, Agbenyega T et al. Transactions of the Royal Society of Tropical Medicine and Hygiene (1997)
    37. [37]
      Epidural complications and a case of malignant meningitis. — Jennings AL, Rothwell MP, Naysmith A Palliative medicine (1997)
    38. [38]
      Parenteral chlorpromazine and a meningitis headache. — Fernandes CM The Journal of emergency medicine (1995)
    39. [39]
      Acquisition of heme iron by Neisseria meningitidis does not involve meningococcal transferrin-binding proteins. — Martel N, Lee BC Infection and immunity (1994)
    40. [40]
      Staphylococcal meningitis following Synchromed intrathecal pump implant: a case report. — Bennett MI, Tai YMA, Symonds JM Pain (1994)
    41. [41]
      Cost containment, quality assurance, and physician microscopy of cerebrospinal fluid with normal cell counts. Analysis of 1,677 consecutive specimens. — Fairbanks VF, Folger WN American journal of clinical pathology (1990)
    42. [42]
      A young meningitically deaf child with a cochlear implant: a case study. — Corbetta LK, Danhauer JL, Prutting CA International journal of pediatric otorhinolaryngology (1990)
    43. [43]
      Meningitis presenting as hypertension. — Waters K, Gillis J Archives of disease in childhood (1987)
    44. [44]
      Transient paraparesis following bacterial meningitis. — Nadal D, Boltshauser E Helvetica paediatrica acta (1987)
    45. [45]
      Vagoglossopharyngeal neuralgia with syncope in the course of carcinomatous meningitis. — Sozzi G, Marotta P, Piatti L Italian journal of neurological sciences (1987)
    46. [46]
      Streptococcus suis bacteraemia. — Dickie AS, Bremner DA, Wong PY, North JD, Robertson ID The New Zealand medical journal (1987)
    47. [47]
      Headache caused by serious illness. Evaluation in an emergency setting. — Shesser R Postgraduate medicine (1987)
    48. [48]
      Meningism following Salmonella virchow food poisoning. — Norris PG Postgraduate medical journal (1986)
    49. [49]
      Group B streptococcal meningitis in a diabetic adult. — Lakhani M, Smith EA Postgraduate medical journal (1986)
    50. [50]
      Fatal Yersinia enterocolitica meningitis in thalassemia major. — De Virgiliis S, Dessì S, Melis R, Cao A Bollettino dell'Istituto sieroterapico milanese (1984)
    51. [51]
      Pneumococcaemia complicated by meningitis. — Aärimaa T, Peltola H, Ruuskanen O Archives of disease in childhood (1982)
    52. [52]
      Fatal meningitis due to Serratia marcescens after stapedectomy. — Jablokow VR, Kathuria S Archives of otolaryngology (Chicago, Ill. : 1960) (1982)
    53. [53]
      A case of Mollaret's meningitis associated with a lymphoma. — Swithinbank IM, Rake MO Postgraduate medical journal (1978)
    54. [54]
      Flavobacterium meningosepticum as an opportunist. — Mani RM, Kuruvila KC, Batliwala PM, Damle PN, Shirgaonkar GV, Soni RP et al. Journal of clinical pathology (1978)
    55. [55]
      Septicemia and meningitis caused by Fusobacterium aquatile. — Maller R, Frydén A, Nordström K, Anséhn S Scandinavian journal of infectious diseases (1978)
    56. [56]
      An adult with haemophilus meningitis: case report. — Smith ER The New Zealand medical journal (1976)
    57. [57]
      Meningitis caused by Rhodotorula. — Pore RS, Chen J Sabouraudia (1976)
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