Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management—summary of updated NICE guidance

• Published in: BMJ (Online) 2024-11, Vol.387, p.q2452
• Main Authors: Paing, Aye, Elliff-O’Shea, Laura, Boardman, Lisa, Turner, David, Glennie, Linda, Arora, Amit, Hitchings, Andrew, Trivedi, Ashifa, Maconochie, Ian, Jawaid, Imran, Thomas, Mark, Bryan, Michael, Griffiths, Nathan, Heyderman, Robert, Faust, Saul, Nadel, Simon
• Format: Article
• Language: English
• Subjects: Antibiotics; Children; Children & youth; Clinical practice guidelines; Cognition; Cognition & reasoning; Cognitive ability; Consciousness; Cyanosis; Delirium; Families & family life; Fever; Headache; Headaches; Medical diagnosis; Meningitis; Meningococcal disease; Neck; Older people; Pain; Practice; Sepsis; Skin; Young adults
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj.q2452

Aye Paing [e-mail] What you need to know Identification of red flag combinations of symptoms and signs should raise the index of suspicion of bacterial meningitis or meningococcal disease A senior clinical decision maker should perform an initial assessment and ensure that antibiotics start within 1 hour of the person arriving at hospital Review people who have had bacterial meningitis or meningococcal disease within 4-6 weeks after discharge from hospital Bacterial meningitis and meningococcal disease are uncommon but life-threatening conditions. Table 1 Symptoms and signs that may indicate bacterial meningitis in babies, children, and young people Symptoms and signs in babies, children, and young people Notes Red flag combination Fever, headache, neck stiffness, and altered level of consciousness or cognition (including confusion or delirium) Fever and neck stiffness are less common in babies. Moderately to highly specific and not sensitive to moderately sensitive Other Unexplained body pain, including limb, back or abdominal pain Moderately specific but not sensitive (based on data from an undefined age range) Vomiting Not specific to moderately specific and not sensitive to moderately sensitive Information on the sensitivity and specificity of individual symptoms or signs provided for which evidence was available Table 2 Symptoms and signs that may indicate bacterial meningitis in adults Symptoms and signs in adults Notes Red flag combination Fever, headache, neck stiffness, and altered level of consciousness or cognition (including confusion or delirium) Fever is less common in older adults. Moderately to highly sensitive and not specific to moderately specific (including data from older children) Ill appearance Ask the person (or their family members or carers) if they have taken antipyretics, because this may make ill appearance harder to identify.