Pediatric Bacterial Meningitis Differential Diagnoses

Updated: Jan 16, 2019
  • Author: Martha L Muller, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Diagnostic Considerations

A definitive diagnosis of meningitis requires examination of cerebrospinal fluid (CSF) via lumbar puncture. The presence or absence of classic meningeal signs and symptoms should not be used as the sole criteria for referring patients for further diagnostic testing. [16]

Missed meningitis is one of the most frequent lawsuits in pediatrics, leading to large claims. Therefore, a high index of suspicion is needed and accurate charting of pertinent positive and negative findings is crucial. Missed meningitis is second only to missed myocardial infarction in total damages per year. Many lawsuits are filed even though treatment was promptly instituted because of the frequency of neurologic sequelae.

Delay in initiating antibiotic therapy has resulted in lawsuits. Even though morbidity is known to be associated with even the most prompt and appropriate therapy, if there are sequelae and antibiotics were delayed, the clinician will be at a disadvantage if legal action is taken.

Partially treated meningitis is difficult to diagnose; therefore, children on antibiotics should be carefully evaluated. Children who have partially treated meningitis or develop it while on antibiotics have modified signs and symptoms, and the diagnosis is usually delayed.

Besides the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Brain abscess

  • Subdural/epidural abscess

  • Brain tumors

  • Central nervous system (CNS) leukemia

  • Lead encephalopathy

  • CNS tuberculosis

  • Hypersensitivity to drugs (eg, trimethoprim-sulfamethoxazole, intravenous immune globulin, and antithymocyte globulin)

  • Disorders associated with vasculitis (eg, Kawasaki disease and collagen vascular disease)