Diagnostic Considerations

Missed meningitis is one of the most frequent causes of lawsuits in pediatrics, leading to large claims.^{[50, 51]}Therefore, a high index of suspicion is needed, and accurate charting of pertinent positive and negative findings is crucial Claims relating to meningitis are the second most common claim in pediatrics in the USA (behind Brain-damaged infant).^[50]Litigation related to meningitis commonly focuses on a missed diagnosis which entails high expenses and defence fees.

A critical diagnostic issue involves differentiating aseptic meningitis from bacterial meningitis. To this end, clinical decision rules have been formulated (eg, the Bacterial Meningitis Score developed by Nigrovic et al.^[52] These rules identify patients who are at low risk for bacterial meningitis by scoring or modeling clinical variables, blood variable, and cerebrospinal fluid (CSF) variables. The Bacterial Meningitis Score has shown high accuracy and usability and continues to be evaluated.^{[53, 54]}

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

Viral encephalitis

Meningoencephalitis

Acute disseminated encephalomyelitis (ADEM)

Atypical migraine

Hydrocephalus

Differential Diagnoses

Workup

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Media Gallery

Skin lesions due to echovirus type 9 on neck and chest of young girl. Echoviruses belong to genus Enterovirus and are associated with illnesses including aseptic meningitis, nonspecific rashes, encephalitis, and myositis.

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Author

Daniel Owens, BM, MRCPCH(UK) Clinical Research Fellow, NIHR Clinical Research Facility, Southampton General Hospital, UK

Disclosure: Nothing to disclose.

Coauthor(s)

Katrina Cathie, MD, MRCPCH(UK), BM(Hons) Consultant in General Pediatrics and Pediatric Research, University Hospital Southampton NHS Foundation Trust, UK

Katrina Cathie, MD, MRCPCH(UK), BM(Hons) is a member of the following medical societies: Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.

Saul N Faust, MA, MBBS, PhD, MRCPCH(UK) Senior Lecturer in Pediatric Immunology and Infectious Diseases, University of Southampton Faculty of Medicine; Director, NIHR Clinical Research Facility, Southampton University Hospital NHS Foundation Trust, UK

Saul N Faust, MA, MBBS, PhD, MRCPCH(UK) is a member of the following medical societies: British Paediatric Allergy, Immunity and Infection Group, European Society for Paediatric Infectious Diseases, International Society for Infectious Diseases, Royal College of Paediatrics and Child Health

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer meningococcal vaccines<br/>Received research grant from: Pfizer<br/>Institution (no personal fees) received consulting fees from Pfizer, Sanofi, Seqrius, Merck, Medimmune, AstraZeneca.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

David Stuart Baguley, MBChB Critical Care Registrar, The Alfred Hospital, Australia

Disclosure: Nothing to disclose.

Acknowledgements

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa