Last updated: October 31, 2023

Summarytoggle arrow icon

Meningitis is an infection of the meninges in the brain or spinal cord. Common causes include viruses and bacteria, although fungal, parasitic, and noninfectious causes of meningitis are possible. The most common bacterial pathogens (N. meningitidis, S. pneumoniae, H. influenzae, Group B streptococcus, and L. monocytogenes) vary depending on age and underlying medical conditions. Enteroviruses and herpes simplex virus (HSV) are the leading causes of viral meningitis. The classic triad of meningitis (fever, meningismus, altered mental state) occurs in less than half of adult patients and meningitis in infants and children frequently presents with nonspecific symptoms. Advanced infection includes signs of increased intracranial pressure (ICP), neurological deficits, altered mental status, and seizures. Diagnosis is confirmed with CSF analysis and microbiological studies (e.g., PCR, culture). If increased ICP is suspected, a CT of the head is recommended prior to lumbar puncture (LP). Antibiotic therapy should not be delayed for diagnostic testing. Bacterial meningitis requires rapid initiation of empiric antimicrobials and sometimes glucocorticoids to prevent complications, which include neurological deficits (e.g., hearing loss) and end-organ damage (e.g., Waterhouse-Friderichsen syndrome in patients with meningococcal meningitis). While most cases of viral meningitis are self-limiting, herpesvirus infections (e.g., HSV, VZV) must be promptly recognized and treated with IV acyclovir to prevent serious complications and death. Prevention is through vaccination against common causes of meningitis, and chemoprophylaxis for exposed contacts.

Epidemiologytoggle arrow icon

  • In the pediatric population, meningitis most often occurs in children < 1 year of age. [1]
  • The median age for meningitis in the adult population is 43 years. [2]
  • Sub-Saharan Africa has the worldwide highest incidence of meningitis caused by N. meningitidis. [3]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Common causes

Risk factors

Most common causative agents of bacterial meningitis by age group and underlying condition [4][5]

Patient population Pathogen
By age
< 1 month [1][6][7]
1 month–2 years [2][6] [9]
2–50 years [2][11]
> 50 years [2][12]
By underlying condition
Immunocompromise [13]
Basilar skull fracture [12]
Penetrating trauma [12]
Health care-associated [14]

Less common bacterial pathogens

Other etiologies

Causes of meningitis in immunocompromised individuals

Pathophysiologytoggle arrow icon

Pathways of infection

  • Most pathogens that cause meningitis colonize the nasopharynx or the upper airways before entering the CNS via:
    • Hematogenous dissemination [22]
    • Contiguous spread of infections in nose, eyes, and ears
    • Retrograde transport along or within peripheral or cranial nerves
  • Direct infection (e.g., due to trauma or head surgery) [23]

Incubation periods

  • Bacterial meningitis: usually 3–7 days [24]
  • Viral meningitis: usually 2–14 days, depending on the type of virus


Clinical featurestoggle arrow icon

Clinical features of bacterial and viral meningitis are similar, although viral meningitis is less acute and usually self-limiting within 5–14 days. [26]

Symptoms of meningitis [4][6]

Pathogen-specific symptoms

Less than half of adult patients have all three features of the classic triad of meningitis; the percentage is even lower in neonates and young infants, who typically present with nonspecific symptoms[4]

Subarachnoid hemorrhage manifests with the classic triad of meningitis, but it typically has a more sudden onset and affected individuals often lose consciousness.

Physical examination [29][30]

Features suggestive of meningoencephalitis [33][34]

In addition to the features of meningitis, meningoencephalitis is characterized by signs of inflammation of the brain parenchyma (encephalitis).

Initial managementtoggle arrow icon

General approach

Do not delay empiric antibiotic therapy in patients suspected of having bacterial meningitis.


  • Diagnosis
  • Treatment
    • Bacterial meningitis can be rapidly progressive and life-threatening.
    • Patients may present as critically ill and with complications (e.g., sepsis, multiorgan failure) requiring early aggressive supportive care.
    • Empiric antibiotic treatment must be initiated as soon as possible (i.e., often prior to diagnosis).

Diagnosticstoggle arrow icon

Approach [5][27][28][35][36]

Start empiric antibiotics immediately after obtaining blood cultures and CSF samples. If LP is delayed for any reason (e.g., the need for a CT or hemodynamic stabilization), obtain blood cultures and administer antibiotics until it can be performed.

Laboratory studies [5][27][28][35]

Neuroimaging [23][35][36]

Imaging is not necessary to establish the diagnosis of meningitis in most patients and should only be considered in patients with significant risk factors for complications.

To remember the indications for imaging before LP, think of LP FAILS: Focal neurological deficits, Altered mental status, Immunocompromised or ICP, Lesions (space-occupying lesions in the brain), Seizures.

Cerebrospinal fluid analysis

Lumbar puncture is indicated in all patients with suspected meningitis (see “Lumbar puncture” for details on indications, LP contraindications, procedural steps, and complications).

Interpretation of CSF analysis

Routine testing [35][36][37]

Cerebrospinal fluid analysis in meningitis [35][37]
Normal Bacterial meningitis Viral meningitis
  • Clear fluid
  • Clear fluid
Cell count and differential
  • Cell count < 5/mm3
Opening pressure [39]
  • 5–18 cm H2O
  • ↑↑
  • Normal or ↑
Lactate [36]
  • 1.2–2.1 mmol/L
  • ↑↑
  • Variable
  • 15–45 mg/dL
  • Normal or ↑
  • 40–75 mg/dL
  • Normal
Gram stain and culture [36][37]
  • No organisms present
  • No organisms present

Atypical pathogen testing

Atypical pathogen testing is not necessary for all patients and should be performed as directed by clinical suspicion.

Cerebrospinal fluid analysis in meningitis due to atypical pathogens [37]
Tuberculous meningitis [40] Lyme meningitis [41] Cryptococcal meningitis [42]
  • Clear fluid with a spiderweb clot
  • Clear fluid
  • Cloudy fluid
Cell count and differential
Opening pressure
  • ↑↑
  • ↑↑
  • ↑↑
Lactate [36]
  • Variable
  • Normal or ↑ [41]
  • [42]
  • Normal or ↓
  • [42]

Additional microbiological testing

Treatmenttoggle arrow icon


Do not delay administering antibiotics if neuroimaging is indicated prior to LP. Obtain blood cultures, start antibiotics (and steroids, if needed) immediately, then proceed with the CT and LP.

Immediate stabilization for meningitis

Antimicrobial therapy

Empiric antibiotic therapy [35]

  • The choice of initial empiric therapy depends primarily on the prevalence of organisms in certain age groups and individual patient risk factors for resistant organisms.
  • Factors to consider:
    • Epidemiological factors (e.g., local flora, resistance patterns)
    • Bioavailability: Antimicrobial agents should cross the blood-brain barrier and higher doses may be needed.
    • Individual patient risk factors and comorbidities
Empiric antibiotic therapy for bacterial meningitis [35]
Patient characteristics Recommended regimen
Age <18 years
Age 18–50 years
Age > 50 years



Healthcare-associated infections [23]

Suspected rickettsial (e.g., RMSF) or ehrlichial infection [44]

Basilar skull fracture
Penetrating head trauma

Ampicillin is added if patients are at risk of Listeria spp. infection (e.g., newborns, pregnant women, adults > 50 years of age, or immunocompromised patients) because cephalosporins are ineffective against Listeria spp.

Empiric therapy for viral meningitis [44][45]

Most cases of viral meningitis (e.g., caused by enteroviruses) can be treated supportively. Specific antiviral therapy is only warranted if viral encephalitis is also suspected (see HSV encephalitis for further details).

Treatment with acyclovir should be started in all patients who present with typical clinical signs of viral meningoencephalitis and only discontinued after PCR and antibody tests are negative for HSV and VZV, even if CSF is initially normal.

Pathogen-specific therapy

The decision to narrow therapy should be guided by final culture and sensitivity results, as well as local resistance patterns. We list a few examples of antimicrobial agents that may be used against specific pathogens.

Pathogen-specific therapy in meningitis [9][35]
Pathogen Examples of antimicrobial agents

S. pneumoniae (penicillin-resistant strains)
S. epidermidis
H. influenzae
N. meningitidis
E. coli
L. monocytogenes
S. agalactiae
Enterococcus spp.
P. aeruginosa
R. rickettsii
Herpes viruses
Less frequent pathogens, e.g., M. tuberculosis, C. neoformans, B. burgdorferi
  • See “Subtypes and variants.”

Corticosteroids [36][50]

Do not delay antibiotics to administer adjuvant therapy. If dexamethasone is not readily available, start antibiotics immediately.

Supportive therapy

Monitoring and disposition

  • Most patients with meningitis require admission; select patients may be considered for outpatient therapy with close follow-up. [35]
  • Serial neuro examinations
  • Consultations:
    • Infectious disease
    • Consider also ICU , neurology, neurosurgery as needed.

Acute management checklisttoggle arrow icon

Subtypes and variantstoggle arrow icon

Tuberculous meningitis

Cryptococcal meningitis

Tick-borne diseases

North America

Eurasia: Tick-borne meningoencephalitis

  • Pathogen: tick-borne encephalitis virus (TBEV)
    • TBEVs are part of the Flaviviridae family and occur predominantly in parts of Europe, Russia, and Asia.
    • TBEV is very closely related to the Powassan virus in the US and Russia, which is a rare cause of encephalitis.
  • Route of infection: tick-borne
    • Ixodid tick acts as a vector; therefore, transmission is predominantly in June/July and September/October.
    • Occasional transmission via unpasteurized dairy products from infected livestock
  • Incubation period: usually 7–14 days
  • Clinical features:
    • Nearly 90% of cases are asymptomatic.
    • Biphasic course: initial flu-like symptoms and fever, followed (after ∼ 8 days) by a fever-free interval and subsequent increase in temperature, which is associated with the onset of meningoencephalitis
  • Treatment: symptomatic
  • Prognosis:
    • Full recovery is common (particularly in children and adolescents).
    • In symptomatic disease, residual symptoms may occur.
  • Prevention: A vaccine is not available in the US.

Primary amebic meningoencephalitis [57]


Complicationstoggle arrow icon


Waterhouse-Friderichsen syndrome


We list the most important complications. The selection is not exhaustive.

Prognosistoggle arrow icon

  • Bacterial meningitis
    • Fatal if left untreated
    • Prognosis in treated patients depends on age, overall condition, immune status and the pathogen(s) involved.
  • Viral meningitis
  • Fungal meningitis


Preventiontoggle arrow icon

Primary prevention [70]

Meningococcal vaccine [9][71]

Individuals for whom both the meningococcal ACWY and meningococcal B vaccine are indicated at the same visit can be offered the pentavalent meningococcal vaccine. [72]

Prevention of onward transmission

Meningococcal disease is a nationally notifiable disease; other etiologies of meningitis may also be reportable depending on local state law. [74]

Postexposure chemoprophylaxis [75]

Administer chemoprophylaxis as soon as possible, preferably within 24 hours of symptom onset in the index patient. [9]

Postexposure chemoprophylaxis for bacterial meningitis [9][75]
Pathogen Indications Recommended regimens [9]
N. meningitidis [9][76][77]
  • All close contacts within 7 days of symptom onset, i.e.:
    • Household members
    • Individuals exposed in a childcare setting
    • Individuals directly exposed to respiratory secretions
    • Passengers on long flights
H. influenzae [9] [79]
  • Close contacts
  • All household contacts if anyone in the household meets any of the following criteria:
  • Childcare facility members (all children and possibly caregivers) if:
    • ≥ 2 cases occur within 60 days
    • AND any child is not up to date on age-recommended Hib vaccine

Special patient groupstoggle arrow icon

Meningitis in infants and children [6][7][9]

Etiology [6][9][80]

Rates of bacterial meningitis in infants and children are declining due to a combination of vaccination against Hib and Streptococcus pneumoniae and prenatal GBS screening and prophylaxis. [70]

Clinical features [6][80][81]

Diagnostics for meningitis in children [80]

Treatment for meningitis in children [80][84]

Empiric antibiotic therapy

Avoid ceftriaxone in neonates because of the risk of kernicterus; use cefotaxime or ceftazidime when possible. [9]

Pathogen-specific management

Glucocorticoids are not recommended in neonates with meningitis because of a paucity of high-quality evidence to support benefits. [9][88]


  • Repeat LP in neonates with gram-negative or HSV meningitis. [4][9][35]
  • Monitor BMP to help adjust IV fluids and antimicrobial dosages, and to assess for the development of SIADH. [70]

Ongoing management [4][9][35]

  • Obtain an audiology evaluation prior to discharge from the hospital. [4][70]
  • In children with residual neurological defects, refer to appropriate services. [70]
  • The primary medical provider should monitor closely for:

Referencestoggle arrow icon

  1. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases. 2004; 39 (9): p.1267-1284.doi: 10.1086/425368 . | Open in Read by QxMD
  2. Mount HR, Boyle SD. Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention.. Am Fam Physician. 2017; 96 (5): p.314-322.
  3. Bamberger. Diagnosis, Initial Management, and Prevention of Meningitis. American Family Physician. 2010.
  4. Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial Meningitis in Infants. Clin Perinatol. 2015; 42 (1): p.29-45.doi: 10.1016/j.clp.2014.10.004 . | Open in Read by QxMD
  5. Blaney SM, Giardino AP, Orange JS, et al. Rudolph's Pediatrics, 23rd Edition. McGraw-Hill Education / Medical ; 2018
  6. Pantell RH, Roberts KB, Adams WG, et al. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021; 148 (2).doi: 10.1542/peds.2021-052228 . | Open in Read by QxMD
  7. Ouchenir L, Renaud C, Khan S, et al. The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics. 2017; 140 (1).doi: 10.1542/peds.2017-0476 . | Open in Read by QxMD
  8. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial Meningitis in the United States, 1998–2007. N Engl J Med. 2011; 364 (21): p.2016-2025.doi: 10.1056/nejmoa1005384 . | Open in Read by QxMD
  9. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021
  10. Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV. Bacterial Meningitis in the United States, 1986: Report of a Multistate Surveillance Study. J Infect Dis. 1990; 162 (6): p.1316-1323.doi: 10.1093/infdis/162.6.1316 . | Open in Read by QxMD
  11. Castelblanco RL, Lee M, Hasbun R. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study. Lancet Infect Dis. 2014; 14 (9): p.813-819.doi: 10.1016/s1473-3099(14)70805-9 . | Open in Read by QxMD
  12. Bamberger DM. Diagnosis, initial management, and prevention of meningitis.. Am Fam Physician. 2010; 82 (12): p.1491-8.
  13. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis. Clin Microbiol Rev. 2010; 23 (3): p.467-492.doi: 10.1128/cmr.00070-09 . | Open in Read by QxMD
  14. Srihawan C, Castelblanco RL, Salazar L, et al. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis. Open Forum Infectious Diseases. 2016; 3 (2): p.ofw077.doi: 10.1093/ofid/ofw077 . | Open in Read by QxMD
  15. Hasbun R, Rosenthal N, Balada-Llasat JM, et al. Epidemiology of Meningitis and Encephalitis in the United States, 2011–2014. Clinical Infectious Diseases. 2017; 65 (3): p.359-363.doi: 10.1093/cid/cix319 . | Open in Read by QxMD
  16. Miskin DP, Koralnik IJ. Novel syndromes associated with JC virus infection of neurons and meningeal cells. Curr Opin Neurol. 2015; 28 (3): p.288-294.doi: 10.1097/wco.0000000000000201 . | Open in Read by QxMD
  17. Pires SAP, Lemos AP, Pereira EPMN, Maia PA da SV, Agro JP de S e AB do. IBUPROFEN-INDUCED ASEPTIC MENINGITIS: A CASE REPORT. Revista Paulista de Pediatria. 2019; 37 (3): p.382-385.doi: 10.1590/1984-0462/;2019;37;3;00016 . | Open in Read by QxMD
  18. Overturf GD. Indications for the Immunological Evaluation of Patients with Meningitis. Clinical Infectious Diseases. 2003; 36 (2): p.189-194.doi: 10.1086/345527 . | Open in Read by QxMD
  19. Chadwick DR. Viral meningitis. Br Med Bull. 2005; 75-76 (1): p.1-14.doi: 10.1093/bmb/ldh057 . | Open in Read by QxMD
  20. Charalambous LT, Premji A, Tybout C, et al. Prevalence, healthcare resource utilization and overall burden of fungal meningitis in the United States. J Med Microbiol. 2018; 67 (2): p.215-227.doi: 10.1099/jmm.0.000656 . | Open in Read by QxMD
  21. Baliu C, Sanclemente G, Cardona M, et al. Toxoplasmic encephalitis associated with meningitis in a heart transplant recipient. Transplant Infectious Disease. 2014; 16 (4): p.631-633.doi: 10.1111/tid.12242 . | Open in Read by QxMD
  22. Kohil A, Jemmieh S, Smatti MK, Yassine HM. Viral meningitis: an overview. Arch Virol. 2021; 166 (2): p.335-345.doi: 10.1007/s00705-020-04891-1 . | Open in Read by QxMD
  23. Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis. N Engl J Med. 2004; 351 (18): p.1849-1859.doi: 10.1056/nejmoa040845 . | Open in Read by QxMD
  24. Weisfelt M, Van De Beek D, Spanjaard L, Reitsma JB, De Gans J. Community-Acquired Bacterial Meningitis in Older People. J Am Geriatr Soc. 2006; 54 (10): p.1500-1507.doi: 10.1111/j.1532-5415.2006.00878.x . | Open in Read by QxMD
  25. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015
  26. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education ; 2015
  27. Tunkel AR. Clinical features and diagnosis of acute bacterial meningitis in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: August 17, 2016. Accessed: March 28, 2017.
  28. Tsai J, Nagel MA, Gilden D. Skin rash in meningitis and meningoencephalitis. Neurology. 2013; 80 (19): p.1808-1811.doi: 10.1212/wnl.0b013e3182918cda . | Open in Read by QxMD
  29. Daroff RB, et al.. Bradley's Neurology in Clinical Practice. Elsevier
  30. Silva MTT. Viral encephalitis. Arq Neuropsiquiatr. 2013; 71 (9B): p.703-709.doi: 10.1590/0004-282x20130155 . | Open in Read by QxMD
  31. Novak RT, Ronveaux O, Bita AF, et al. Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa. J Infect Dis. 2019; 220 (Supplement_4): p.S279-S285.doi: 10.1093/infdis/jiz421 . | Open in Read by QxMD
  32. Van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clinical Microbiology and Infection. 2016; 22: p.S37-S62.doi: 10.1016/j.cmi.2016.01.007 . | Open in Read by QxMD
  33. Tunkel et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017; 64 (6): p.e34-e65.doi: 10.1093/cid/ciw861 . | Open in Read by QxMD
  34. Seehusen, et al. Cerebrospinal Fluid Analysis. American Family Physician. 2003.
  35. Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRX. 2005; 2 (2): p.324-332.doi: 10.1602/neurorx.2.2.324 . | Open in Read by QxMD
  36. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical ; 2018
  37. Thwaites G. Neurological aspects of tropical disease: Tuberculous meningitis. Journal of Neurology, Neurosurgery & Psychiatry. 2000; 68 (3): p.289-299.doi: 10.1136/jnnp.68.3.289 . | Open in Read by QxMD
  38. Krawczuk K, Czupryna P, Pancewicz S, Ołdak E, Król M, Moniuszko-Malinowska A. Comparison of Neuroborreliosis Between Children and Adults. Pediatr Infect Dis J. 2020; 39 (1): p.7-11.doi: 10.1097/inf.0000000000002493 . | Open in Read by QxMD
  39. Bahr NC, Boulware DR. Methods of rapid diagnosis for the etiology of meningitis in adults. Biomarkers in Medicine. 2014; 8 (9): p.1085-1103.doi: 10.2217/bmm.14.67 . | Open in Read by QxMD
  40. Van de Beek D, Brouwer MC, Thwaites GE, Tunkel AR. Advances in treatment of bacterial meningitis. Lancet. 2012; 380 (9854): p.1693-1702.doi: 10.1016/s0140-6736(12)61186-6 . | Open in Read by QxMD
  41. Tunkel AR, Glaser CA, Bloch KC, et al. The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2008; 47 (3): p.303-327.doi: 10.1086/589747 . | Open in Read by QxMD
  42. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  43. Kim KS. Neonatal Bacterial Meningitis. NeoReviews. 2015; 16 (9): p.e535-e543.doi: 10.1542/neo.16-9-e535 . | Open in Read by QxMD
  44. Alamarat Z, Hasbun R. Management of Acute Bacterial Meningitis in Children. Infect Drug Resist. 2020; Volume 13: p.4077-4089.doi: 10.2147/idr.s240162 . | Open in Read by QxMD
  45. Tan JS, File T, Salata RA. Expert Guide to Infectious Diseases. ACP Press ; 2008
  46. McCollough M. RMSF and Serious Tick-Borne Illnesses (Lyme, Ehrlichiosis, Babesiosis and Tick Paralysis). Springer International Publishing ; 2018: p. 215-240
  47. De Gans J, van de Beek D. Dexamethasone in Adults with Bacterial Meningitis. N Engl J Med. 2002; 347 (20): p.1549-1556.doi: 10.1056/nejmoa021334 . | Open in Read by QxMD
  48. Sexton DJ. Neurologic complications of bacterial meningitis in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: September 1, 2015. Accessed: March 28, 2017.
  49. Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Dermatology. Springer Science & Business Media ; 2012
  50. Scheld WM, Whitley RJ, Marra CM. Infections of the Central Nervous System. Wolters Kluwer ; 2014
  51. Jong EC, Stevens DL. Netter's Infectious Diseases E-Book. Elsevier Health Sciences ; 2011
  52. Scheld WM, Whitley RJ, Marra CM. Infections of the Central Nervous System. Lippincott Williams & Wilkins ; 2004
  53. Swanson D. Meningitis. Pediatr Rev. 2015; 36 (12): p.514-526.doi: 10.1542/pir.36.12.514 . | Open in Read by QxMD
  54. Child and Adolescent Immunization Schedule. Recommendations for Ages 18 Years or Younger, United States, 2022. Updated: February 17, 2022. Accessed: August 9, 2022.
  55. CDC committee OKs recommendations for pentavalent meningococcal, mpox vaccines. . Accessed: October 27, 2023.
  56. Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007; 35 (10): p.S65-S164.doi: 10.1016/j.ajic.2007.10.007 . | Open in Read by QxMD
  57. CDC Clinical Info: Meningococcal Disease. . Accessed: October 19, 2023.
  58. Meningococcal disease. Updated: November 12, 2021. Accessed: September 15, 2022.
  59. $Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease.
  60. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP).. MMWR: Recommendations and reports. 2013; 62 (RR-2): p.1-28.
  61. Patel K, Goldman JL. Safety Concerns Surrounding Quinolone Use in Children.. J Clin Pharmacol. 2016; 56 (9): p.1060-75.doi: 10.1002/jcph.715 . | Open in Read by QxMD
  62. Saag MS et al. The Sanford Guide to Antimicrobial Therapy 2016. Antimicrobial Therapy, Inc ; 2016
  63. American Academy of Pediatrics. Textbook of Pediatric Care. American Academy of Pediatrics ; 2016
  64. Ershad M, Mostafa A, Dela Cruz M, Vearrier D. Neonatal Sepsis. Curr Emerg Hosp Med Rep. 2019; 7 (3): p.83-90.doi: 10.1007/s40138-019-00188-z . | Open in Read by QxMD
  65. Gupta N, Grover H, Bansal I, et al. Neonatal cranial sonography: ultrasound findings in neonatal meningitis—a pictorial review. Quant Imaging Med Surg. 2017; 7 (1): p.123-131.doi: 10.21037/qims.2017.02.01 . | Open in Read by QxMD
  66. Nabower AM, Miller S, Biewen B, et al. Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management. Hosp Pediatr. 2019; 9 (10): p.763-769.doi: 10.1542/hpeds.2019-0064 . | Open in Read by QxMD
  67. Young SM, Saguil A. Bacterial Meningitis in Children.. Am Fam Physician. 2022; 105 (3): p.311-312.
  68. Garges HP, Moody MA, Cotten CM, et al. Neonatal Meningitis: What Is the Correlation Among Cerebrospinal Fluid Cultures, Blood Cultures, and Cerebrospinal Fluid Parameters?. Pediatrics. 2006; 117 (4): p.1094-1100.doi: 10.1542/peds.2005-1132 . | Open in Read by QxMD
  69. Nigrovic LE. Clinical Prediction Rule for Identifying Children With Cerebrospinal Fluid Pleocytosis at Very Low Risk of Bacterial Meningitis. JAMA. 2007; 297 (1): p.52.doi: 10.1001/jama.297.1.52 . | Open in Read by QxMD
  70. Mintegi S, García S, Martín MJ, et al. Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis. Pediatrics. 2020; 146 (3).doi: 10.1542/peds.2020-1126 . | Open in Read by QxMD
  71. Ogunlesi TA, Odigwe CC, Oladapo OT. Adjuvant corticosteroids for reducing death in neonatal bacterial meningitis. Cochrane Database Syst Rev. 2015; 2015 (11).doi: 10.1002/14651858.cd010435.pub2 . | Open in Read by QxMD
  72. Sharma et al.. Incidence, predictors and prognostic value of cranial nerve involvement in patients with tuberculous meningitis: A retrospective evaluation. European Journal of Internal Medicine. 2011.
  73. Cho B-H, Kim BC, Yoon G-J, et al. Adenosine deaminase activity in cerebrospinal fluid and serum for the diagnosis of tuberculous meningitis. Clin Neurol Neurosurg. 2013; 115 (9): p.1831-1836.doi: 10.1016/j.clineuro.2013.05.017 . | Open in Read by QxMD
  74. Ekermans P, Dusé A, George J. The dubious value of cerebrospinal fluid adenosine deaminase measurement for the diagnosis of tuberculous meningitis. BMC Infect Dis. 2017; 17 (1).doi: 10.1186/s12879-017-2221-3 . | Open in Read by QxMD
  75. Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care.;jsessionid=8C1829AA433952F2B1308E3FFCBA7734?sequence=1. Updated: June 1, 2017. Accessed: May 25, 2021.
  76. Abassi M, Boulware DR, Rhein J. Cryptococcal Meningitis: Diagnosis and Management Update.. Current tropical medicine reports. 2015; 2 (2): p.90-99.doi: 10.1007/s40475-015-0046-y . | Open in Read by QxMD
  77. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Updated: August 18, 2020. Accessed: December 18, 2020.
  78. Grace E et al.. Naegleria fowleri: Pathogenesis, Diagnosis, and Treatment Options. Antimicrobial Agents Chemother (Bethesda). 2015; 59 (11): p.6677-6681.doi: 10.1128/aac.01293-15 . | Open in Read by QxMD
  79. CDC — Primary Amebic Meningoencephalitis (PAM) — Treatment. Updated: April 4, 2019. Accessed: July 21, 2020.
  80. Cherian A, Thomas SV. Central nervous system tuberculosis. Afr Health Sci. 2011; 11 (1): p.116-127.
  81. Cox GM, Perfect JR. Epidemiology, clinical manifestations, and diagnosis of Cryptococcus neoformans meningoencephalitis in HIV-infected patients. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: January 4, 2016. Accessed: March 28, 2017.
  82. Cox GM, Perfect JR. Clinical management and monitoring during antifungal therapy of the HIV-infected patient with cryptococcal meningoencephalitis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 22, 2016. Accessed: March 28, 2017.
  83. Tick-borne Encephalitis (TBE). Updated: March 31, 2014. Accessed: March 28, 2017.
  84. Travelers' Health: Tick-borne Encephalitis. Updated: March 9, 2013. Accessed: March 28, 2017.
  85. Naegleria fowleri - Primary Amebic Meningoencephalitis (PAM). Updated: February 28, 2017. Accessed: March 30, 2020.
  86. Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infect Dis. 2010; 10 (12): p.853-861.doi: 10.1016/s1473-3099(10)70251-6 . | Open in Read by QxMD
  87. $Epidemiology and Prevention of Vaccine-Preventable Diseases.
  88. Bacterial Meningitis. Updated: January 25, 2017. Accessed: March 28, 2017.
  89. Management of bacterial meningitis. Updated: January 1, 2004. Accessed: October 6, 2017.
  90. 2018 National Notifiable Infectious Diseases. Updated: January 1, 2018. Accessed: May 9, 2018.

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer