Meningitis / Meningococcal septicaemia

Meningitis

• Fever

• Bulging fontanelle

• Reduced LOC

• Neck stiffness

• Convulsive status epilepticus

*Note: typical signs of meningitis maybe absent in infants

Meningococcal disease

Non-blanching rash and one of the following:

• Child appears unwell

• Purpura (lesion > 2 mm in diameter)

• Prolonged capillary re-fill time (CRT > three seconds)

• Neck stiffness

• Classical signs of meningitis may be absent in small children who may present with non-specific signs such as fever, vomiting, respiratory symptoms, irritability, and sometimes seizures.

• Primary healthcare professionals should transfer children and young people with suspected bacterial meningitis or suspected meningococcal septicaemia to secondary care as an emergency by blue-light ambulance

• Patients with suspected meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) should be given parenteral antibiotics (intramuscular or intravenous benzylpenicillin) at the earliest opportunity, either in primary or secondary care. GPs are advised to give a single injection of benzylpenicillin intravenously (or by intramuscular injection) before urgent transfer to hospital. This should not delay urgent transfer to hospital.

Benzylpenicillin doses:

• Infant <1: 300 mg

• Child 1-9: 600 mg

• ≥10 years and adults: 1.2 g

Withhold benzylpenicillin only in children and young people who have a clear history of anaphylaxis after a previous dose. If penicillin-allergic, cefotaxime may be used as an alternative: chloramphenicol may be used if there is a history of immediate hypersensitivity to penicillins or cephalosporins.

A third-generation cephalosporin (cefotaxime or ceftriaxone) is often used in hospital as empirical treatment before identification of the causative organism.

Patients with suspected bacterial meningitis without non-blanching rash should be transferred as an emergency to hospital without giving parenteral antibiotics unless there is likely to be a significant delay in transfer (e.g. due to remote location or adverse weather) in which case antibiotics should be administered in the community.

Prevention of secondary cases of meningococcal disease is usually with oral rifampicin or ciprofloxacin.

It is currently estimated that around 10% of the population are asymptomatic carriers but figures quoted can vary up to 25% of the population.

Resources

• Public Health England. Meningococcal Disease: guidance, data and analysis. 2014 (updated 2022).

• Meningitis (bacterial) and Meningococcal Septicaemia in Under 16s: recognition, diagnosis and management (CG 102, 2015)

• Meningitis - bacterial meningitis and meningococcal disease (CKS)

• Meningitis (NHS Choices)

• Meningitis (Patient.info)

Encephalitis

• Encephalitis (NHS Choices), Encephalitis (Patient.info), Encephalitis (Mayo clinic), The Encephalitis Society (encephalitis.info)