Pediatric Guidance
Bacterial Meningitis

Bacterial Meningitis

Definition

Acute inflammation of the meninges, the membranes lining the brain and spinal cord

The cause can be infectious or non-infectious (e.g. associated with autoimmunity)

Diagnosis

Neonates:

  • Symptoms are usually non-specific; often a combination of fever, poor feeding, lethargy, drowsiness, vomiting, irritability, seizures or a full fontanelle
  • Neck stiffness is very uncommon

Older children:

  • Acute onset (<48 h) of:
    • Fever (>38.0°C) and/or
    • Headache and/or confusion and/or
    • Neck stiffness
  • Haemorrhagic rash may be present (especially in case of meningococcal infection)

Ideally before starting antibiotic treatment:

  • Microscopy and culture of cerebrospinal fluid (CSF)
  • Blood cultures
  • Note: testing should not delay giving antibiotics
  • Cerebrospinal fluid (CSF) examination (leukocyte count and differential leukocyte count, protein and glucose)

CSF findings suggestive of bacterial etiology:

  • High opening pressure (normal range, 80-200 mm H₂O or 8-20 cm H₂O)
  • Turbid aspect
  • Elevated white blood cell count (often several hundred to several thousand WBC/mm³)
  • Elevated % of neutrophils (>80%)
  • Elevated protein (>45 mg/dL or >0.45 g/L)
  • Low glucose (<40 mg/dL or <2.2 mmol/L)
  • CSF/Serum glucose ratio ≤0.4

Consider doing a head CT scan before doing the lumbar puncture in patients with focal neurological signs, decreased level of consciousness/coma or a history of central nervous system disease or recent seizures (<1 week)

Microbiology

Prevention

  • Vaccination against meningococcal, pneumococcal and Haemophilus influenzae type b disease
  • Post-exposure antibiotic prophylaxis with ciprofloxacin or ceftriaxone for close contacts (only for meningococcal meningitis)
  • https://www.who.int/health-topics/meningitis#tab=tab_3

Treatment

  • Important: due to the severity of this condition all suspected cases of meningitis should be treated as soon as possible as bacterial meningitis until this has been excluded/viral cause has been clearly identified
  • Empiric treatment is based on:
    • Age of the patient
    • Immune status of the patient
    • Local prevalence of Streptococcus pneumoniae isolates resistant to third-generation cephalosporins (rare but can occur especially in patients with prolonged or multiple exposures to β-lactam antibiotics in the previous three months)
  • If a pathogen is isolated and its susceptibilities are known, review and modify antibiotics accordingly

Additional Information

Please check regularly for updates