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Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management

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Last updated:23rd Jun 2010

This guideline covers recognising, diagnosing and managing bacterial meningitis and meningococcal septicaemia (blood poisoning) in babies, children and young people under 16. It aims to reduce deaths and disability by promoting early recognition of symptoms and timely effective management.

Bacterial meningitis is an infection of the surface of the brain (meninges) by bacteria that have usually travelled there from mucosal surfaces via the bloodstream. In children and young people aged 3 months or older, the most frequent causes of bacterial meningitis include Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib). These organisms occur normally in the upper respiratory tract and can cause invasive disease when acquired by a susceptible person. In neonates (children younger than 28 days), the most common causative organisms are Streptococcus agalactiae (Group B streptococcus), Escherichia coli, S pneumoniae and Listeria monocytogenes.

Most N meningitidis colonisations are asymptomatic, but occasionally the organism invades the bloodstream to cause disease. Meningococcal disease most commonly presents as bacterial meningitis (15% of cases) or septicaemia (25% of cases), or as a combination of the two syndromes (60% of cases). Meningococcal disease is the leading infectious cause of death in early childhood, making its control a priority for clinical management (as well as public health surveillance and control).

This guideline does not consider meningitis associated with tuberculosis (TB), because tuberculous meningitis (or meningeal TB) is covered in Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control (NICE clinical guideline 33). However, some features of the presentation of tuberculous meningitis are indistinguishable from bacterial meningitis.

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