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Bacterial meningitis in children older than one month: Clinical features and diagnosis

Sheldon L Kaplan, MD
Section Editors
Morven S Edwards, MD
Douglas R Nordli, Jr, MD
Deputy Editor
Carrie Armsby, MD, MPH


Meningitis is an inflammatory disease of the leptomeninges, the tissues surrounding the brain and spinal cord. The meninges consist of three parts: the pia, arachnoid, and dura mater. Meningitis reflects inflammation of the arachnoid mater and the cerebrospinal fluid (CSF) in both the subarachnoid space and in the cerebral ventricles.

Suspected bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause so that appropriate antimicrobial therapy can be initiated. The mortality rate of untreated bacterial meningitis approaches 100 percent. Even with optimal therapy, morbidity and mortality may occur. Neurologic sequelae are common among survivors.

The clinical and laboratory features of bacterial meningitis in infants and children older than one month will be reviewed here. The epidemiology, pathogenesis, treatment, prognosis, and prevention of acute meningitis and the clinical features, diagnosis, treatment, and prognosis of bacterial meningitis in neonates (<1 month of age) and adults are discussed separately. (See "Pathogenesis and pathophysiology of bacterial meningitis" and "Bacterial meningitis in children older than one month: Treatment and prognosis" and "Bacterial meningitis in the neonate: Clinical features and diagnosis" and "Bacterial meningitis in the neonate: Treatment and outcome" and "Epidemiology of bacterial meningitis in adults" and "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Treatment of bacterial meningitis caused by specific pathogens in adults".)


After the introduction of the Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines to the infant immunization schedule (in 1990 and 2000, respectively) the incidence of bacterial meningitis declined in all age groups except children younger than two months [1]. The median age shifted from <5 years to 42 years [1,2]. The peak incidence continues to occur in children younger than two months.

In population-based surveillance (2006 to 2007), the incidence of bacterial meningitis in United States children varied with age [1]:

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Literature review current through: Nov 2017. | This topic last updated: Aug 30, 2017.
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