On this page
Quick Reference
Overview and Recommendations
Background
- •Define meningitis as the acute or chronic inflammation of the protective membranes surrounding the brain and spinal cord, specifically the leptomeninges. It is a critical global health challenge with significant geographic heterogeneity, such as the high burden seen in the African Meningitis Belt.
- •Identify the primary infectious etiologies, which vary by age and risk factors: and dominate adult bacterial cases, while is the leading cause in neonates. Viral or 'aseptic' meningitis is most frequently caused by and is generally less severe but more common.
- •Recognize the high morbidity associated with the condition, as more than 30% of survivors worldwide suffer from long-term neurological sequelae, including sensorineural hearing loss (SNHL), cognitive impairment, and seizure disorders.
- •Distinguish between acute (hours to days) and chronic (more than 4 weeks) forms. Tuberculous meningitis (TBM) and cryptococcal meningitis often present subacutely and are major causes of mortality in immunocompromised populations, particularly those with HIV/AIDS.
- •Consider non-infectious triggers such as drug-induced aseptic meningitis (DIAM)—often linked to NSAIDs or antibiotics—and systemic autoinflammatory diseases like (NPSLE) or GFAP astrocytopathy.
Evaluation
- •Suspect meningitis in any patient presenting with fever, severe headache, and nuchal rigidity (neck stiffness), though be aware that this 'classic triad' is present in less than half of confirmed cases. In neonates, look for non-specific signs like irritability, poor feeding, bulging fontanelles, or hypothermia (Temperature ≤ 36.0°C).
- •Perform a targeted physical exam for meningeal irritation using Kernig’s sign (resistance to knee extension with the hip flexed) and Brudzinski’s sign (involuntary hip flexion during passive neck flexion). Utilize the jolt accentuation of headache—increasing pain with rapid horizontal head rotation—as it is a highly sensitive sign for meningeal inflammation.
- •Assess for 'red flags' that indicate high-risk complications, such as rapidly progressive purpura (suggestive of meningococcemia), focal neurological deficits, papilledema, or a Glasgow Coma Scale (GCS) score < 12.
- •Order a non-contrast CT prior to performing a lumbar puncture (LP) only if specific contraindications are present: focal neurological deficits, new-onset seizures, papilledema, or known immunocompromise. Do not delay the first dose of antibiotics for imaging if an LP is deferred.
- •Obtain blood cultures and a simultaneous serum glucose level immediately upon arrival. Blood cultures are positive in 50-80% of patients with bacterial meningitis and may provide a diagnosis if the LP is 'dry' or contraindicated.
- •Perform a lumbar puncture to analyze cerebrospinal fluid (CSF) for opening pressure, cell count with differential, glucose, and protein. Typical bacterial findings include neutrophilic pleocytosis (>5 cells/μL), elevated protein, and a CSF/serum glucose ratio < 0.4.
- •Utilize rapid molecular diagnostics such as the Meningitis/Encephalitis panel, which can identify 14 common pathogens via multiplex PCR within approximately one hour, significantly improving time-to-targeted-therapy.
- •Evaluate for (TBM) in patients with subacute symptoms or high-risk backgrounds using CSF biomarkers (IFN-γ, IL-6) and molecular tools like CBNAAT or Loop-mediated isothermal amplification (LAMP), which has a sensitivity of ~62.5% in pediatric populations.
- •Screen for cryptococcal antigen (CrAg) in all HIV-positive patients with a CD4 count < 100 cells/μL, as high blood CrAg titers are strongly predictive of concurrent meningitis and increased mortality.
- •Rule out mimics such as (via CT or presence of xanthochromia in CSF) and autoimmune encephalitis (via MRI findings like linear perivascular radial enhancement in GFAP astrocytopathy).
Management
- •Administer empiric antimicrobial therapy within 60 minutes of patient arrival; every hour of delay is associated with increased mortality. For most adults, initiate Ceftriaxone 2 g IV every 12 hours and Vancomycin 15-20 mg/kg IV every 8-12 hours.
- •Add Ampicillin 2 g IV every 4 hours to the empiric regimen for patients over age 50, pregnant individuals, or those with immunocompromise to provide coverage for Listeria monocytogenes.
- •Administer adjunctive Dexamethasone 0.15 mg/kg IV every 6 hours (maximum 10 mg) starting 10-20 minutes before or concurrently with the first dose of antibiotics to reduce the risk of hearing loss and neurological sequelae in bacterial cases.
- •Continue dexamethasone for 4 days in patients confirmed to have Streptococcus pneumoniae meningitis; discontinue if the pathogen is found to be viral or a different bacterium where steroid benefit is less clear.
- •Manage (TBM) with a standard 4-drug regimen (Rifampin, Isoniazid, Pyrazinamide, and Ethambutol) plus adjunctive dexamethasone for 6-8 weeks. Consider high-dose Rifampin 35 mg/kg/day to improve CNS penetration, though its mortality benefit is still debated.
- •Treat HIV-associated cryptococcal meningitis using the AMBITION protocol: a single high dose of Liposomal Amphotericin B 10 mg/kg on Day 1, followed by 14 days of oral Flucytosine 100 mg/kg/day and Fluconazole 1200 mg/day.
- •Monitor and manage increased intracranial pressure (ICP) using head elevation to 30 degrees and osmotic therapy (Mannitol 0.5-1.0 g/kg). Consider external ventricular drainage (EVD) for patients with refractory hypertension or symptomatic hydrocephalus.
- •Implement seizure precautions and treat active seizures with benzodiazepines (e.g., Lorazepam 0.1 mg/kg IV), followed by maintenance anticonvulsants like Levetiracetam if cortical involvement is suspected.
- •Provide post-exposure prophylaxis (PEP) to close contacts of patients with N. meningitidis or H. influenzae type b using Ciprofloxacin 500 mg PO (single dose) or Rifampin 600 mg PO twice daily for 2 days.
- •Perform formal audiological diagnostic testing at the time of discharge or within 4 weeks of recovery to detect sensorineural hearing loss (SNHL), as early intervention is critical for preventing cognitive decline.
- •Avoid the use of adjunctive corticosteroids in HIV-positive adults with TBM, as trials have shown they may not provide the same survival benefit as seen in HIV-negative populations.
- •Refer to neurosurgery immediately if imaging reveals a (complicating ~1.9% of bacterial cases) or if there is evidence of obstructive hydrocephalus requiring a shunt.
Board Review — High Yield
- •Jolt accentuation — The most sensitive physical exam maneuver for identifying meningeal irritation (worsening headache with horizontal head rotation).
- •CSF/Serum Glucose Ratio < 0.4 — A classic laboratory finding strongly suggestive of bacterial, fungal, or tuberculous meningitis over viral causes.
- •Waterhouse-Friderichsen syndrome — Adrenal insufficiency caused by bilateral adrenal hemorrhage, a catastrophic complication of meningococcemia.
- •LTA4H genotype — A genetic marker that predicts whether a patient with tuberculous meningitis will benefit from adjunctive corticosteroids.
- •AMBITION-cm Trial — Validated a single high-dose of liposomal amphotericin B as part of an effective, less toxic induction regimen for cryptococcal meningitis.
- •Sensorineural hearing loss — The most common long-term sequela of bacterial meningitis, necessitating audiological follow-up for all survivors.
- •Dexamethasone timing — Must be given before or with the first dose of antibiotics to be effective in reducing inflammatory neurological damage.
- •Enterovirus — The most common cause of 'aseptic' meningitis, typically presenting with a benign, self-limiting course.
Deep Dive — Evidence Details
Definition, Synonyms, and Classification
- ▸Meningitis is an inflammatory meningeal and CSF syndrome that may occur alone or with encephalitis.[269][271][274][276]
- ▸Aseptic meningitis indicates absence of demonstrated bacterial infection, not necessarily absence of infection.[9][11]
- ▸Probable meningitis may be diagnosed with meningitis-consistent CSF abnormalities despite negative culture, including culture-negative CSF with pleocytosis and neutrophil predominance in a neonatal sepsis study.[271]
- ▸Major etiological classes represented in the evidence are bacterial, viral, mycobacterial, fungal, and parasitic meningitis.[3][8][9][10][11][12][269][270][271][272][274][275][276]
- ▸Subarachnoid neurocysticercosis is a compartment-specific parasitic form defined by pathology, characteristic cyst location, serology or Del Brutto criteria, or inflammatory CSF with positive parasite testing and exclusion of other pathogens.[269]
Definition
Meningitis is an inflammatory syndrome involving the meninges and cerebrospinal fluid (CSF), identified clinically and/or through CSF abnormalities; the available evidence includes infectious disease presentations ranging from isolated meningitis to meningoencephalitis and meningomyelitis.[269]C[271][274][276]C In practice, the term may describe disease caused by bacteria, viruses, fungi, mycobacteria, parasites, or less commonly other infectious agents.[3][6]C[8]C[9]C[10]C[11]C[12]C[274][275]C[276]C “Aseptic meningitis” generally denotes meningitis without a demonstrated bacterial cause; however, the term does not imply a noninfectious origin, because enteroviruses and lymphocytic choriomeningitis virus have been associated with aseptic meningitis.[9]C[11]C
Meningitis should be distinguished conceptually from encephalitis, although the two may coexist. The term meningoencephalitis is appropriate when meningeal inflammation occurs with brain inflammation, as described for West Nile virus, bat reovirus, pigeon paramyxovirus type 1, and Angiostrongylus cantonensis infection.[6]C[12]C[276]C[278]C Neurolisteriosis may also present as central nervous system infection, including meningitis or meningoencephalitis, whereas listeriosis cohorts separately classify bacteremia, neurolisteriosis, perinatal infection, and other disease.[275]C
Synonyms and related terms
Common clinical descriptors include acute meningitis, bacterial meningitis, viral or aseptic meningitis, tuberculous meningitis, cryptococcal meningitis, meningococcal meningitis, neonatal meningitis, and neurocysticercal meningitis.[3][8]C[9]C[10]C[11]C[269]C[270][271][274][275]C These labels may refer to the suspected cause, epidemiological setting, age group, or anatomical compartment rather than to different inflammatory processes.[269]C[270][271][274]
“Probable meningitis” is an operational term used when CSF findings are consistent with meningitis but culture confirmation is absent. In very preterm and/or very-low-birth-weight infants with early-onset sepsis, this designation required culture-negative CSF with pleocytosis and neutrophil predominance, together with other meningitis-consistent abnormalities reported in the study definition.[271] This category is distinct from culture-confirmed bacterial meningitis and illustrates that meningitis classification may remain clinical or laboratory-based when microbiological confirmation is unavailable.[271]
“Neuroborreliosis” or Lyme neuroborreliosis refers to neurological infection associated with Borrelia burgdorferi; patients evaluated for suspected disease may have neurological manifestations and positive two-tier serology, but diagnosis incorporates lumbar-puncture findings and a formal European case definition.[277]C Thus, positive serum antibodies alone should not be treated as synonymous with Lyme meningitis.[277]C
Classification by aetiology
Bacterial meningitis
Bacterial meningitis includes disease caused by organisms such as Neisseria meningitidis, Escherichia coli, and Listeria monocytogenes.[8]C[10]C[272][275]C N. meningitidis remains associated with invasive meningococcal disease and meningitis, while genomic surveillance has also identified urogenital disease and imported serogroup W, sequence type 11, clonal complex 11 infections among travellers returning from Saudi Arabia.[8]C[10]C In neonatal invasive disease, E. coli is an important cause of bloodstream and CSF infection; longitudinal surveillance specifically examined the historical assumption that K1-capsule-positive strains dominate these infections.[272] Listeriosis may involve the nervous system, with neurolisteriosis representing a clinically distinct manifestation within broader confirmed listeriosis cohorts.[275]C
Viral meningitis
Viral meningitis includes enterovirus-associated disease, parechovirus-A infection, lymphocytic choriomeningitis virus infection, and arboviral disease such as West Nile virus infection.[9]C[11]C[274][276]C A recombinant echovirus 6/coxsackievirus B1 enterovirus caused an aseptic meningitis cluster involving a daycare teacher and children, demonstrating that genetically recombinant enteroviruses can produce meningitis-associated outbreaks.[11]C Parechovirus-A3 was investigated in febrile neonates and infants younger than 4 months hospitalized with suspected sepsis, meningitis, and/or encephalitis, using serum and/or CSF PCR and sequencing.[274] LCMV is a recognized cause of aseptic meningitis and can cause severe disease after exposure to aerosolized excreta from infected house mice; severe illness can occur even in an immunocompetent person.[9]C West Nile virus may produce neuroinvasive disease with meningoencephalitis, particularly in older adults; a 2024 Turkish outbreak cohort had a mean age of 63.3 years.[276]C
Mycobacterial and fungal meningitis
Tuberculous meningitis (TBM) is the most severe clinical manifestation of tuberculosis and may be classified as definite, probable, or possible according to a uniform case definition.[3] In a Thai adult cohort, 32.7% of patients had definite TBM, 23.0% probable TBM, and 44.2% possible TBM, illustrating the importance of graded diagnostic certainty.[3] Cryptococcal meningitis is an opportunistic disease particularly relevant to advanced HIV disease; optimized care models therefore incorporate enhanced CD4 testing and cryptococcal-antigen screening among patients with advanced HIV disease.[270]
Parasitic and compartment-specific meningitis
Parasitic meningitis includes subarachnoid neurocysticercosis caused by Taenia solium and eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis.[12]C[269]C Subarachnoid neurocysticercosis is defined by histopathology; cysts in the basilar subarachnoid spaces, Sylvian fissures, or spinal subarachnoid spaces with T. solium antibody positivity or fulfillment of Del Brutto criteria; or inflammatory CSF with T. solium antigen or quantitative PCR positivity and negative testing for viral, fungal, and bacterial causes.[269]C This anatomical classification emphasizes that meningitis may be categorized by the meningeal compartment involved as well as by pathogen.[269]C
Classification by age, setting, and associated pathology
Meningitis may be classified as neonatal or infant disease, including early-onset sepsis-associated meningitis and parechovirus infection; as adult disease, including TBM and West Nile neuroinvasive disease; or as disease associated with advanced HIV and opportunistic infection.[270][271][274][276]C It may also be categorized as community-associated, outbreak-associated, travel-associated, zoonotic, or procedure/anatomy-associated. Examples include daycare-associated enterovirus transmission, household exposure concerns in invasive group A streptococcal disease, travel-associated serogroup W meningococcal disease, rodent-associated LCMV, mosquito-associated West Nile virus, bat-associated reovirus, avian-associated pigeon paramyxovirus type 1, and meningitis risk arising from a skull-base CSF leak.[6]C[9]C[10]C[11]C[273]C[276]C[278]C[279]C These epidemiological labels supplement, but do not replace, classification by clinical syndrome, CSF findings, microbiology, and anatomical distribution.[269]C[271][277]C[279]C
| Classification axis | Examples supported by the evidence |
|---|---|
| Clinical syndrome | Meningitis; aseptic meningitis; meningoencephalitis; meningomyelitis-related disease [6]C[9]C[11]C[12]C[269]C[276]C[278]C |
| Aetiology | Bacterial, viral, mycobacterial, fungal, parasitic [3][8]C[9]C[10]C[11]C[12]C[269]C[270][274][275]C[276]C |
| Diagnostic certainty | Confirmed, probable, possible, or operationally probable meningitis [3][271][277]C |
| Age or host context | Neonates/young infants, adults, advanced HIV disease, immunocompetent hosts [9]C[270][271][274][276]C |
| Epidemiology or anatomy | Outbreak-associated, travel-associated, zoonotic, CSF-leak-associated, or subarachnoid disease [9]C[10]C[11]C[269]C[273]C[276]C[278]C[279]C |
Epidemiology and Risk Factors
- ▸Risk varies strongly by age, pathogen, geography, vaccination coverage, healthcare access, and diagnostic surveillance [282][287][35].
- ▸Important recognized risk factors include CSF leakage, cochlear implantation, and selected neurosurgical or healthcare-associated exposures [51][288].
- ▸Meningococcal disease is concentrated in children younger than 5 years and adolescents; reported prevalence and case fatality are much higher during epidemics than in endemic settings [287].
- ▸TBM evidence is dominated by cohorts of diagnosed patients and treatment trials; the supplied references do not establish a population incidence estimate or complete acquisition-risk profile [31][286][290].
- ▸Neurological sequelae, hearing loss, stroke, and brain abscess substantially influence the measured burden of meningitis [33][34][41][289].
Scope and epidemiological context
Meningitis is a syndrome with infectious and non-infectious causes; the supplied updated evidence is concentrated on community-acquired bacterial meningitis, tuberculous meningitis (TBM), meningococcal disease, and selected viral or inflammatory conditions. Epidemiological estimates vary substantially by age, pathogen, geographic setting, vaccination coverage, diagnostic practice, and access to follow-up care [33][35][287]. In low- and middle-income countries, the burden of bacterial meningitis and antimicrobial resistance is particularly important, although the available resistance review emphasizes that surveillance remains fragmented [35].
Age and demographic risk
Age is a major determinant of meningitis risk. In a systematic review of previously healthy, well-appearing febrile infants aged 60–90 days, invasive bacterial infection—including bacteremia and bacterial meningitis—was sufficiently prevalent to warrant dedicated age-specific evaluation; the review was designed specifically because international guidance differs for this third-month age group [282]. In a seven-year pediatric bacterial-meningitis cohort from Southwest China, the median age was 17 months, and 58.1% of patients were male; the cohort included only children with positive cerebrospinal-fluid cultures and therefore does not represent all pediatric meningitis [288].
Meningococcal disease has a bimodal age distribution, with the highest burden in children younger than 5 years and in adolescents. In the Indian consensus review, 61.8% of reported cases occurred in children younger than 5 years; serogroup A remained predominant, while serogroups C, W, and Y were increasingly recognized [287]. Epidemic prevalence was reported as 12.1%, compared with 0.76% in endemic settings; corresponding case-fatality ratios were 12.8% and 3.0%, respectively, although under-recognition and weak surveillance probably lead to underestimation [287].
Established and setting-specific risk factors
A cerebrospinal-fluid (CSF) leak caused by a meningeal breach or a cochlear implant is a recognized risk factor for bacterial meningitis [51]D. In a nationwide French prospective cohort, 251 of 5,879 (4.3%) pediatric bacterial-meningitis cases in children older than 3 months occurred in children with known CSF leakage; the study also evaluated the effect of 13-valent pneumococcal conjugate vaccination in this population [51]D. These patients represent a clinically important subgroup because anatomical communication between the subarachnoid space and upper airway or middle ear can facilitate bacterial invasion [51]D.
Neurosurgical or other healthcare-associated exposures are additional context-specific risks. A pediatric study from Southwest China specifically analyzed post-neurosurgical cases and found a region-specific bacterial spectrum and antimicrobial-resistance pattern, emphasizing that epidemiology differs between community-acquired and post-procedural meningitis [288]. Antimicrobial resistance among Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae was assessed globally and by WHO region for 2010–2024, with the review highlighting the disproportionate importance of resistance data in low- and middle-income countries [35].
Tuberculous meningitis
TBM is a severe extrapulmonary manifestation of tuberculosis with substantial mortality and long-term neurological morbidity [31][283]. The evidence supplied does not provide a population incidence estimate or a definitive set of host-acquisition risk factors; most contemporary studies address treatment, complications, or prognosis among already diagnosed patients [31][156][286][290][292]. A network meta-analysis included 29 randomized trials involving 4,640 patients, whereas a high-dose-rifampicin meta-analysis included 7 randomized trials involving 1,296 patients; these figures describe trial populations, not disease incidence [286][31].
Among children younger than 15 years with TBM, age-stratified clinical characteristics and predictors of severe neurological sequelae were assessed for those younger than 5 years versus those aged 5–14 years, indicating that age is an important prognostic and epidemiological stratifier [292]. In adults, cognitive impairment after TBM ranged from 12% to more than 90% across studies, reflecting substantial heterogeneity in assessment methods and follow-up rather than a single prevalence estimate [283]. Cerebral infarction is described as a frequent and serious TBM complication; a secondary analysis of the ACT-TBM trial evaluated associated factors and predictors in 237 patients [156].
Other infectious and inflammatory contexts
Tick-borne encephalitis (TBE) illustrates the importance of geography and vector exposure. In northeastern Poland, a 1993–2023 cohort of 1,654 hospitalized patients comprised meningitis (50.1%), meningoencephalitis (41.9%), and meningoencephalomyelitis (8.0%), supporting substantial regional variation in meningeal infection patterns [291]. HIV-associated neurological complications can occur at any stage of HIV infection; a Cameroonian hospital cohort from 2016–2023 evaluated prevalence and mortality among people living with HIV who developed neurological complications, but the supplied abstract does not provide a meningitis-specific incidence estimate [284]. Neuropsychiatric systemic lupus erythematosus and lupus-associated psychosis are inflammatory neurological conditions that may enter the differential diagnosis of meningitis-like presentations, but the supplied reviews do not establish them as infectious-meningitis risk factors [281][32].
Consequences relevant to epidemiological assessment
Reported meningitis burden is affected by incomplete ascertainment of sequelae. A global systematic review found that neurological sequelae after acute meningitis are often underreported or undetected because of inadequate follow-up, limited healthcare access, and diagnostic challenges [33]. Formal audiological testing is important after acute infectious meningitis because sensorineural hearing loss may otherwise be missed; early detection can reduce the consequences of permanent deafness, including cognitive, social, and mental-health effects [34]. In bacterial meningitis, brain abscess occurred in 1.9% of 2,918 Dutch cohort episodes, with a 95% confidence interval of 1.5–2.5%, demonstrating that disease complications also contribute to observed morbidity [41]. Stroke occurred in 72 of 540 (13%) children with laboratory-confirmed bacterial meningitis in a New Zealand tertiary-center cohort [289]. These complication estimates are cohort-specific and should not be generalized to all meningitis cases [33][34][41][289].
| Population or context | Finding | Reference |
|---|---|---|
| Febrile infants aged 60–90 days | Systematic review of invasive bacterial infection prevalence, including meningitis | [282] |
| Indian meningococcal disease | 61.8% of reported cases in children younger than 5 years; epidemic prevalence 12.1% versus 0.76% in endemic settings | [287] |
| French children with bacterial meningitis | 251/5,879 (4.3%) had known CSF leakage | [51]D |
| Pediatric bacterial meningitis, Southwest China | Median age 17 months; 58.1% male among culture-positive cases | [288] |
| Pediatric bacterial meningitis, New Zealand | Stroke in 72/540 (13%) | [289] |
| Community-acquired bacterial meningitis, Netherlands | Brain abscess in 56/2,918 (1.9%; 95% CI 1.5–2.5) | [41] |
| Hospitalized TBE, northeastern Poland | Meningitis 50.1%, meningoencephalitis 41.9%, meningoencephalomyelitis 8.0% among 1,654 cases | [291] |
Etiology and Triggering Factors
- ▸Documented etiologies include bacterial, viral, fungal, tuberculous, zoonotic, congenital, postoperative, and post-neurosurgical meningitis. [294][295][296][301][304][307][309]
- ▸Febrile infants aged ≤90 days are a key high-risk population for invasive bacterial infection, defined in the cited reviews as bacteremia or bacterial meningitis. [293][282]
- ▸PCV13 reduced vaccine-serotype pneumococcal disease in Taiwan, but non-vaccine serotypes remain an increasing concern. [297]
- ▸Recent neurosurgery, posterior fossa tumor surgery, immunosuppression, HIV, geographic exposure to Coccidioides, and tropical zoonotic exposure to Leptospira are important contextual triggers. [295][296][301][304][309]
- ▸A negative multiplex meningitis–encephalitis panel does not exclude infection when the panel lacks the causative organism. [306]
Overview
Meningitis is etiologically heterogeneous and may result from bacterial, viral, fungal, mycobacterial, zoonotic, or noninfectious inflammatory processes. The supplied evidence particularly documents bacterial meningitis, tuberculous meningitis, coccidioidal meningitis, cryptococcal meningitis, leptospiral meningitis, congenital lymphocytic choriomeningitis virus (LCMV) infection, and postoperative or post-neurosurgical meningitis. [294][295]C[296][297]C[301][304][307]C[309]
The likely cause is influenced by age, immune status, geographic exposure, vaccination history, recent neurosurgery, and healthcare-associated exposures. In febrile infants, invasive bacterial infection (IBI) is defined in the cited literature as bacteremia or bacterial meningitis; systematic reviews have specifically evaluated infants aged up to 90 days, including a separate assessment of previously healthy, well-appearing infants aged 60–90 days. [293][282]
Bacterial meningitis
Bacterial meningitis may occur in young infants, children, and adults. In pediatric disease, the causative spectrum and antimicrobial-resistance patterns vary by region and over time. A seven-year study from Southwest China analyzed culture-positive pediatric bacterial meningitis and specifically emphasized differences between community-acquired disease and post-neurosurgical cases, demonstrating that local epidemiology is important when considering likely pathogens and empirical therapy. [288]
Streptococcus pneumoniae remains a major cause of bacterial meningitis. Following implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) in Taiwan, vaccine-serotype invasive disease declined, while non-vaccine serotypes became an increasing concern; therefore, vaccination reduces—but does not eliminate—the risk of pneumococcal meningitis and may alter the circulating serotype distribution. [297]C
Healthcare-associated bacterial meningitis can follow neurosurgical procedures. Pediatric posterior fossa tumor surgery is a documented setting for postoperative meningitis, and postoperative cases may be culture-positive or culture-negative. [301] Post-neurosurgical bacterial meningitis is also reported after neurosurgical intensive-care treatment, where early recognition is difficult and diagnostic prediction models have been developed. [304] Rarely, invasive exposure to traditional procedures may precede infection: one reported patient developed Escherichia coli meningitis after cupping and acupuncture, although this represents case-report evidence rather than an established population-level risk estimate. [305]C
Spontaneous Gram-negative bacillary meningitis is rare in adults and is associated with particularly severe illness in older patients with substantial comorbidity. Proteus mirabilis meningitis may be missed by a limited multiplex meningitis–encephalitis panel despite cerebrospinal-fluid findings strongly suggestive of bacterial infection, illustrating that the apparent pathogen profile depends partly on test coverage. [306]C
Viral and congenital infections
LCMV is a congenital viral cause of neurologic disease. Reported congenital infection has been associated with chorioretinitis, cerebral ventriculomegaly, major neurologic malformations, placental vascular or other placental pathology, and fetal demise. [307]C In suspected congenital LCMV infection, the cited report recommends assessment for chorioretinitis, LCMV antibodies, and placental evidence of infection. [307]C
Fungal and mycobacterial meningitis
Coccidioidal meningitis is a manifestation of disseminated coccidioidomycosis, a fungal infection endemic to the southwestern United States. Hospitalization data from Texas identified substantial effects in western Texas and metropolitan areas, supporting geographic exposure as an important epidemiologic trigger. [296] Coccidioidal meningitis occurs in approximately 1% of coccidioidomycosis cases in the cited study and may lead to hydrocephalus requiring shunting and lifelong antifungal therapy. [308]
Cryptococcus neoformans is an opportunistic fungal pathogen and a leading cause of HIV-associated meningitis, particularly in Africa. The associated disease burden is substantial, with high mortality among people with AIDS; host genetic variation, including HLA alleles, is being investigated as a potential determinant of susceptibility to cryptococcal disease in people with HIV. [309]
Tuberculous meningitis is an important alternative diagnosis to acute bacterial meningitis. Distinguishing the two may be especially difficult after empirical antibiotic exposure. A prospective cohort included 125 patients with bacterial meningitis and 56 with tuberculous meningitis, regardless of pre-admission antibiotic treatment, and evaluated cerebrospinal-fluid procalcitonin and neutrophil percentage as discriminatory markers. [294]
Zoonotic and environmental triggers
Leptospirosis can cause central nervous system disease, including leptospiral-associated meningitis, although CNS involvement is uncommon and under-recognized. Evidence from northeastern Brazil combined three institutional cases with a meta-summary of 176 published cases, indicating that leptospiral meningitis should be considered in compatible patients with exposure risk in tropical or endemic settings. [295]C
Host and contextual factors
Immunosuppression is an important context for unusual or opportunistic meningitis. In a real-world evaluation of a multiplex meningitis–encephalitis panel, positive results in cerebrospinal-fluid samples with fewer than 10 leukocytes/µL occurred exclusively in immunocompromised individuals and children, emphasizing that a low inflammatory-cell count does not exclude infection in these groups. [299] HIV is specifically associated with cryptococcal meningitis, while systemic lupus erythematosus and chronic renal failure were present in a reported case of E. coli meningitis after cupping and acupuncture. [309][305]C
Clinical presentation alone may not reliably identify the cause. Serum procalcitonin has been evaluated in adults with intracranial infection, and cerebrospinal-fluid NGAL, heparin-binding protein, procalcitonin, and conventional markers have been studied to distinguish acute bacterial meningitis from other CNS infections and inflammatory diseases; these tests support etiologic classification but do not replace microbiologic evaluation. [300][298]
Practical etiologic considerations
Etiologic assessment should incorporate age—especially ≤90 days in febrile infants—immune status, vaccination, recent neurosurgery, geographic residence or travel, zoonotic exposure, congenital findings, and prior antimicrobial treatment. [293][282][295]C[296][297]C[307]C[309] Rapid molecular panels can assist early pathogen identification, but their restricted target range means that a negative result does not exclude bacterial meningitis when clinical and cerebrospinal-fluid findings remain strongly suggestive. [299][302]C[306]C
| Etiologic category | Associated context or trigger | Evidence |
|---|---|---|
| Bacterial | Infancy, childhood, adulthood; regional pathogen and resistance patterns | [282][288] |
| Pneumococcal | Incomplete or altered vaccine-serotype protection; emergence of non-vaccine serotypes | [297]C |
| Postoperative/post-neurosurgical bacterial | Posterior fossa tumor surgery or other neurosurgical treatment | [301][304] |
| Viral congenital | Maternal/congenital LCMV infection with placental and fetal neurologic abnormalities | [307]C |
| Fungal | Southwestern US or Texas exposure for Coccidioides; HIV-associated immunosuppression for Cryptococcus | [296][308][309] |
| Tuberculous | Alternative CNS infection, including after empirical antibiotic exposure | [294] |
| Zoonotic | Leptospira exposure in tropical or endemic settings | [295]C |
| Unusual healthcare or procedural exposure | Cupping and acupuncture preceding reported E. coli meningitis | [305]C |
Pathophysiology
- ▸Meningitis pathophysiology includes infectious and noninfectious meningeal inflammation, with overlapping CSF abnormalities across bacterial, tuberculous, fungal, parasitic, viral, autoimmune, and postoperative conditions. [294][295][301][310][312][313][314][318]
- ▸Bacterial meningitis is associated with neutrophilic CSF inflammation and increased inflammatory biomarkers, while prior antibiotics may reduce culture yield without eliminating CSF abnormalities. [294][298][304]
- ▸Tuberculous meningitis commonly causes severe CSF inflammation, hyponatraemia, and pressure-related complications; **92.6%** of participants in one cohort were hyponatraemic at presentation. [311]
- ▸Cerebral vascular injury is clinically important: stroke occurred in **13%** of children with bacterial meningitis in one retrospective cohort. [289]
- ▸Chronic meningitis can obstruct CSF circulation and cause hydrocephalus, particularly in coccidioidal and tuberculous disease. [313][318]
Overview
Meningitis is an inflammatory syndrome involving the leptomeninges and cerebrospinal fluid (CSF), with pathophysiology determined by the initiating infection, immune process, or postoperative insult. The available evidence demonstrates that meningitis may be caused by bacteria, Mycobacterium tuberculosis, fungi, parasites, spirochetes, viruses, or noninfectious autoimmune inflammation, and that these causes can produce overlapping CSF abnormalities and neurological complications. [294][295]C[288][312]C[313]C[314]C[317]C[318]C
Infection and meningeal inflammation
In bacterial meningitis, microbial invasion of the CSF is associated with an acute inflammatory response characterized by CSF pleocytosis, increased protein, and reduced glucose; these abnormalities may persist even when CSF cultures are negative, particularly after antimicrobial exposure or in very preterm and very-low-birth-weight infants. [294][271][301][304] Neutrophil activation is reflected by increased CSF neutrophil percentage and release of inflammatory proteins, including neutrophil gelatinase-associated lipocalin and heparin-binding protein; combined measurement of these markers with conventional CSF indices has been investigated to distinguish acute bacterial meningitis from other central nervous system infections and inflammatory diseases. [298]
Prior antibiotic treatment can reduce microbiological yield without abolishing the inflammatory CSF phenotype. In a prospective cohort including patients regardless of pre-admission antibiotic exposure, CSF procalcitonin and neutrophil percentage were evaluated as complementary indicators for differentiating bacterial from tuberculous meningitis. [294] Serum procalcitonin has also been assessed as a systemic marker of intracranial infection, although its diagnostic performance is not equivalent to direct characterization of CSF inflammation. [300]
The causative microbial spectrum is heterogeneous and regionally dynamic. A seven-year pediatric study in Southwest China examined culture-confirmed bacterial meningitis and emphasized differences in pathogen distribution and antimicrobial resistance, particularly in post-neurosurgical disease. [288] Listeria monocytogenes can produce meningitis beyond the neonatal period in children, while anthrax can cause rapidly progressive hemorrhagic meningoencephalitis with markedly elevated CSF protein and reduced glucose. [315]C[316]C
Tuberculous, fungal, parasitic, and zoonotic mechanisms
Tuberculous meningitis produces sustained meningeal inflammation that may involve the brain parenchyma, impair CSF circulation, and increase intracranial pressure. In tuberculous meningoencephalitis, CSF pleocytosis, increased protein, and reduced glucose were observed together with leptomeningeal enhancement and markedly increased intracranial pressure; simultaneous autoimmune GFAP astrocytopathy can reproduce or amplify these inflammatory findings. [318]C Hyponatraemia is frequent in tuberculous meningitis: 92.6% of participants with sodium measured at presentation were hyponatraemic, and lower sodium concentrations were associated with more severe disease and greater CSF inflammation. [311]
Fungal meningitis may cause chronic basal or leptomeningeal inflammation, obstruct CSF pathways, and alter ventricular compliance. In coccidioidal meningitis, hydrocephalus is a recognized complication, and impaired ventricular compliance or shunt dysfunction may produce low-pressure hydrocephalus despite the presence of a CSF-diversion requirement. [313]C
Neurocysticercosis-associated meningitis represents an inflammatory response to cysticercal infection within or adjacent to the CSF spaces. In a systematic review of 48 cases, headache was reported in 94%, with fever and vomiting also common, supporting a predominantly chronic or subacute meningeal presentation in the reported cases. [312]C Leptospiral-associated meningitis is an under-recognized manifestation of leptospirosis and generally presents within the spectrum of aseptic meningitis, with CSF profiles characterized in a meta-summary of 176 reported cases. [295]C
Viral neuroinvasion can produce meningitis or meningoencephalitis through infection-associated CNS inflammation. Tick-borne encephalitis virus was identified as an important cause of acute and subacute neurological disease in western Auvergne-Rhône-Alpes, where it emerged as the third leading cause of encephalitis or meningoencephalitis in the evaluated cohort. [314]C
Vascular, pressure-related, and systemic complications
Meningeal inflammation can extend beyond the CSF compartment to affect cerebral vessels, producing ischemia and stroke. In a pediatric cohort with laboratory-confirmed bacterial meningitis, neuroimaging-confirmed stroke occurred in 13% of patients, demonstrating that vascular injury is a clinically important complication rather than an exceptional event. [289] Inflammatory obstruction of CSF flow may cause hydrocephalus, as documented particularly in coccidioidal meningitis and in chronic meningoencephalitic disorders. [313]C[318]C
Autoimmune and postoperative inflammation
Not all meningitis-like CSF inflammation is caused by an active pathogen. Neuropsychiatric systemic lupus erythematosus can produce CNS symptoms that overlap clinically with CNS infection; CSF anti-suprabasin antibody is being evaluated as a biomarker to help distinguish NPSLE from SLE-associated CNS infection and from SLE without either condition. [310] Autoimmune GFAP astrocytopathy may coexist with tuberculous meningoencephalitis and generate overlapping CSF, imaging, and clinical features, complicating attribution of the inflammatory process. [318]C
Postoperative meningitis may reflect bacterial inoculation, altered CSF dynamics, or sterile postoperative inflammation. Pediatric posterior fossa tumor surgery and neurosurgical procedures are associated with postoperative meningitis syndromes in which CSF cytology, biochemical abnormalities, culture results, and clinical context may not align; culture-negative cases therefore require careful interpretation rather than automatic exclusion of meningitis. [301][304] In very preterm or very-low-birth-weight infants with early-onset sepsis, culture-negative CSF pleocytosis and neutrophil predominance may operationally define probable meningitis, indicating that inflammation can be present despite failure to recover an organism. [271]
Pathophysiological synthesis
Across etiologies, the central mechanisms are pathogen or antigen exposure within the CSF, recruitment of inflammatory leukocytes, disruption of the blood–CSF barrier, altered CSF composition, vascular injury, and impaired CSF circulation. The relative contribution of each mechanism varies: acute bacterial disease is associated with neutrophilic inflammation; tuberculosis, fungi, and parasites may produce chronic meningeal inflammation and hydrocephalus; autoimmune disease can mimic infection; and postoperative or partially treated disease may produce inflammatory CSF findings without microbiological confirmation. [294][295]C[298][301][310][311][312]C[313]C[318]C
| Etiological pattern | Dominant mechanism or complication | Evidence |
|---|---|---|
| Acute bacterial meningitis | Neutrophilic CSF inflammation; increased CSF inflammatory biomarkers; possible culture negativity after antibiotics | [294][298][304] |
| Tuberculous meningitis | Chronic meningeal inflammation, reduced CSF glucose, increased pressure, hyponatraemia, and possible hydrocephalus | [311][318]C |
| Fungal meningitis | Chronic inflammation with impaired CSF circulation, hydrocephalus, and altered ventricular compliance | [313]C |
| Parasitic or zoonotic meningitis | Antigen-driven or infection-associated aseptic meningeal inflammation | [295]C[312]C |
| Autoimmune or postoperative meningitis-like syndromes | Sterile or immune-mediated inflammation that may mimic CNS infection | [301][310][318]C |
History and Physical Examination
- ▸In infants aged **28 days or younger**, fever may be the only sign of bacteremia or bacterial meningitis. [60]
- ▸Consider invasive bacterial infection in well-appearing febrile infants aged **60–90 days** and in infants aged **0–60 days** with temperature **≤36°C**. [116][282]
- ▸Ask specifically about CSF leakage, skull-base or temporal-bone trauma, cochlear implantation, immunosuppression, and prior neurosurgery. [51][107][124]
- ▸Document altered consciousness and all acute symptomatic seizures because seizures may be life-threatening and are associated with later epilepsy risk. [81][319]
- ▸Screen for hearing loss and other neurological sequelae during follow-up; formal audiological testing is important after infectious meningitis. [33][34]
Initial clinical assessment
Meningitis should be considered in patients with acute febrile illness accompanied by neurological or systemic features suggestive of central nervous system infection; however, the clinical presentation may be nonspecific, particularly in young infants. In infants aged 28 days or younger, fever may be the only sign of bacteremia or bacterial meningitis, and international guidance commonly recommends lumbar puncture in this age group. [60] In febrile infants aged 60–90 days, invasive bacterial infection (IBI)—defined in the cited review as bacteremia or bacterial meningitis—remains an important diagnostic consideration even when the infant appears well. [282] A systematic review of machine-learning models likewise addressed febrile infants aged up to 90 days, emphasizing the need to identify those at risk for IBI while limiting unnecessary invasive procedures. [293]
The history should establish the timing and degree of fever or temperature instability, irritability, lethargy, feeding difficulty, altered responsiveness, seizures, rash, and focal neurological symptoms, while recognizing that the absence of a classic presentation does not exclude meningitis in early infancy. This is particularly relevant for hypothermic infants: in a cohort of infants aged 0–60 days with temperature ≤36°C, serious infection included IBI and herpes simplex virus infection, demonstrating that hypothermia may also prompt evaluation for invasive infection. [116]D Temperature instability was also the clinical context examined in a retrospective cohort of hospitalized infants aged ≤60 days undergoing cerebrospinal-fluid testing and meningoencephalitis-panel evaluation. [323]
Risk-factor history
The history should specifically ask about cerebrospinal-fluid (CSF) leakage, previous skull-base or temporal-bone trauma, ear disease or surgery, cochlear implantation, immunosuppression, and recent healthcare-associated procedures. CSF leakage is a recognized risk factor for bacterial meningitis, and a national prospective pediatric cohort identified meningitis occurring in children with a known meningeal breach or cochlear implant. [51]D Spontaneous lateral skull-base CSF leaks have also been evaluated as a setting in which meningitis may occur before or after surgical repair. [107] Temporal-bone fractures may be associated with meningitis, CSF leakage, hearing loss, facial-nerve disorders, and labyrinthitis; these complications were assessed in a multinational adult database study. [124]D
The examination should include inspection for external evidence of trauma or CSF leakage, otologic abnormalities, and rash; assessment of mental status; and a complete neurological examination, including cranial nerves, hearing, motor function, coordination, and signs of focal deficit. In children with CSF leakage or cochlear implants, the possibility of bacterial meningitis should remain prominent even when the presenting symptoms are not distinctive. [51]D In adults with varicella-zoster-virus meningitis, altered level of consciousness, immunosuppression, rash, CSF findings, and timing of antiviral treatment were specifically examined in relation to clinical outcome. [81]D
Seizures and altered consciousness
Document any seizure before or during presentation, including focal or generalized features, duration, recurrence, impaired awareness, and postictal state. Acute symptomatic seizures are a frequent complication of meningitis and may be life-threatening; they are also associated with subsequent epilepsy risk. [319] The cited systematic review and meta-analysis compared cessation of antiseizure medication within 3 months of treatment initiation with cessation after more than 3 months, reflecting the importance of documenting the acute seizure history and subsequent neurological course. [319]
Altered consciousness should be assessed serially and recorded alongside focal neurological findings, because impaired consciousness may identify a more severe clinical phenotype. In PCR-confirmed adult varicella-zoster-virus meningitis, altered level of consciousness was explicitly analyzed as a host or clinical factor associated with disability and outcome. [81]D Neurological manifestations may also occur in noninfectious inflammatory disease: a systematic review found chorea in approximately 1.1% of patients with systemic lupus erythematosus, while a juvenile-onset neuropsychiatric lupus cohort evaluated seizures and other neuropsychiatric manifestations. [108][119]D
Hearing and follow-up examination
Baseline hearing should be assessed when feasible, and the history should ask about new hearing difficulty, tinnitus, vertigo, imbalance, or communication change. Sensorineural hearing loss is a recognized neurological sequela of acute infectious meningitis, and formal audiological testing has been studied as a method for detecting hearing loss after the acute illness. [34] Post-meningitis deafness may be clinically significant in patients who later undergo cochlear implantation; trans-impedance imaging has been investigated in adult cochlear-implant recipients with post-meningitis pathology. [321]
Clinical review after acute meningitis should actively screen for neurological sequelae rather than relying only on spontaneous patient reports. A systematic review and meta-analysis examined when healthcare-provider assessments detect sequelae in adults and children after all-cause acute meningitis, noting that neurological outcomes may be underreported or missed without adequate follow-up. [33] Follow-up should therefore include cognition, behavior, speech and language, motor function, seizures, balance, cranial-nerve function, and hearing, with formal audiology when hearing impairment is suspected or clinically indicated. [33][34]
Special infectious presentations
The examination should remain attentive to atypical or pathogen-specific presentations. Pediatric listeriosis beyond the neonatal period included neurolisteriosis, bacteremia, and abdominal or skin infection, indicating that meningitis may occur in children presenting with systemic or non-neurological manifestations. [320]C In adults with tuberculous meningitis, a nationwide Brazilian study compared clinical and laboratory profiles according to HIV status and evaluated factors associated with in-hospital mortality, supporting careful assessment of immunocompromise and systemic disease in suspected cases. [122]D In children with invasive pneumococcal disease, clinical characteristics have been used to distinguish patients with and without meningitis and to develop risk-stratification models, although the cited study was small and single-center. [322]
Diagnostic essential
A normal or reassuring appearance does not by itself exclude meningitis in young febrile infants, and hypothermia or temperature instability should not be considered reassuring. [60][116]D[282] Clinical assessment should integrate age, temperature pattern, mental status, seizures, rash, focal neurological findings, hearing or vestibular symptoms, immune status, CSF-leak or cochlear-implant history, and evidence of invasive bacterial disease. [51]D[81]D[122]D[293]
Diagnosis and Workup
- ▸Perform lumbar puncture when safe and obtain CSF cell count with differential, glucose, protein, Gram stain, culture, susceptibility testing, and targeted molecular or antigen testing; prior antibiotics can reduce diagnostic clarity [271][294].
- ▸In very preterm or very-low-birth-weight infants, culture-negative CSF with pleocytosis and neutrophil predominance may still represent probable meningitis [271].
- ▸Consider CSF PCT, neutrophil percentage, NGAL, and HBP as adjunctive tests when bacterial and tuberculous or other CNS infections are difficult to distinguish; they do not replace standard CSF and microbiological evaluation [294][298].
- ▸Use multiplex CSF PCR panels for rapid pathogen detection, but interpret positive and negative results against clinical probability and conventional testing [302].
- ▸Evaluate for hydrocephalus, stroke, and other complications with neuroimaging when consciousness is impaired, focal deficits or seizures occur, or fungal, postoperative, or complicated meningitis is suspected [289][301][313][326].
- ▸TBM workup should include severity assessment and monitoring for hyponatraemia; low sodium supports severity assessment but is not diagnostic of TBM [311].
- ▸In SLE with new neurological symptoms, investigate both CNS infection and NPSLE; CSF anti-suprabasin antibody is investigational [310].
Clinical approach
Meningitis is a clinical emergency in which evaluation should proceed in parallel with stabilization and, when bacterial disease is plausible, timely empiric treatment; the cited studies emphasize that clinical presentation and routine laboratory findings may be insufficient to distinguish bacterial, tuberculous, viral, fungal, postoperative, autoimmune, and other causes [294][298][300]. The diagnostic objective is to establish whether meningeal inflammation is present, identify the causative organism, detect complications, and recognize host- or exposure-specific alternatives.
The initial assessment should document fever or hypothermia, headache, vomiting, photophobia, neck stiffness, altered consciousness, seizures, focal deficits, rash, cranial-nerve abnormalities, and evidence of systemic infection. In infants—particularly those born at <32 weeks’ gestation and/or weighing <1500 g—meningitis may accompany early-onset sepsis despite negative CSF culture; one multicenter study defined “probable meningitis” as culture-negative CSF with meningitis-consistent abnormalities, including pleocytosis and neutrophil predominance [271]. In children with bacterial meningitis, stroke occurred in 13% of 540 laboratory-confirmed cases, supporting active neurological surveillance and neuroimaging when focal deficits, seizures, or deterioration occur [289].
Lumbar puncture and CSF analysis
Lumbar puncture is central to diagnosis when clinically safe. CSF should be assessed for opening pressure, appearance, leukocyte count and differential, protein, glucose with a paired blood-glucose measurement, Gram stain, bacterial culture and susceptibility testing, and targeted molecular or antigen testing according to the epidemiological and clinical context. Interpretation should account for prior antimicrobial exposure, because antibiotic pretreatment complicates differentiation between bacterial meningitis (BM) and tuberculous meningitis (TBM) [294]. Culture-negative disease does not exclude meningitis, particularly in pretreated patients or in neonatal sepsis-associated disease [271][294].
A multiplex meningitis/encephalitis PCR panel can rapidly test multiple pathogens directly in CSF, but real-world diagnostic yield and clinical relevance vary; results should therefore be interpreted with the CSF profile, pretest probability, and confirmatory microbiology rather than used in isolation [302]C. Bacterial culture remains important for organism identification and antimicrobial susceptibility. In a seven-year pediatric study of culture-positive bacterial meningitis, pathogen distribution and antimicrobial resistance were region-specific, and post-neurosurgical cases had distinct microbiological patterns [288]. Similarly, surveillance before and after PCV13 implementation showed that pneumococcal meningitis continued to require organism-level characterization because non-vaccine serotypes may emerge despite reduction in vaccine serotypes [297]C.
Biomarkers and differential diagnosis
CSF biomarkers may assist when conventional testing is equivocal. In antibiotic-pretreated patients, a prospective cohort evaluated CSF procalcitonin (PCT), neutrophil percentage, and related variables to distinguish BM from TBM; the combined-marker approach was specifically designed for this difficult clinical setting [294]. A separate prospective study evaluated CSF neutrophil gelatinase-associated lipocalin (NGAL), heparin-binding protein (HBP), PCT, and conventional markers for distinguishing acute BM from other CNS infections, inflammatory diseases, and non-inflammatory controls [298]. Serum PCT has also been assessed in a systematic review of adult intracranial infections, but its diagnostic performance should be regarded as an adjunct rather than a replacement for CSF examination and microbiological testing [300].
TBM should be considered with a subacute course, constitutional symptoms, cranial-nerve or focal findings, hydrocephalus, or compatible epidemiology. The linezolid meta-analysis included patients with clinically diagnosed TBM, illustrating that treatment trials may use clinical diagnostic criteria even when microbiological confirmation is incomplete [324]. The steroid meta-analysis likewise evaluated controlled TBM trials and found that disease severity and outcomes were clinically important, but the study does not establish a new diagnostic test [325]. Hyponatraemia is common in TBM: 92.6% of adults with sodium measured at presentation were hyponatraemic in one observational cohort, and lower sodium was associated with more severe TBM and greater CSF inflammation; sodium and osmolality assessment can therefore support severity assessment and complication monitoring, but cannot establish TBM [311].
Fungal and exposure-related causes require targeted testing. Cryptococcal meningitis has clinically relevant differences between HIV-negative and HIV-positive patients; in an observational cohort, unfavorable 12-month outcome was more frequent in HIV-negative patients (19.1% versus 5.0%), and impaired consciousness and motor deficits predicted poorer outcome [326]. These findings support HIV testing, cryptococcal antigen testing, fungal culture or molecular testing, and neuroimaging when cryptococcosis is suspected [326]. Coccidioidal meningitis may be complicated by hydrocephalus and can require CSF diversion; compatible travel or residence in endemic regions should prompt Coccidioides-specific testing [313]C. Leptospiral meningitis is an under-recognized cause of aseptic meningitis in tropical settings, and diagnosis should incorporate exposure history plus targeted laboratory testing when compatible CSF findings and systemic features are present [295]C.
Imaging and special populations
Neuroimaging is indicated before or after lumbar puncture according to clinical risk and whenever there are focal deficits, impaired consciousness, seizures, suspected hydrocephalus, raised intracranial pressure, stroke, abscess, or postoperative complications. Imaging is particularly important in cryptococcal and coccidioidal meningitis because hydrocephalus and other structural complications may determine management [313]C[326]. In pediatric bacterial meningitis, neuroimaging confirmed stroke in affected patients and helped define neurological outcome [289]. After posterior fossa tumor surgery, postoperative meningitis may be culture-positive or culture-negative; early CSF cytology and analysis of CSF biochemical and cellular characteristics were evaluated as part of risk stratification [301].
In patients with systemic lupus erythematosus and new neuropsychiatric symptoms, infection must be distinguished from neuropsychiatric SLE. A prospective cohort classified patients as NPSLE, SLE with CNS infection, or SLE without either condition and evaluated CSF anti-suprabasin antibody by ELISA; this remains an investigational biomarker requiring validation before routine use [310].
Diagnostic essentials
Diagnosis should integrate clinical syndrome, CSF inflammation, microbiology, molecular testing, imaging, host factors, exposure history, and treatment history. No single biomarker or negative culture excludes meningitis, and novel tests—including CSF PCT-related markers, NGAL, HBP, anti-suprabasin antibody, and multiplex PCR—should be interpreted within this integrated framework [271][294][298][300][302]C[310].
| Clinical context | Diagnostic emphasis |
|---|---|
| Antibiotic-pretreated suspected BM or TBM | Interpret CSF profile with CSF PCT, neutrophil percentage, culture, and molecular testing; pretreatment complicates discrimination [294]. |
| Very preterm/VLBW infant with early-onset sepsis | Do not exclude meningitis solely because CSF culture is negative; pleocytosis and neutrophil predominance may define probable meningitis [271]. |
| Suspected TBM | Use clinical, CSF, microbiological, imaging, and epidemiological evidence together; monitor sodium and osmolality because hyponatraemia is frequent [311][324][325]. |
| Suspected cryptococcal or coccidioidal meningitis | Obtain targeted fungal testing and image for hydrocephalus or other structural complications; HIV status influences cryptococcal prognosis [313]C[326]. |
| Tropical exposure with aseptic meningitis | Consider leptospirosis and obtain targeted testing when exposure and systemic findings are compatible [295]C. |
| SLE with neuropsychiatric symptoms | Exclude CNS infection while evaluating NPSLE; anti-suprabasin antibody testing remains investigational [310]. |
| Post-neurosurgical or posterior fossa surgery | Combine CSF culture, cytology, biochemical and cellular findings, and clinical course; culture-negative postoperative meningitis occurs [288][301]. |
Differential Diagnosis of Meningitis
- ▸Antibiotic administration prior to lumbar puncture occurs in nearly 45% of cases and significantly impairs the sensitivity of CSF cultures, necessitating the use of molecular methods like multiplex PCR or mNGS.
- ▸GFAP astrocytopathy is a critical autoimmune mimic of infectious meningitis, often distinguishable by linear perivascular radial enhancement on MRI and a positive response to corticosteroids.
The differential diagnosis of meningitis is broad, encompassing infectious, autoimmune, and neoplastic etiologies that often present with overlapping clinical features such as fever, headache, and meningismus. Distinguishing between these entities is critical, as strategies vary significantly—ranging from urgent antimicrobial therapy for bacterial pathogens to immunosuppression for autoimmune mimics like (GFAP) astrocytopathy [131][143]C. ### Diagnostic Criteria Formal diagnosis of meningitis requires a combination of clinical suspicion and laboratory confirmation.
Management of Meningitis
- ▸Empiric antibiotics (e.g., Ceftriaxone 2 g + Vancomycin 15-20 mg/kg) must be administered within 60 minutes of presentation to reduce mortality.
- ▸Dexamethasone (0.15 mg/kg) should be given before or with the first antibiotic dose to mitigate the inflammatory response to bacteriolysis.
The of is a medical emergency requiring rapid stabilization, immediate administration of empiric antimicrobials, and targeted adjunctive therapies to mitigate neuroinflammation. Delay in treatment is a primary driver of poor outcomes, particularly in bacterial and tuberculous forms where the host immune response often exacerbates brain injury [73]D[158]. ### Step 1: Initial Assessment and Severity Classification Upon presentation, clinicians must immediately assess for signs of increased intracranial pressure (ICP) and systemic instability.
Supportive Care and Complication Management
- ▸Begin empiric antimicrobial treatment promptly when acute bacterial meningitis is suspected; the optimal early-versus-delayed threshold remains uncertain in the available evidence [331].
- ▸Use local pediatric pathogen and antimicrobial-resistance data to guide empiric therapy, particularly after neurosurgery [288].
- ▸Consider uncommon etiologies such as Naegleria fowleri, Listeria, Leptospira, and West Nile virus when clinical or epidemiological features are atypical [332,315,98,335].
- ▸Individualize ASM duration after meningitis-associated acute symptomatic seizures; the key evidence comparison is cessation within versus beyond **3 months** [319].
- ▸LD/EVD may be considered for severe meningitis with raised ICP or CSF-flow obstruction, but indications and timing are not standardized [166].
- ▸Arrange structured post-discharge surveillance, including formal hearing assessment and neurological, cognitive, developmental, and seizure follow-up [33,34,333].
Immediate supportive priorities
Acute bacterial meningitis is a medical emergency: empiric antimicrobial treatment should be initiated promptly when bacterial meningitis is suspected, because delayed therapy may increase mortality and neurological sequelae [331]. The available 2026 systematic review identified three prospective cohort studies comparing earlier with delayed empiric treatment, but the supplied evidence does not establish a definitive timing threshold or a universally superior strategy [331]. Empiric regimens should therefore be selected according to age, immune status, exposure history, local epidemiology, and antimicrobial-resistance data, with subsequent narrowing when microbiological results become available [288]. Pediatric pathogen distribution and resistance patterns are region-specific and dynamic; a 7-year study from Southwest China included 258 culture-positive children and specifically emphasized the importance of local surveillance, particularly in post-neurosurgical meningitis [288].
The differential diagnosis should remain broad when the presentation or cerebrospinal-fluid findings are atypical. Naegleria fowleri primary amoebic meningoencephalitis can mimic bacterial meningitis, and delayed recognition in neonates and infants is associated with poor outcomes [332]C. Other regionally or epidemiologically relevant causes include neuroleptospirosis, which was investigated among patients presenting with meningitis, meningoencephalitis, or encephalitis in a multicentre Sri Lankan study [98]D, and neuroinvasive West Nile virus infection, which included meningitis and meningoencephalitis during an Istanbul outbreak [335]C. Listeria monocytogenes should remain a consideration beyond the neonatal period; a Turkish multicentre pediatric series described 11 previously unpublished, microbiologically confirmed cases in children aged 1 month to 18 years [315]C.
Seizures and antiseizure medicines
Acute symptomatic seizures are a potentially life-threatening complication of meningitis and may indicate increased risk of subsequent epilepsy [319]. The optimal duration of antiseizure medication (ASM) after meningitis-associated acute symptomatic seizures remains uncertain; a 2026 systematic review and meta-analysis compared cessation within 3 months of treatment initiation with cessation after more than 3 months [319]. Decisions about continuation or withdrawal should therefore be individualized according to seizure recurrence, electroclinical findings, structural injury, neurological examination, and specialist follow-up; the supplied abstract does not provide sufficient outcome estimates to mandate one duration for all patients [319]. Evidence from adults with HIV and new-onset seizures is not specific to meningitis, although it demonstrates that recurrence and mortality remain clinically important outcomes requiring follow-up in immunocompromised populations [337]. Veterinary epilepsy data should not be extrapolated to human meningitis management [327].
Raised intracranial pressure, hydrocephalus, and CSF diversion
Raised intracranial pressure (ICP) is associated with substantial morbidity and mortality in meningitis [166]. Lumbar drainage and external ventricular drainage (LD/EVD) have been used as adjuncts to antimicrobial therapy in severe disease, but there is no established standard for incorporating CSF diversion into routine meningitis care [166]. A systematic review identified 41 studies of LD and/or EVD and emphasized consideration of divertive treatment even when hydrocephalus is not demonstrated; this evidence should be interpreted by multidisciplinary teams because the optimal device, indications, and timing remain unsettled [166].
Post-meningitic hydrocephalus may require temporary CSF diversion in children. In a pediatric cohort managed with an Ommaya reservoir, delayed CSF sterilization was defined as requiring more than 14 days to obtain two sterile cultures collected at least 48 hours apart; a multivariable prediction model was developed to estimate this risk [336]. Persistent infection, impaired consciousness, focal deficits, or radiological hydrocephalus warrant urgent neurosurgical and infectious-disease assessment [326][336]. In cryptococcal meningitis, choroid plexitis may cause ependymitis, synechiae, trapped ventricles, and obstructive hydrocephalus, while gelatinous pseudocysts may contribute to false-negative smear or culture results [334]. A retrospective cohort of 181 cryptococcal meningitis patients evaluated neuroimaging predictors and surgical intervention, with unfavorable 12-month outcomes reported more often in HIV-negative than HIV-positive patients (19.1% vs 5.0%) [326].
Fungal, granulomatous, and inflammatory complications
Cryptococcal meningitis may occur in immunocompetent as well as immunocompromised individuals and can present with seizures, altered mentation, and obstructive CSF-flow abnormalities [334]. Pediatric central nervous system coccidioidomycosis is severe and generally requires lifelong antifungal therapy; fluconazole is recommended as initial treatment in children, although fluconazole failure has prompted use of intravenous liposomal amphotericin B in case-series practice [163]C. Tuberculous meningitis in childhood carries a high risk of death or severe neurological sequelae, and age-disaggregated clinical predictors have been studied in children younger than 15 years [292]. Neuropsychiatric systemic lupus erythematosus may produce inflammatory or leukodystrophy-like neurological syndromes, but evidence concerning anifrolumab is based on rationale, case reports, and systematic literature review rather than randomized trials in neuropsychiatric disease [129][85]. These inflammatory disorders should not be presumed to represent infectious meningitis without appropriate diagnostic evaluation [129][85].
Discharge planning and surveillance for sequelae
Follow-up should actively assess neurological, cognitive, behavioral, motor, and sensory outcomes because post-meningitic sequelae may be underdetected when review is delayed or access to healthcare is limited [33]. Formal audiological testing is important after acute infectious meningitis because sensorineural hearing loss may otherwise remain unrecognized; early detection can reduce the consequences of permanent deafness, including cognitive, social, and mental-health effects [34]. Childhood bacterial meningitis is associated with post-discharge complications, and a systematic review and meta-analysis evaluated these outcomes in patients aged 29 days to 18 years [333]. Discharge plans should therefore include scheduled clinical review, hearing assessment, seizure review, developmental and educational screening in children, rehabilitation referral where needed, and clear return precautions for worsening headache, altered consciousness, recurrent seizures, focal deficits, or fever [33][34][333].
| Complication or risk | Supportive-care action | Evidence |
|---|---|---|
| Acute symptomatic seizures | Treat acutely and reassess the need and duration of ASM individually; compare withdrawal decisions against the unresolved 3-month threshold | [319] |
| Raised ICP or hydrocephalus | Obtain urgent specialist assessment; consider LD/EVD when clinically indicated, recognizing the absence of a standardized approach | [166][336] |
| Hearing loss | Arrange formal audiological testing after infectious meningitis and provide early hearing rehabilitation when required | [34] |
| Long-term neurological sequelae | Schedule clinical, developmental, cognitive, behavioral, and functional review after discharge | [33][333] |
| Cryptococcal CSF-flow complications | Consider choroid plexitis, trapped ventricles, and obstructive hydrocephalus when imaging or microbiology is discordant | [334][326] |
Prognosis and Long-term Outcomes
- ▸Prognosis varies by organism, age, baseline neurological status, complications, host factors, and treatment timing; outcome estimates should not be generalized across etiologies. [287][325][326]
- ▸Meningococcal disease has reported case-fatality ratios of 12.8% in epidemic settings and 3.0% in endemic settings in the cited systematic review. [287]
- ▸In TBM, adjunctive corticosteroids reduced adult mortality but did not show a significant mortality benefit in children; overall neurological and functional benefits were not significant in the cited meta-analysis. [325]
- ▸Adjunctive linezolid showed a possible mortality benefit in TBM, but the evidence was low certainty and the 95% credible interval included no effect. [324]
- ▸Hyponatraemia was present in 92.6% of assessed Vietnamese adults with TBM and was associated with greater disease severity and CSF inflammation. [311]
- ▸Unfavorable 12-month outcomes in cryptococcal meningitis were more frequent in HIV-negative than HIV-positive patients, and impaired consciousness and motor deficits were adverse prognostic factors. [326]
- ▸Stroke occurred in 13% of children with bacterial meningitis in the cited Auckland cohort. [289]
- ▸Primary amoebic meningoencephalitis in neonates and infants is rare but often fatal, and delayed recognition may worsen outcomes. [332]
Overall prognosis
Prognosis depends substantially on the causative organism, age, baseline neurological status, complications, host factors, and speed of effective treatment. The available evidence is heterogeneous: it includes randomized trials and meta-analyses for tuberculous meningitis (TBM), observational cohorts for cryptococcal and bacterial meningitis, and case series or systematic reviews for uncommon causes. Consequently, outcome estimates should not be generalized across meningitis etiologies.
Invasive meningococcal disease may progress rapidly and is associated with substantial mortality and severe sequelae. In India, reported case-fatality ratios were 20.9% during the 1966 Delhi outbreak and 12.8% across epidemic settings in a systematic review; the reported case-fatality ratio in endemic settings was 3.0%. [287] Pneumococcal meningitis remains a major cause of bacterial meningitis, and post-PCV13 epidemiology requires ongoing assessment because non-vaccine serotypes may emerge; the cited Taiwanese cohort compared clinical characteristics, antimicrobial susceptibility, outcomes, and serotype distributions from 2009–2025 but the supplied abstract does not report the numerical outcome estimates. [297]C
Tuberculous meningitis
TBM remains associated with a high risk of death and neurological disability despite standard therapy; one recent review describes case-fatality rates of up to 50% in resource-limited settings. [341] Adjunctive corticosteroids reduced mortality in adults in a 14-trial meta-analysis involving 2,028 patients (RR 0.83, 95% CI 0.72–0.95), but a significant mortality benefit was not demonstrated in children (RR 0.68, 95% CI 0.36–1.29). The same review found no significant overall reduction in neurological complications or improvement in functional recovery. [325]
A separate systematic review and meta-analysis evaluated corticosteroid-associated mortality, gastrointestinal bleeding, visual and auditory impairment, hydrocephalus, and joint disorders using GRADE assessment; the supplied abstract does not provide the pooled numerical results, so these outcomes should not be assigned an effect estimate from that source. [341]
Adjunctive linezolid may improve survival, but certainty remains low. In three randomized trials, linezolid had a 92% probability of preventing one death per 100 treated patients, corresponding to RR 0.55 (95% credible interval 0.23–1.31), with low heterogeneity (I² 13%) and 104 participants; the credible interval includes no effect, and the evidence was rated low certainty. [324] A 29-trial network meta-analysis including 4,640 TBM patients compared available drug regimens for mortality, neurological events, and adverse events; the supplied abstract does not report the comparative estimates, so treatment rankings cannot be inferred from the available information. [286]
TBM complications may themselves predict poor outcome. In a cohort of 208 Vietnamese adults enrolled in corticosteroid trials, hyponatraemia was present in 92.6% of 190 patients with sodium measured at presentation; lower sodium was associated with more severe TBM and greater CSF inflammation. Clinical endpoints were recorded through 12 months, but the supplied abstract does not report the adjusted association between hyponatraemia and final outcomes. [311] Management of TBM-related drug-induced liver injury is also clinically relevant because premature withdrawal of rifampicin or isoniazid may contribute to poor outcomes; a randomized comparison evaluated three management strategies over the 60 days after DILI randomization, but numerical outcome results are not supplied. [338] An open-label randomized trial comparing streptomycin with ethambutol as the fourth intensive-phase drug was stopped early because of slow recruitment; both groups received prolonged therapy, and the primary endpoint was mortality at 6 months, but the supplied abstract does not report results. [339]
Cryptococcal, amoebic, and other uncommon meningitides
In a retrospective cohort of 181 patients with cryptococcal meningitis, the unfavorable 12-month modified Rankin Scale outcome rate was higher in HIV-negative than HIV-positive patients (19.1% vs 5.0%). Impaired consciousness and motor deficits were independent adverse prognostic factors, with reported odds ratios of 5.51 (95% CI 2.13–14.26) and 3.83, respectively. [326]
Primary amoebic meningoencephalitis caused by Naegleria fowleri is rare but often fatal, particularly in neonates and infants; its clinical similarity to bacterial meningitis can delay diagnosis and treatment. [332]C Meningitis associated with neurocysticercosis is underdiagnosed; a systematic review of 48 published cases found headache in 45 cases (94%), with fever and vomiting each reported among 20 cases. [312]C
Neurological sequelae and predictors
Stroke complicated laboratory-confirmed pediatric bacterial meningitis in 72 of 540 patients (13%) in a retrospective Auckland cohort; stroke was evaluated by neuroimaging and was associated with additional neurological risk, although the supplied abstract does not provide the final comparative outcome estimates. [289] In very preterm or very-low-birth-weight infants with early-onset sepsis, probable meningitis was defined by meningitis-consistent CSF abnormalities without culture confirmation; a multicenter retrospective study developed a prediction nomogram, but the supplied abstract does not report its discrimination or long-term outcome data. [271]
In children with enterovirus-associated meningoencephalitis assessed after widespread EV71 vaccination, EV71 cases did not show significantly greater clinical severity or different outcomes than cases caused by other enterovirus subtypes in a 160-patient single-center cohort. [328] Long-term sequelae are also important after related neuroinfections: among 105 Latvian adults followed at least 6 months after laboratory-confirmed tick-borne encephalitis, structured assessments evaluated neurocognitive, subjective, and neurological sequelae, although the supplied abstract does not provide their frequencies. [340]
HIV-related neurological complications remain associated with mortality; a Cameroonian retrospective cohort from 2016–2023 assessed prevalence and mortality predictors among people living with HIV, but the supplied abstract does not report the numerical mortality estimates. [284] The veterinary MUO study in older dogs is not directly applicable to human meningitis; it nevertheless illustrates that age-specific presentation, relapse, and survival may differ and should not be extrapolated across species. [329]
Practical interpretation
Long-term assessment should extend beyond survival to functional status, cognition, motor deficits, sensory impairment, hydrocephalus, seizures, and other neurological complications when relevant to the etiology. Available evidence supports early etiologic diagnosis, prompt pathogen-directed therapy, careful management of complications, and structured follow-up, while recognizing that several newer studies report incomplete or population-specific outcome data. [287][324][325][326][332]C[340]
| Condition or population | Outcome finding | Reference |
|---|---|---|
| Meningococcal disease, Indian epidemic settings | Case-fatality ratio 12.8% | [287] |
| Meningococcal disease, Indian endemic settings | Case-fatality ratio 3.0% | [287] |
| TBM, adults receiving adjunctive corticosteroids | Mortality RR 0.83 (95% CI 0.72–0.95) | [325] |
| TBM, linezolid meta-analysis | RR for mortality 0.55 (95% CrI 0.23–1.31); low-certainty evidence | [324] |
| TBM, Vietnamese adults | Hyponatraemia at presentation 92.6% | [311] |
| Cryptococcal meningitis | Unfavorable 12-month mRS: 19.1% HIV-negative vs 5.0% HIV-positive | [326] |
| Pediatric bacterial meningitis | Stroke in 72/540 patients (13%) | [289] |
Landmark Trials and Key Evidence
- ▸Early empiric antimicrobial treatment is biologically compelling, but comparative evidence remains limited to three prospective cohort studies in the cited review.[331]
- ▸High-dose rifampin regimens of up to 35 mg/kg have pharmacokinetic rationale, but pooled randomized evidence did not reduce all-cause mortality.[59][31][188]
- ▸Adjunctive linezolid showed a favorable probability signal but low-certainty evidence and a confidence/credible interval crossing no effect.[324]
- ▸Dexamethasone benefit in tuberculous meningitis may vary by LTA4H genotype, with greatest prior benefit associated with the hyperinflammatory TT genotype.[84]
- ▸Single-dose liposomal amphotericin B plus fluconazole is a tested strategy for preventing cryptococcal meningitis in people with HIV-associated cryptococcal antigenemia.[193]
- ▸Meningococcal vaccination evidence now includes a pentavalent conjugate vaccine covering serogroup X in addition to A, C, W, and Y.[190]
Scope and interpretation
Recent evidence spans acute bacterial, tuberculous, cryptococcal, neonatal, pediatric, vaccine-prevention, and immune-mediated meningitis. The strongest evidence comes from systematic reviews and meta-analyses of randomized controlled trials, although several contemporary studies remain limited by small samples, heterogeneous populations, or incomplete outcome information in the available reports.[324][319][331][31]
Acute bacterial meningitis: timing, duration, and adjunctive corticosteroids
Prompt empiric antimicrobial treatment is biologically and clinically important in acute bacterial meningitis, but the comparative evidence for “early” versus “delayed” administration remains limited. A systematic review identified three prospective cohort studies; the review used GRADE assessment, but the supplied abstract does not provide pooled effect estimates.[331] Antibiotic duration in children has also been reassessed. A systematic review and meta-analysis compared courses of ≤7 days with longer treatment, defined as 10 days or twice the short-course duration, for meningitis caused predominantly by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, evaluating treatment failure, death, neurologic sequelae, hearing impairment, and other complications.[343]
The role of adjunctive corticosteroids in pediatric bacterial meningitis remains controversial. A meta-analysis of randomized trials evaluated hearing loss and neurologic sequelae as primary outcomes, with fever resolution, mortality, secondary fever, and reactive arthritis as secondary outcomes.[185] The available abstract establishes the scope of the evidence but does not provide the pooled numerical results; therefore, corticosteroid benefit should not be generalized across all pediatric etiologies or outcomes solely from this review.[185]
For infants aged 0–59 days, a systematic review of randomized trials compared alternative antibiotic regimens and assessed critical clinical outcomes, reflecting the uncertainty surrounding optimal treatment in this high-risk age group.[342]
Tuberculous meningitis: intensified antimicrobial and adjunctive strategies
The 2025 double-blind, placebo-controlled trial of high-dose oral rifampin enrolled adults with tuberculous meningitis, with and without HIV, in Indonesia, South Africa, and Uganda. Participants received standard isoniazid, rifampin 10 mg/kg, ethambutol, and pyrazinamide, plus either additional rifampin to a cumulative dose of 35 mg/kg or placebo.[59] A 2026 meta-analysis pooled seven randomized trials involving 1,296 patients and reported that high-dose rifampin did not reduce all-cause mortality; the supplied abstract does not include the complete mortality estimate or serious-adverse-event result.[31]
Pharmacokinetic analyses explain the rationale for dose intensification. In adults with HIV-associated tuberculous meningitis, experimental regimens used oral rifampin 35 mg/kg or intravenous rifampin 20 mg/kg, with linezolid, with or without aspirin, versus standard oral rifampin 10 mg/kg; rifampin concentrations were modeled in plasma and cerebrospinal fluid on study days 3 and 28.[188] A nested pharmacokinetic study evaluated dexamethasone exposure in a randomized comparison of high-dose rifampin plus linezolid, with or without aspirin, versus standard-dose rifampin; all participants received dexamethasone beginning at 0.4 mg/kg/day, divided every 12 hours, and rifampin-associated reduction in dexamethasone exposure was a principal concern.[345]
Adjunctive linezolid has emerging but low-certainty support. A Bayesian meta-analysis of three randomized trials found a 92% probability that linezolid prevents one death per 100 treated patients, with pooled RR 0.55 (95% credible interval 0.23–1.31), low heterogeneity (I²=13%), and 104 participants.[324] The uncertainty interval crosses no effect, so linezolid should be viewed as investigational or selectively adjunctive rather than established mortality-reducing standard therapy.[324]
A randomized prospective pharmacokinetic study in 10 patients compared linezolid-containing and contezolid-containing regimens, five patients per group. Contezolid cerebrospinal-fluid concentrations exceeded the M. tuberculosis MIC of 0.5 μg/mL at 2 hours, with a median of 1.0806 μg/mL, but declined by 6 hours to a median of 0.7920 μg/mL; the study primarily addressed CSF exposure and safety, not clinical efficacy.[83]
Adjunctive corticosteroid therapy remains genotype-sensitive. In a phase 3 placebo-controlled trial of HIV-negative Vietnamese adults, 613 LTA4H CC- or CT-genotype participants were randomized to 6–8 weeks of dexamethasone or placebo, with a prespecified hazard-ratio noninferiority margin of 0.75 for placebo.[84] The trial was designed around evidence that benefit is more apparent in the hyperinflammatory TT genotype, whereas benefit is uncertain in CC and CT genotypes.[84]
Management of treatment toxicity has also been tested prospectively. Adults developing antituberculous-treatment drug-induced liver injury were randomized to: continuing all drugs unless severe biochemical or clinical thresholds were reached; stopping pyrazinamide unless predefined deterioration occurred; or stopping rifampin, isoniazid, and pyrazinamide while continuing ethambutol and adding levofloxacin plus an aminoglycoside.[338] The parent ACT HIV and LAST ACT corticosteroid trials contributed 520 and 720 participants, respectively, and the primary outcome was time on treatment during the 60 days after liver-injury randomization.[338]
Cerebrovascular complications and cryptococcal meningitis
The ACT-TBM randomized trial enrolled 237 patients in a secondary analysis examining cerebral infarction patterns, associated factors, and predictors; the parent trial evaluated aspirin or clopidogrel added to standard antituberculous therapy for stroke or cerebral infarction outcomes.[156]
In HIV-associated cryptococcal meningitis, AMBITION-cm data were used to study EBV and CMV coinfections and mortality; the parent randomized trial’s primary endpoint was 10-week all-cause mortality, and participants were recruited across seven sites in five African countries.[38] Pooled ACTA and AMBITION-cm trial data also supported development and validation of individualized mortality-prediction tools for adults with HIV-associated cryptococcal meningitis in sub-Saharan Africa.[189]
Pre-emptive therapy is another major prevention strategy. In Ugandan adults with HIV and asymptomatic cryptococcal antigenemia, single-dose liposomal amphotericin B 10 mg/kg plus fluconazole was compared with fluconazole alone for 24-week meningitis-free survival; historically, 25–30% of asymptomatic antigen-positive people receiving fluconazole alone developed breakthrough meningitis or died.[193]
Prevention and special populations
A phase 3 noninferiority trial in Mali evaluated the pentavalent meningococcal conjugate vaccine NmCV-5, targeting serogroups A, C, W, Y, and X, against MenACWY-TT when co-administered with routine childhood vaccines at ages 9 and 15 months.[190] Finally, evidence relevant to inflammatory mimics includes a systematic review of 90 studies addressing treatment of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus, a heterogeneous group that can resemble infectious meningitis but requires disease-specific management.[344]
Evidence gaps
Important uncertainties persist regarding optimal empiric-treatment timing, abbreviated pediatric antibiotic courses, corticosteroid selection, high-dose rifampin, linezolid and contezolid efficacy, genotype-guided dexamethasone use, and management of antituberculous drug-induced liver injury.[331][343][185][31][324][83][84][338]
| Evidence area | Design/population | Principal reported finding or endpoint |
|---|---|---|
| Adjunctive linezolid in TBM | Bayesian meta-analysis; 3 RCTs; n=104 | RR for death 0.55; 92% probability of preventing one death per 100 treated; low certainty.[324] |
| High-dose rifampin in TBM | Meta-analysis; 7 RCTs; n=1,296 | No reduction in all-cause mortality reported in the supplied abstract.[31] |
| High-dose rifampin trial | Double-blind RCT; adults with and without HIV | Standard regimen plus rifampin 35 mg/kg cumulative versus placebo.[59] |
| Genotype-stratified dexamethasone | Phase 3 RCT; HIV-negative Vietnamese adults; n=613 CC/CT | Dexamethasone versus placebo; placebo noninferiority margin HR 0.75.[84] |
| Cryptococcal antigenemia prevention | Randomized trial; adults with HIV in Uganda | Liposomal amphotericin B 10 mg/kg once plus fluconazole versus fluconazole; 24-week meningitis-free survival.[193] |
| NmCV-5 vaccination | Phase 3 noninferiority RCT; Malian infants | Pentavalent A, C, W, Y, X vaccine versus MenACWY-TT.[190] |
Special Populations
- ▸Maintain a low threshold for CSF evaluation in febrile infants aged **≤90 days**, premature infants, and very-low-birth-weight infants with sepsis [293][271][348].
- ▸Neonatal meningitis can cause ventriculitis, hydrocephalus, empyema, brain abscess, encephalomalacia, death, and long-term neurodevelopmental impairment [347][351][208].
- ▸Children require post-discharge surveillance because stroke and persistent developmental, neurological, hearing, and functional complications are well documented [289][333].
- ▸Consider LCMV in suspected congenital CNS infection with chorioretinitis, ventriculomegaly, neurological malformations, or fetal loss [75][307].
- ▸In advanced HIV disease, cryptococcal meningitis commonly coexists with major risks from opportunistic infection and tuberculosis; preventive-therapy delivery and shorter antifungal induction strategies are being evaluated [155][215][349].
Neonates and young infants
Meningitis in neonates and young infants may present atypically, and the threshold for investigation should remain low because invasive bacterial infection can progress rapidly. A systematic review of machine-learning models in febrile infants aged ≤90 days evaluated their ability to identify invasive bacterial infection, defined as bacteremia and/or meningitis; however, the clinical role of these models remains under evaluation and they should not replace clinical assessment, cultures, or cerebrospinal-fluid (CSF) analysis when indicated [293]. In a Saudi Arabian children’s hospital, a retrospective study of infants aged ≤90 days examined the organisms causing invasive bacterial infection and potential mismatch between empiric therapy and pathogen susceptibility, highlighting the importance of local epidemiology when selecting initial antibiotics [348]C.
Early-onset neonatal bacterial meningitis, defined in one 20-year retrospective study by symptom onset within 7 days of birth, showed clinically important differences between preterm and full-term infants. Preterm infants had higher frequencies of premature rupture of membranes, apnea, and need for respiratory support than full-term infants [350]. In very preterm and/or very-low-birth-weight infants with early-onset sepsis, a multicenter study defined “probable meningitis” as culture-negative CSF with meningitis-consistent abnormalities, including pleocytosis and neutrophil predominance; all included infants underwent lumbar puncture [271]. These findings support careful consideration of meningitis even when CSF culture is negative, particularly in high-risk premature infants [271].
Neonatal bacterial meningitis carries a substantial risk of acute neurological complications, including subdural effusion or empyema, ventriculitis, hydrocephalus, brain abscess, and encephalomalacia [351]. In a cohort of 68 neonates, 20 developed one or more such complications; the study identified differences in age at symptom onset and laboratory findings between neonates with and without complications, although the abstract does not provide the complete multivariable results [351]. Culture-proven neonatal meningitis in Australian tertiary hospitals was uncommon but severe: among 21 infections, four infants died, and neurological sequelae were frequent among survivors [347]. Early developmental surveillance is therefore important. In a retrospective infant cohort, motor assessment at 3–4 months’ corrected age using the Motor Optimality Score–Revised was evaluated for association with Bayley developmental outcomes at 12 or 24 months [208].
Children and adolescents
The pediatric burden extends beyond acute mortality. A systematic review and meta-analysis of bacterial meningitis in patients aged 29 days to 18 years assessed post-discharge complications and excluded tuberculosis meningitis; pooled results from 13 studies demonstrate the need for structured follow-up for neurological, developmental, hearing, and functional sequelae, with certainty assessed using GRADE [333]. Stroke is a particularly serious complication. In a retrospective case-control cohort of 540 children aged 0–15 years with bacterial meningitis, stroke occurred in 72 (13%) and was confirmed by neuroimaging; affected children were compared with age- and organism-matched controls to evaluate presentation, treatment, and neurological outcome [289].
Population-based Danish data from 2017–2023 identified 465 previously healthy children aged 0–17 years with microbiologically verified CNS infection or imaging-confirmed cerebral abscess/empyema. The annual incidence of viral CNS infection was 49 per million, bacterial meningitis 24 per million, and cerebral abscess or related focal infection 7 per million [346]. Listeria monocytogenes meningitis remains rare beyond the neonatal period but should not be excluded solely because a child is older than the neonatal age range. A Turkish multicenter case series described 11 microbiologically confirmed pediatric cases aged 1 month–18 years; CSF culture was positive in 10/11 (90.9%), while CSF PCR confirmed infection in all nine tested patients [315]C.
Pregnancy, fetuses, and newborns
Lymphocytic choriomeningitis virus (LCMV) is a rodent-borne infection capable of causing severe congenital CNS disease. In Philadelphia, LCMV IgG seroprevalence was 2.4% among 700 pregnant women in a high-risk group and 2.7% among 300 randomly selected pregnant women; prevalence varied by hospital, maternal race or ethnicity, and neighborhood deprivation [75]D. Probable congenital infection has been associated with chorioretinitis, cerebral ventriculomegaly, major neurological malformations, and fetal demise. Reported cases support testing for LCMV antibodies, ophthalmological assessment for chorioretinitis, and review of placental pathology when congenital infection is suspected [307]C.
Primary amoebic meningoencephalitis caused by Naegleria fowleri can mimic bacterial meningitis. A systematic review focused specifically on neonates and infants and examined clinical features, diagnostic challenges, treatment strategies, and outcomes; the rarity and high fatality of this infection make early recognition essential when the epidemiological and clinical context is compatible [332]C.
People living with HIV and other immunocompromised patients
Cryptococcal meningitis is a major opportunistic CNS infection in people with HIV and is associated with considerable mortality and morbidity [215]D. In Uganda, the IMPROVE phase-3 open-label non-inferiority randomized strategy trial recruited adults with advanced HIV disease hospitalized for cryptococcal meningitis who had been screened for active tuberculosis during hospitalization. It evaluated inpatient initiation of 1 month of daily isoniazid plus rifapentine (1HP) as an approach to improve tuberculosis preventive-therapy coverage; the study was designed to assess safety and feasibility in this high-risk population [155].
Treatment strategies for cryptococcal meningitis continue to evolve. A US pre-post cohort evaluated the AMBITION protocol—single-dose liposomal amphotericin followed by two weeks of fluconazole and flucytosine—and compared mortality and recurrence outcomes with a guideline-compliant daily amphotericin-based regimen in people with HIV treated at a large public hospital [215]D. In Ethiopia, a systematic review and meta-analysis examined the prevalence of opportunistic fungal infections, including cryptococcal meningitis and candidiasis, among people living with HIV across different regions [349].
Neurological complications remain clinically important despite the Test and Treat era. A retrospective cohort from two hospitals in Douala, Cameroon, reviewed HIV-associated neurological complications from 2016–2023 and evaluated demographic, clinical, laboratory, imaging, treatment, and mortality predictors [284]. New-onset seizures also require broad consideration of infectious and noninfectious etiologies. In a prospective rural cohort of adults with HIV, 95 were eligible and 89 enrolled; two-year seizure recurrence and mortality were assessed, including among participants receiving antiretroviral therapy, many of whom were not virologically suppressed [337]. Recurrent HSV-2 (Mollaret) meningitis is uncommon even among people with HIV. A case report described recurrent self-limited aseptic meningitis in a virologically suppressed man with preserved CD4 count and explored patient-initiated episodic valacyclovir [352]C.
| Population | Key concerns | Evidence |
|---|---|---|
| Neonates and young infants | Atypical presentation, culture-negative probable meningitis, rapid neurological deterioration | [271][293][348]C[350] |
| Children and adolescents | Stroke, post-discharge sequelae, rare pathogens including Listeria | [289][315]C[333] |
| Pregnancy and newborn period | Congenital LCMV with chorioretinitis, ventriculomegaly, malformations, or fetal demise | [75]D[307]C |
| Advanced HIV disease | Cryptococcal meningitis, opportunistic fungal infection, tuberculosis-prevention needs, seizures, and recurrent HSV-2 meningitis | [155][215]D[284][337][349][352]C |
Prevention and Screening
- ▸Use routine childhood immunisation and locally appropriate meningococcal conjugate vaccination as the primary prevention strategy for vaccine-preventable meningitis. [186][190][287]
- ▸NmCV-5 targets serogroups A, C, W, Y, and X and has been evaluated with routine vaccines at 9 and 15 months in Mali. [190]
- ▸Reactive NmCV-5 vaccination has been evaluated after outbreaks in Niger among people aged 1–19 years, with effectiveness assessment beginning 10 days after vaccination. [356]
- ▸MenAfriVac has sharply reduced serogroup A epidemics in the African meningitis belt, but surveillance for serogroups C, W, X, and other pathogens remains essential. [356][357]
- ▸Children with CSF leakage, cochlear implants, or sickle cell disease require particular attention to pneumococcal prevention. [51][354]
- ▸The supplied references do not establish routine screening of asymptomatic people for meningitis. [51][190][287][357]
Vaccination as the principal preventive strategy
Vaccination is the most important population-level intervention for preventing vaccine-preventable meningitis, particularly disease caused by Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and selected viral pathogens. The references supplied here primarily provide updated evidence for meningococcal and pneumococcal prevention; they do not establish a universal laboratory-screening programme for asymptomatic meningitis.
In the African meningitis belt, the MenA conjugate vaccine PsA-TT (MenAfriVac) was introduced in preventive campaigns for people aged 1–29 years and was subsequently evaluated for incorporation into routine infant and toddler immunisation. Randomised trials assessed one or two doses administered with Expanded Programme on Immunization (EPI) vaccines at 14–18 weeks, 9–12 months, and 12–18 months; the evidence supports immunogenicity and safety assessment of MenA vaccination in these age groups. [186] Post-MenAfriVac surveillance indicates that serogroup A epidemics have declined sharply, although other meningococcal serogroups and non-meningococcal pathogens remain important. [357]
The pentavalent meningococcal conjugate vaccine NmCV-5 targets serogroups A, C, W, Y, and X, thereby broadening protection beyond MenA. In a phase 3, double-blind, randomised, controlled non-inferiority trial in Bamako, Mali, NmCV-5 was evaluated against licensed quadrivalent MenACWY-TT in children aged 9–11 months, with co-administration of routine childhood vaccines at 9 months and 15 months. [190] This trial directly supports the feasibility of integrating pentavalent meningococcal vaccination with routine childhood immunisation in the meningitis belt; vaccine safety and immunogenicity were the prespecified outcomes. [190]
NmCV-5 was also used in reactive vaccination campaigns in Niger during 2024 in response to outbreaks involving serogroups C, W, and X. A matched case-control study evaluated effectiveness against PCR-confirmed meningococcal meningitis in vaccinated and unvaccinated people aged 1–19 years, counting disease with symptom onset at least 10 days after the campaign. [356]C These data support post-campaign effectiveness evaluation and the use of targeted reactive vaccination during outbreaks, while continued surveillance remains necessary because circulating serogroups can change after successful control of one serogroup. [356]C[357]
A locally manufactured quadrivalent ACWY vaccine, Ingovax ACWY, was compared with an approved quadrivalent polysaccharide vaccine in an observer-blinded phase 3 non-inferiority trial among 88 healthy adults aged 18–45 years. Participants received a single subcutaneous dose and were followed for 3 months; the study assessed immunogenicity, clinical laboratory parameters, and safety. [194] These findings support evaluation of locally produced MenACWY vaccines where access, supply, or affordability limits use of imported products, although the study population was small and restricted to healthy adults. [194]
Pneumococcal and other routine immunisation
Pneumococcal conjugate vaccination has reduced disease caused by vaccine serotypes, but pneumococcal meningitis continues to occur and non-vaccine serotype replacement remains a prevention concern. [297]C In Taiwan, a cohort examining pneumococcal meningitis before and after introduction of PCV13 into the national paediatric programme specifically evaluated changes in clinical characteristics, serotype distribution, antimicrobial susceptibility, and outcomes through 2025. [297]C In children with cerebrospinal-fluid leakage or a cochlear implant, PCV13 vaccination is particularly relevant because these conditions represent recognised risk factors for bacterial meningitis; a nationwide French cohort included cases from 2001–2024 to assess this high-risk population. [51]D
Children with sickle cell disease remain at increased risk of invasive pneumococcal disease despite pneumococcal immunisation and antibiotic prophylaxis. A French multicentre study of pneumococcal meningitis in children with sickle cell disease therefore supports intensified prevention and continued assessment of vaccine failure, serotype distribution, and antimicrobial resistance in this group. [354]C In regions with substantial childhood mortality, post-mortem surveillance has also identified meningitis pathogens and comorbidities in children younger than 5 years, helping to assess residual disease burden after pneumococcal vaccine introduction. [355]
Surveillance and targeted prevention
Prevention should be linked to laboratory and epidemiological surveillance. In Guinea, surveillance of suspected meningitis with adequate cerebrospinal-fluid sampling during 2021–2024 was used to describe post-MenAfriVac trends and emerging serogroups and pathogens. [357] Regional surveillance is important because the decline of serogroup A disease may be accompanied by increased prominence of serogroups C, W, or X, as well as pneumococcal and H. influenzae disease. [356]C[357] In India, an expert consensus described serogroup A as historically predominant but noted emerging C, W, and Y disease, with the highest reported burden in children younger than 5 years and a second peak in adolescents; it therefore supports risk-based consideration of MenACWY conjugate vaccination where local epidemiology warrants it. [287]
Safety monitoring and screening considerations
Routine vaccination programmes should maintain adverse-event surveillance. Systematic reviews identified rare reported cases of meningitis or meningoencephalitis after COVID-19 vaccination: one review included 35 cases from 33 articles, while another included 31 patients from 27 studies; headache and fever were frequent presenting symptoms. These reports are based mainly on case reports or case series and cannot establish causation or incidence. [217][219] Varicella vaccine has an excellent overall safety record, but a review identified 15 cases of varicella vaccine meningitis in apparently immunocompetent children and adolescents, with a median age of 11 years; serious vaccine-related complications are more frequent after inadvertent vaccination of immunocompromised people. [218] These rare reports warrant clinical evaluation and pharmacovigilance, not avoidance of indicated vaccination.
The RTS,S/AS01E malaria vaccine was evaluated in national programme pilot implementation in Ghana, Kenya, and Malawi, including assessment of previously observed safety signals involving meningitis, cerebral malaria, and possible sex-specific mortality differences. [195] Pre-vaccine surveillance in Ghana and Kenya established background incidence rates for malaria, meningitis, hospitalisation, and death in children younger than 5 years, illustrating the importance of baseline disease surveillance when monitoring vaccine safety. [222]
No reference supplied here supports routine screening of asymptomatic individuals for meningitis. Prevention should therefore focus on age-appropriate routine immunisation, outbreak-responsive meningococcal vaccination, enhanced protection of high-risk groups, and timely epidemiological and laboratory surveillance. [51]D[186][190][287][354]C[356]C[357]
| Population or setting | Preventive approach | Evidence |
|---|---|---|
| African meningitis belt | MenA vaccination, expanded where indicated to multivalent meningococcal conjugate vaccination | [186][190][356]C[357] |
| Infants and toddlers | Integrate MenA or NmCV-5 with routine EPI vaccines at studied ages | [186][190] |
| Outbreak areas | Reactive NmCV-5 campaigns with post-campaign effectiveness surveillance | [356]C |
| Children with CSF leakage or cochlear implant | Ensure pneumococcal prevention and surveillance | [51]D |
| Children with sickle cell disease | Pneumococcal vaccination plus antibiotic prophylaxis and follow-up | [354]C |
| All programmes | Monitor serogroup distribution, vaccine impact, and rare adverse neurological events | [195][217][218][219][222][357] |
Guidelines and Resources
- ▸Use current TBM guidance for diagnosis, antituberculosis chemotherapy, adjunctive anti-inflammatory therapy, and neurocritical or neurosurgical care; suspected TBM requires prompt empiric treatment without waiting for microbiological confirmation. [239][258]
- ▸Acute bacterial meningitis requires rapid hospital assessment, safe LP consideration, and treatment that is not delayed for imaging or other investigations. [248][259]
- ▸For suspected viral encephalitis, aciclovir delay beyond **48 hours after admission** is associated with worse prognosis. [252][253]
- ▸Lyme neuroborreliosis diagnosis relies on neurological symptoms, CSF pleocytosis, and intrathecal Borrelia-specific antibodies; PCR is mainly corroborative when symptoms are present for **less than 6 weeks**. [257]
- ▸Pregnancy, neonatal, vaccine-preventable, and mass-casualty resources address syphilis, listeriosis, intraamniotic infection, neonatal case definitions, pneumococcal disease, and anthrax-related meningitis risks. [241][245][247][249][251][254][256]
Scope and prioritisation
Meningitis is a medical emergency requiring rapid assessment, appropriate cerebrospinal-fluid (CSF) investigation when safe, and prompt empiric treatment when bacterial or tuberculous disease is suspected. The UK joint specialist-societies guideline addresses diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults, reflecting input from infectious-disease, neurological, acute-care, intensive-care, microbiology, public-health, and patient representatives. [248] The EFNS guideline similarly addresses community-acquired bacterial meningitis in older children and adults, recommending rapid hospital assessment and consideration of lumbar puncture (LP) when clinically safe; neuroimaging may be required before LP, but antibiotic treatment should not be delayed beyond the guideline’s emergency-treatment threshold. [259]
Tuberculous meningitis
The 2025 Tuberculous Meningitis International Research Consortium guideline is the principal updated resource for tuberculous meningitis (TBM), which is described as the most severe form of tuberculosis and causes death or disability in approximately half of affected patients. [239] It was developed after a systematic review because internationally current guidance had been lacking, and it uses Population, Intervention, Comparator, Outcome questions covering TBM diagnosis, antituberculosis chemotherapy, adjunctive anti-inflammatory treatment, and neurocritical and neurosurgical care. [239] The multinational consortium included representatives from India, Indonesia, South Africa, Uganda, Viet Nam, Australia, the Netherlands, the United Kingdom, and the United States. [239]
The earlier British Infection Society guideline remains a practical reference for central-nervous-system tuberculosis in adults and children, including TBM, intracerebral tuberculoma without meningitis, and spinal-cord tuberculosis. [258] It characterises TBM as a medical emergency and recommends prompt empiric antituberculosis therapy when TBM is suspected rather than waiting for microbiological or molecular confirmation; it identifies LP with CSF examination as the preferred diagnostic approach. [258]
Acute complications and specialist care
For acute cerebral oedema and raised intracranial pressure, the Neurocritical Care Society guideline evaluates hyperosmolar therapies, including mannitol and hypertonic saline, corticosteroids, and selected non-pharmacological interventions. [243] Its purpose is to guide initial therapy selection and monitoring while balancing efficacy and safety in patients with neurological injury. [243] Hydrocephalus may require specialist paediatric neurosurgical assessment; a Congress of Neurological Surgeons evidence review specifically examined management strategies for posthaemorrhagic hydrocephalus in premature infants and graded recommendations using evidence classes. [250]
The Congress of Neurological Surgeons guideline on myelomeningocele closure is not a meningitis-treatment guideline, but it is relevant to infection prevention in a major congenital neural-tube disorder. It evaluates whether closure within 48 hours reduces wound infection or ventriculitis and is based on a systematic PubMed and Embase review through September 2016. [244]
Viral, Lyme, and autoimmune mimics
For suspected viral encephalitis—an important differential diagnosis of meningitis—the adult and paediatric British national guidelines emphasise that delayed aciclovir treatment, particularly beyond 48 hours after hospital admission, is associated with worse prognosis. [252][253] The adult guideline was produced by the Association of British Neurologists and British Infection Association, while the paediatric guideline was produced by the corresponding paediatric neurology, allergy, immunology, and infection bodies. [252][253]
The EFNS Lyme neuroborreliosis guideline defines definite disease using neurological symptoms, CSF pleocytosis, and intrathecal Borrelia burgdorferi sensu lato-specific antibodies, with two of these criteria sufficient for possible disease. [257] PCR and CSF culture may support diagnosis when symptom duration is less than 6 weeks, but PCR is otherwise not recommended; evidence was also insufficient for several other proposed diagnostic tests. [257] The retired American Academy of Neurology practice parameter reviewed antimicrobial treatment, manifestation-specific regimens, treatment duration, and post-Lyme syndrome using evidence published through 2003. [260]
Neuropsychiatric systemic lupus erythematosus can enter the differential diagnosis of inflammatory meningeal or encephalopathic presentations. EULAR recommendations address diagnosis, prevention, treatment, and prognosis of neuropsychiatric SLE; reported common manifestations include cerebrovascular disease and seizures, whereas severe cognitive dysfunction, major depression, acute confusional state, peripheral nervous disorders, and psychosis were described as less common. [255]
Pregnancy, neonates, and prevention
The 2025 US Preventive Services Task Force reaffirmation recommends attention to syphilis screening during pregnancy because untreated infection can cause congenital syphilis, including neurological disease and meningitis. [241] The update was prompted by 3,882 congenital syphilis cases in the United States in 2023, including 279 congenital-syphilis-related stillbirths and neonatal or infant deaths. [241] Intrapartum-management guidance for intraamniotic infection notes that neonatal complications can include pneumonia, meningitis, sepsis, and death, while the accompanying summary provides the same clinical context. [245][246]
The Brighton Collaboration GAIA neonatal-infection resource provides internationally standardised case definitions for neonatal bloodstream infection, meningitis, and lower-respiratory-tract infection for maternal-vaccine research and immunisation-safety surveillance. [247] Pregnancy-associated listeriosis guidance highlights that infection is approximately 13 times more common in pregnancy than in the general population and that fetal or neonatal disease may cause fetal loss, preterm labour, neonatal sepsis, meningitis, or death. [251]
Prevention resources include ACIP guidance on pneumococcal vaccination, which addresses invasive pneumococcal disease—including bacteraemia, meningitis, and infection of other normally sterile sites—in adults aged 65 years or older and younger adults with conditions increasing risk. [254] Anthrax resources cover diagnosis, treatment, and medical countermeasure use during mass-casualty incidents, while separate ACIP recommendations address anthrax vaccine use in the United States, including pre-event and pre-exposure vaccination. [249][256]
| Clinical area | Principal resource | Key scope or threshold |
|---|---|---|
| Acute bacterial meningitis | UK specialist-societies guideline; EFNS guideline | Adult meningitis and meningococcal sepsis; rapid assessment, LP when safe, and no undue treatment delay. [248][259] |
| Tuberculous meningitis | 2025 international consortium; British Infection Society | Diagnosis, chemotherapy, anti-inflammatory, neurocritical, and neurosurgical care; empiric treatment when suspected. [239][258] |
| Cerebral oedema | Neurocritical Care Society | Mannitol, hypertonic saline, corticosteroids, monitoring, and non-pharmacological care. [243] |
| Viral encephalitis | British adult and paediatric national guidelines | Aciclovir delay beyond 48 hours is associated with worse prognosis. [252][253] |
| Lyme neuroborreliosis | EFNS; retired AAN parameter | CSF and intrathecal-antibody criteria; treatment evidence and duration. [257][260] |
| Pregnancy, neonates, prevention | USPSTF, ACOG, GAIA, ACIP, CDC resources | Congenital and neonatal infection, vaccination, surveillance definitions, and anthrax countermeasures. [241][245][247][249][254][256] |
References
- [1]
Håndstad M, Alaoui-Ismaili A, Juhler M et al.. “A systematic review of reviews on ventriculostomy related infection definitions: A fundamental problem.” Neurosurgical review (2025). PMID: 40069523 ↗
L2aSR_OBSCited in: Definition, Synonyms, and Classification - [2]
Vaezipour N, Bigi S, Song R et al.. “Rifampicin and its neuroprotective properties in humans - A systematic review.” Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie (2025). PMID: 40024057 ↗
L2aSR_OBSCited in: Definition, Synonyms, and Classification - [3]
Taweephol T, Pongpitakmetha T, Boonwan N et al.. “Clinical characteristics and factors associated with tuberculous meningitis outcomes in Thailand: A 13-year retrospective cohort study.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2025). PMID: 41173203 ↗
L2bCOHORTCited in: Definition, Synonyms, and Classification, Epidemiology and Risk Factors, Prognosis and Long-term Outcomes, Special Populations - [4]
Kane Y, Nalikka B, Tendu A et al.. “Genetic Diversity and Geographic Spread of Henipaviruses.” Emerging infectious diseases (2025). PMID: 40023785 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [5]
Long B, Gottlieb M. “Emergency medicine updates: Evaluation and diagnosis of sepsis and septic shock.” The American journal of emergency medicine (2025). PMID: 39892181 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [6]
Sultana S, Islam A, Ng J et al.. “Bat Reovirus as Cause of Acute Respiratory Disease and Encephalitis in Humans, Bangladesh, 2022-2023.” Emerging infectious diseases (2025). PMID: 41490742 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [7]
Vernygora O, Bourque L, Jones M et al.. “Novel Dolphin Tupavirus from Stranded Atlantic White-Sided Dolphin with Severe Encephalitis, Canada, 2024.” Emerging infectious diseases (2025). PMID: 41379633 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [8]
Zhu Z, Bao Y, Zhang Z et al.. “Emerging Neisseria meningitidis ST-1466 and ST-11026 as urogenital pathogens in China.” BMC infectious diseases (2025). PMID: 41162927 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [9]
Gass JT, Nofchissey RA, Twohig FM et al.. “Discovery of a novel lymphocytic choriomeningitis virus strain associated with severe human disease in immunocompetent patient, New Mexico.” Emerging microbes & infections (2025). PMID: 40838561 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification, Epidemiology and Risk Factors - [10]
Neri A, Taviani E, Ferraro F et al.. “Genomic analysis of Neisseria meningitidis serogroup W causing invasive meningococcal disease in four travellers from Saudi Arabia, Italy, 2025.” Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2025). PMID: 40776895 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [11]
Cherabuddi K, Tagliamonte MS, Lednicky JA et al.. “A Case Cluster of Aseptic Meningitis Associated With a Newly Identified Recombinant Echovirus 6/Coxsackievirus B1 Enterovirus.” The Journal of infectious diseases (2025). PMID: 40359283 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [12]
Garijo-Toledo M, Alarcón-Elbal PM, Montero E et al.. “Mortality associated with Angiostrongylus cantonensis in non-human primates in Europe.” International journal for parasitology (2025). PMID: 40194692 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [13]
Jiang Y, Yang J, Liu Y et al.. “A neonate with meningitis caused by probiotic-related Clostridium butyricum.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2025). PMID: 40185197 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [14]
Ewing A, Haldeman S, Job MJ et al.. “Haemophilus influenzae Type b Meningitis in Infants, New York, New York, USA, 2022-2023.” Emerging infectious diseases (2025). PMID: 40023813 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [15]
Chiu CY, Godasi RR, Hughes HR et al.. “Two Human Cases of Fatal Meningoencephalitis Associated with Potosi and Lone Star Virus Infections, United States, 2020-2023.” Emerging infectious diseases (2025). PMID: 39983710 ↗
L4CASE_REPORTCited in: Definition, Synonyms, and Classification - [16]
Leiva-Ordoñez JE, Quintero B. “Diagnosis of Tuberculous Meningitis: Integrating Clinical Assessment and Molecular Diagnostics.” Diagnostics (Basel, Switzerland) (2026). PMID: 41750700 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [17]
Trejos Pino JV, Rodriguez Delgado JC. “Clinical Presentations and Nosocomial Infections of Neurolisteriosis.” The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale (2025). PMID: 40547324 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [18]
Ciftci E, Ocal D, Somer A et al.. “Current methods in the diagnosis of invasive meningococcal disease.” Frontiers in pediatrics (2025). PMID: 40330073 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [19]
Scheier TC, Tufa TB, Feldt T et al.. “Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries-an extension study of eight countries.” AIDS research and therapy (2025). PMID: 40158188 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [20]
Zhu W, Shao L, Feng S et al.. “Tahyna virus: an emerging threat to public health.” Archives of virology (2025). PMID: 39928175 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [21]
Wu LL, Shi WD, Peng WF et al.. “Unraveling the interplay between meningitis and mitochondria: Etiology, pathogenesis, and therapeutic insights.” International immunopharmacology (2025). PMID: 39765004 ↗
L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification - [22]
Kneubehl AR, Rehm DP, Curtis MW et al.. “Geographically Distinct Circulation of Genotype II and III St. Louis Encephalitis Virus, Texas, USA, 2009-2024.” Emerging infectious diseases (2026). PMID: 41986946 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [23]
Andrus PS, Han QC, Yang LM et al.. “Population genetic diversity of invasive Pomacea snails and surveillance of Angiostrongylus cantonensis in Shanghai, East China.” Parasites & vectors (2026). PMID: 41803893 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [24]
Yang H, Wang H, Han J et al.. “Emergence of a novel cefotaxime- and ciprofloxacin-resistant strain of serogroup Y Neisseria meningitidis sequence type 23 clonal complex in China.” The Journal of infection (2026). PMID: 41724334 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [25]
Gonzales BE, Durand D, Mercado EH et al.. “Genomic features of pneumococcal strains isolated from paediatric patients with invasive disease during pneumococcal conjugate vaccine introduction in Lima, Peru.” Microbial genomics (2026). PMID: 41632608 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [26]
Itani TM, Chalapa VI, Patrusheva AK et al.. “Genetic Diversity of the Non-Polio Enteroviruses Detected in Samples of Patients with Aseptic Meningitis in the Ural Federal District and Western Siberia.” Viruses (2026). PMID: 41600882 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [27]
Aparicio MT, Diop S, Mounier R. “Comments on: risk factors for nosocomial meningitis in patients with external ventricular drainages.” Journal of intensive care (2026). PMID: 41588552 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [28]
Andersen M, Haglund A, Murra M et al.. “Validation of the ICD-10 Diagnoses of Early-Onset Neonatal Infection in the Danish National Patient Register from 2010 to 2018.” Clinical epidemiology (2026). PMID: 41541820 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [29]
Fratty IS, Kriger O, Weiss L et al.. “Epidemiology of Enteroviruses Among Hospitalized Patients in Israel (2016-2024): CNS Involvement, Subtype Variability, and Seasonality.” Journal of medical virology (2026). PMID: 41540956 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [30]
Liao H, Li M, Zeng L et al.. “Molecular characterization of Neisseria meningitidis isolates from healthy individuals in Meigu County, Sichuan Province, 2021-2024.” European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2026). PMID: 41518555 ↗
L5OTHERCited in: Definition, Synonyms, and Classification - [31]
Pu J, Wu S, He JQ. “High dose of rifampicin in the treatment of tuberculous meningitis: a systematic review and meta-analysis of randomized controlled trials.” European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2026). PMID: 41511673 ↗
L1aSR_MA_RCTCited in: Epidemiology and Risk Factors, Management, Prognosis and Long-term Outcomes, Landmark Trials and Key Evidence - [32]
Matmat K, Jamann H, Maazouzi A et al.. “A multidimensional analysis of neuropsychiatric lupus: clinical, biological and imaging insights from systematic evidence.” Frontiers in immunology (2026). PMID: 41918728 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors, Diagnosis and Workup - [33]
Alviz LF, Kim CY, Monette LE et al.. “Detection of sequelae from acute meningitis during clinical review by a healthcare provider: a systematic review and meta-analysis.” BMC medicine (2026). PMID: 41761295 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, Supportive Care and Complication Management, Prognosis and Long-term Outcomes - [34]
Alviz LF, Kim CY, Benevides-Tadinac AC et al.. “Detection of hearing loss by formal audiological testing after acute infectious meningitis: a global systematic review and meta-analysis.” BMC medicine (2026). PMID: 41761238 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, History and Physical Examination, Diagnosis and Workup, Supportive Care and Complication Management, Prognosis and Long-term Outcomes - [35]
Lazarus G, Caddey B, Dean A et al.. “Antimicrobial resistance in bacterial meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae (2010-24): a systematic review and meta-analysis.” The Lancet. Microbe (2026). PMID: 41616789 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, Diagnosis and Workup, Management - [36]
Onohuean H, Choonara YE. “Epidemiological distribution of bacterial meningitis infections in South Africa: a systematic review and meta-analysis.” BMC infectious diseases (2025). PMID: 41073968 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors - [37]
Akwetey SA, Osman AH, Kotey FCN et al.. “The epidemiology of infectious meningitis in Ghana: a systematic review and meta-analysis.” BMC public health (2025). PMID: 40770623 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors - [38]
Ellis J, Groppelli E, Doyle R et al.. “Epstein-Barr virus and cytomegalovirus co-infections and mortality risk in patients with HIV-associated cryptococcal meningitis: a post-hoc analysis of a prospective nested cohort in the AMBITION-cm randomised controlled trial.” The lancet. HIV (2025). PMID: 40915307 ↗
L1bRCTCited in: Epidemiology and Risk Factors, Landmark Trials and Key Evidence, Special Populations - [39]
Rutakingirwa MK, Skipper CP, Dai B et al.. “Evaluating the Use of Lower Dose Flucytosine for the Treatment of Cryptococcal Meningitis: A Clinical Trial.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2026). PMID: 40795226 ↗
L2bTRIAL_NONRANDOMCited in: Epidemiology and Risk Factors, Special Populations - [40]
Verma R, Chakraborty R. “A Clinico-Immunological Perspective of Paradoxical Reaction in HIV-ve Tuberculous Meningitis with Therapeutic Possibilities.” Neurology India (2025). PMID: 40705281 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors, Supportive Care and Complication Management, Special Populations - [41]
Liechti FD, Drost EHGM, Bijlsma MW et al.. “Brain Abscesses Complicating Bacterial Meningitis-A Nationwide Cohort Study From the Netherlands.” European journal of neurology (2026). PMID: 41738138 ↗
L2bCOHORTCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, Differential Diagnosis - [42]
Xu X, Su X, Li W et al.. “Clinical features and mortality risk factors in non-HIV elderly patients with cryptococcal meningitis: A retrospective cohort study from 2013 to 2022.” PLoS neglected tropical diseases (2025). PMID: 40934274 ↗
L2bCOHORTCited in: Epidemiology and Risk Factors - [43]
Kim E, Hong J, Shin H et al.. “Prophylactic antibiotic use in closed basilar skull fractures: A nationwide cohort study.” The journal of trauma and acute care surgery (2026). PMID: 40857668 ↗
L2bCOHORTCited in: Epidemiology and Risk Factors - [44]
Drummond H, Umana E, Mills C et al.. “Prevalence of invasive bacterial infection among febrile infants with positive urinalysis results: a planned secondary analysis of the Febrile Infants Diagnostic assessment and Outcome (FIDO) prospective observational cohort study.” Archives of disease in childhood (2025). PMID: 40628460 ↗
L2bCOHORTCited in: Epidemiology and Risk Factors, History and Physical Examination, Special Populations - [45]
He L, Yu M, Sun Z et al.. “Dynamic analysis of pathogenic distribution and drug resistance mechanism in neonatal suppurative meningitis: a retrospective study.” Italian journal of pediatrics (2025). PMID: 40604892 ↗
L2bCOHORTCited in: Epidemiology and Risk Factors - [46]
Alhajaji R, Alfahmi M, Alamri SA et al.. “Neisseria Meningitidis Carriage Among Hajj and Umrah Pilgrims: A Systematic Review and Meta-Analysis.” European journal of medical research (2025). PMID: 40765002 ↗
L2aSR_OBSCited in: Epidemiology and Risk Factors, Prevention and Screening - [47]
Ali F, Imperial M, Morshed M et al.. “Pediatric Meningoencephalitis Cluster Caused by Snowshoe Hare Virus, Whistler, British Columbia, Canada, 2024.” Emerging infectious diseases (2026). PMID: 41986254 ↗
L4CASE_REPORTCited in: Epidemiology and Risk Factors, Differential Diagnosis - [48]
Szojka ZI, Florian DM, Cabal A et al.. “Imported aseptic meningitis due to Toscana virus infection in Austria since 2006, including a case series from 2023.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2025). PMID: 41615838 ↗
L4CASE_REPORTCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, Diagnosis and Workup, Differential Diagnosis - [49]
Lagare A, Abdoulaye B, Thiaw FD et al.. “First detection of echovirus 18 associated with aseptic meningitis in a child in Niger Republic, 2024: a case report.” BMC infectious diseases (2025). PMID: 41126107 ↗
L4CASE_REPORTCited in: Epidemiology and Risk Factors - [50]
Li Y, Zhang X, Wang M et al.. “Observation on the efficacy of Xiao Chai Hu Tang plus minus Tang combined with sodium valproate in the treatment of meningitis-associated epilepsy.” Pakistan journal of pharmaceutical sciences (2025). PMID: 40761063 ↗
L1bRCTCited in: Epidemiology and Risk Factors - [51]
Levy C, Bizot E, Milcent K et al.. “Epidemiology and Characteristics of Bacterial Meningitis of Children with Cerebrospinal Fluid Leakage or Cochlear Implant.” Journal of the Pediatric Infectious Diseases Society (2026). PMID: 41800559 ↗
L5OTHERCited in: Epidemiology and Risk Factors, Etiology and Triggering Factors, Pathophysiology, History and Physical Examination, Diagnosis and Workup, Prevention and Screening - [52]
Lykke MR, Sørensen HT, Lawn JE et al.. “School performance following invasive Group B Streptococcus disease in early infancy in Denmark.” Annals of epidemiology (2026). PMID: 41643755 ↗
L5OTHERCited in: Epidemiology and Risk Factors, Special Populations - [53]
Hawkins PA, Chochua S, Prasad N et al.. “Group A Streptococcus Meningitis, United States, 1997-2022.” Emerging infectious diseases (2026). PMID: 41612532 ↗
L5OTHERCited in: Epidemiology and Risk Factors, Differential Diagnosis, Special Populations - [54]
André A, Brière O, Bourreau L et al.. “Risk factors for acute kidney injury associated with intravenous acyclovir in older adults: ACICLOAGED study.” Maturitas (2026). PMID: 41604824 ↗
L5OTHERCited in: Epidemiology and Risk Factors, Differential Diagnosis - [55]
Mehl C, Schmidt-Chanasit J, Becker-Ziaja B et al.. “Lymphocytic Choriomeningitis Virus Seroprevalence in a Cohort of German Forestry Workers.” Viruses (2025). PMID: 41600769 ↗
L5OTHERCited in: Epidemiology and Risk Factors - [56]
Anjum SH, Hargarten J, Dulek B et al.. “Cerebral Venous Thrombosis in Previously Healthy Patients with Cryptococcal Meningitis.” The Journal of infectious diseases (2026). PMID: 41443253 ↗
L5OTHERCited in: Epidemiology and Risk Factors - [57]
Mesele DW, Kalayu AA, Teshome S et al.. “Enhanced detection of bacterial etiologies, antibiotic resistance profile, and treatment outcomes of meningitis patients in Ethiopia: a prospective cross-sectional study.” BMC microbiology (2025). PMID: 41387772 ↗
L5OTHERCited in: Epidemiology and Risk Factors - [58]
Lambebo IH, Eba K, Tucho GT. “Association between climatic conditions and infectious diseases: implications for Central Ethiopia region.” BMC infectious diseases (2025). PMID: 41331557 ↗
L5OTHERCited in: Epidemiology and Risk Factors, History and Physical Examination - [59]
Meya DB, Cresswell FV, Dai B et al.. “Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis.” The New England journal of medicine (2025). PMID: 41406445 ↗
L1bRCTCited in: Etiology and Triggering Factors, Management, Prognosis and Long-term Outcomes, Landmark Trials and Key Evidence, Special Populations - [60]
Burstein B, Waterfield T, Umana E et al.. “Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger.” JAMA (2026). PMID: 41359314 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors, History and Physical Examination, Management, Special Populations - [61]
Singh MP, Yadav R, Singh J. “Drug-Induced Aseptic Meningitis: A 25-Year Systematic Review of Case Reports.” Clinical neuropharmacology (Unknown). PMID: 41529234 ↗
L2aSR_OBSCited in: Etiology and Triggering Factors, Pathophysiology, Management - [62]
Liang A, Zhang Y, Li X et al.. “Association of the blood urea nitrogen to serum albumin ratio on prognosis in patients with bacterial meningitis: a retrospective cohort study.” Frontiers in cellular and infection microbiology (2026). PMID: 41929452 ↗
L2bCOHORTCited in: Etiology and Triggering Factors, Diagnosis and Workup, Prognosis and Long-term Outcomes - [63]
Dzięgiel M, Głodowicz Z, Jóźwiak A et al.. “Bacterial meningitis in adults: therapeutic challenges in the era of antibiotic resistance and the potential of bacteriophages and associated by products.” Frontiers in cellular and infection microbiology (2026). PMID: 41728112 ↗
L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Management - [64]
Scott TL, Quezado M, Williamson PR. “Update on the diagnosis, pathophysiology and treatment strategies in non-HIV-associated cryptococcal meningoencephalitis.” Expert review of anti-infective therapy (2026). PMID: 41661810 ↗
L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Pathophysiology, Special Populations - [65]
Shi Y, Liang T, Shi C et al.. “Molecular mechanisms of streptococcal disruption of the blood-brain barrier and their pathogenic role in bacterial meningitis.” Frontiers in immunology (2025). PMID: 41573555 ↗
L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Pathophysiology - [66]
Churcher LM, Bartlett AW, Pendle S et al.. “Impact of the BioFire FilmArray Meningitis-Encephalitis Panel on Management of Suspected Paediatric Central Nervous System Infections: A Single-Centre Retrospective Cohort Study.” Journal of paediatrics and child health (2026). PMID: 41652807 ↗
L2bCOHORTCited in: Etiology and Triggering Factors, Pathophysiology, Diagnosis and Workup, Differential Diagnosis, Prognosis and Long-term Outcomes - [67]
Maeda A, Hayashi K, Izumi R et al.. “Lumbar-peritoneal shunt-associated meningitis and peritoneal abscess due to Corynebacterium striatum: A case report and literature review.” Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (2026). PMID: 41391636 ↗
L4CASE_REPORTCited in: Etiology and Triggering Factors, Supportive Care and Complication Management - [68]
Ba A, Wang L, Ren R et al.. “Purulent meningitis in X-linked agammaglobulinemia: one case report.” Frontiers in immunology (2026). PMID: 41988175 ↗
L4CASE_REPORTCited in: Etiology and Triggering Factors - [69]
Hariswar PT, Mahathi G, Praveenkumar T et al.. “Clinical Reasoning: A 49-Year-Old Man With Meningoencephalitis and Persistent Altered Mental Status.” Neurology (2026). PMID: 41771008 ↗
L4CASE_REPORTCited in: Etiology and Triggering Factors, History and Physical Examination, Diagnosis and Workup - [70]
Grant A, Keegan S, Kulasegaram R. “Role of long-acting injectables in perinatally acquired HIV, with persistent viraemia and non-nucleoside reverse transcriptase inhibitor resistance.” Sexually transmitted infections (2026). PMID: 41545056 ↗
L4CASE_REPORTCited in: Etiology and Triggering Factors, Diagnosis and Workup, Management, Special Populations - [71]
Li XF, Ker A, Liao HL et al.. “Adult-onset Still's disease presenting with aseptic meningitis: a case report.” Frontiers in immunology (2025). PMID: 41476957 ↗
L4CASE_REPORTCited in: Etiology and Triggering Factors, Management, Supportive Care and Complication Management - [72]
Krebs L, Durden B, Saguil A. “Aseptic and Bacterial Meningitis: Diagnosis, Treatment, and Prevention.” American family physician (2026). PMID: 41839077 ↗
L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Pathophysiology - [73]
Tucker EW, Kim J, Erice C et al.. “Host-directed nanotherapy for the treatment and imaging of tuberculous meningitis.” Theranostics (2026). PMID: 41993622 ↗
L5OTHERCited in: Etiology and Triggering Factors, Pathophysiology, Diagnosis and Workup, Management - [74]
Pircher H, Thomas OS, Haefke AS et al.. “Increased Constitutive Interferon-β Levels and Altered CD4 T Cell Homeostasis Induced by Expression of a Viral Glycoprotein.” European journal of immunology (2026). PMID: 41972454 ↗
L5OTHERCited in: Etiology and Triggering Factors - [75]
Flannery DD, Cossaboom CM, Flietstra TD et al.. “Lymphocytic Choriomeningitis Virus Seroprevalence among Urban Pregnant Women and Newborns, Philadelphia, Pennsylvania, USA, 2021.” Emerging infectious diseases (2026). PMID: 41863505 ↗
L5OTHERCited in: Etiology and Triggering Factors, Special Populations - [76]
Kansas GS. “Transient loss of KLF2 expression is essential for CD8 effector T cell expansion.” Journal of immunology (Baltimore, Md. : 1950) (2026). PMID: 41847849 ↗
L5OTHERCited in: Etiology and Triggering Factors, Diagnosis and Workup - [77]
Wang Y, Liu H, Wang Y et al.. “Biosynthesis of a Polysaccharide-based Glycoconjugate Vaccine against Neonatal Meningitis-Causing Escherichia coli O45.” ACS synthetic biology (2026). PMID: 41779879 ↗
L5OTHERCited in: Etiology and Triggering Factors, Prevention and Screening - [78]
George LS, Chakraborty A, Gupta S et al.. “Implementation of India's largest sentinel surveillance for meningitis: an exploratory qualitative analysis of the facilitators and challenges in this sentinel site network.” Frontiers in public health (2026). PMID: 41778120 ↗
L5OTHERCited in: Etiology and Triggering Factors, Prognosis and Long-term Outcomes, Prevention and Screening - [79]
Lux J, Erhardt M, Rechsteiner L et al.. “Synthetic peptide V11A reduces bacterial load and inflammation in pneumococcal meningitis.” Frontiers in cellular and infection microbiology (2025). PMID: 41737843 ↗
L5OTHERCited in: Etiology and Triggering Factors, Management - [80]
Charmoy M, Maier JM, Wyss T et al.. “Memory-like CD8+ T cells lacking PD-1 adapt to persistent stimulation by reducing TCR signal transduction rather than increasing exhaustion.” Frontiers in immunology (2026). PMID: 41727489 ↗
L5OTHERCited in: Etiology and Triggering Factors - [81]
Yabumoto T, Sugiyama S, Hosokawa A et al.. “Viral load and pathophysiology-based framework in varicella-zoster virus meningitis: Focus on altered consciousness and outcomes.” Journal of the neurological sciences (2026). PMID: 41690184 ↗
L5OTHERCited in: Etiology and Triggering Factors, History and Physical Examination - [82]
Wollenweber ML, Beyrer K, Baillot A et al.. “The Meningitis and Encephalitis Registry of Lower Saxony, Germany (MERIN) - design and main results of circulating neurotropic pathogen surveillance, 2003 to 2023.” Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2026). PMID: 41684324 ↗
L5OTHERCited in: Etiology and Triggering Factors, Differential Diagnosis, Special Populations - [83]
Huang M, Wang Y, Chen T et al.. “Evaluation of contezolid's cerebrospinal fluid concentration and safety in tuberculous meningitis patients.” Microbiology spectrum (2026). PMID: 41823550 ↗
L1bRCTCited in: Pathophysiology, Diagnosis and Workup, Management, Prognosis and Long-term Outcomes, Landmark Trials and Key Evidence - [84]
Donovan J, Duc Bang N, Dong HKT et al.. “Genotype-stratified adjunctive dexamethasone for tuberculous meningitis in HIV-negative adults: a randomized controlled phase 3 trial.” Nature medicine (2026). PMID: 41540106 ↗
L1bRCTCited in: Pathophysiology, Management, Prognosis and Long-term Outcomes, Landmark Trials and Key Evidence - [85]
Santiago IB, da Silva AA, Nóbrega ILP et al.. “Leukodystrophy-like phenotype in early-onset neuropsychiatric systemic lupus erythematosus: Case series and systematic review of the literature.” Revue neurologique (2026). PMID: 41638970 ↗
L2aSR_OBSCited in: Pathophysiology, Diagnosis and Workup, Supportive Care and Complication Management - [86]
Muyidi AA, Al-Zaydani IA, Alzahrani SJ et al.. “Neonatal invasive meningococcal disease: Clinical case from Saudi Arabia and updated review of reported cases.” Journal of infection and public health (2026). PMID: 41894900 ↗
L4CASE_REPORTCited in: Pathophysiology, Diagnosis and Workup, Management, Supportive Care and Complication Management, Prognosis and Long-term Outcomes, Special Populations - [87]
Luo Y, Guo Y, Zhu Y et al.. “Differentiating scrub typhus meningitis from brucellar meningitis in children: A single-center retrospective study.” PLoS neglected tropical diseases (2026). PMID: 41824464 ↗
L2bCOHORTCited in: Pathophysiology, Diagnosis and Workup - [88]
Chouksey SS, Singh VK, Chaurasia RN et al.. “Neurocognitive Outcomes and Their Correlation with Brain-Based Biomarkers in Tuberculous Meningitis: A Prospective Study.” The American journal of tropical medicine and hygiene (2026). PMID: 41666470 ↗
L2bCOHORTCited in: Pathophysiology, Diagnosis and Workup, Prognosis and Long-term Outcomes - [89]
Wong EWN, Chan CF, Chan PS. “Ocular Manifestations of Biopsy-Proven B Virus Infection with Central Nervous System Involvement.” JAMA ophthalmology (2026). PMID: 41712248 ↗
L4CASE_REPORTCited in: Pathophysiology, Diagnosis and Workup - [90]
Bao Y, Zhang W, Liu X et al.. “Case Report: Complete remission of Guillain-Barré syndrome in neuropsychiatric lupus with telitacicept.” Frontiers in immunology (2026). PMID: 41659868 ↗
L4CASE_REPORTCited in: Pathophysiology, Diagnosis and Workup, Management, Prognosis and Long-term Outcomes - [91]
Yang X, Li Z, Dai X et al.. “Streptococcus pyogenes and EBV coinfection in severe adult meningoencephalitis: a rare diagnosis in a diabetic patient.” Frontiers in cellular and infection microbiology (2025). PMID: 41625152 ↗
L4CASE_REPORTCited in: Pathophysiology, Diagnosis and Workup, Management - [92]
Ye R, Guo K, Zhou D et al.. “Misdiagnosed tuberculous myelitis turned out to be spinal malignant peripheral nerve sheath tumor: a case report.” Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2026). PMID: 41521307 ↗
L4CASE_REPORTCited in: Pathophysiology - [93]
Liu F, Sun S, Zhang Y et al.. “Possible tuberculous meningitis presenting with predominant voiding dysfunction in an elderly patient: A case report.” Journal of infection and public health (2026). PMID: 41505815 ↗
L4CASE_REPORTCited in: Pathophysiology, Management - [94]
Ito Y, Hoeltermann TA, Anjum S et al.. “Corticosteroid Therapy and Long-Term Outcomes of Post-Infectious Inflammatory Syndrome in Non-HIV Immunosuppressed Cryptococcal Meningitis: A Multicenter Case Series.” The Journal of infectious diseases (2026). PMID: 41486473 ↗
L4CASE_REPORTCited in: Pathophysiology, Supportive Care and Complication Management, Prognosis and Long-term Outcomes, Special Populations - [95]
Nagata W, Ishizuka T. “Pathogenesis and therapeutic strategies for neuropsychiatric lupus centered on innate immune activation.” Human cell (2026). PMID: 41989680 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [96]
Demirtzoglou G, Damanaki A, Flouda S et al.. “Unique brain mechanisms in early events in SLE with diffuse neuropsychiatric disease (NPSLE): Implications for the management.” Lupus (2026). PMID: 41831216 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [97]
Butler HM, Zehntner ME, Van Beusecum JP. “Endothelial Dysfunction: Insights into Systemic Lupus Erythematosus-associated Cardiovascular Disease and Neuropsychiatric Manifestations.” Journal of cardiovascular translational research (2026). PMID: 41795008 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology - [98]
Perera N, Gunawardena C, Abeyratne V et al.. “Neuroleptospirosis in patients presenting with primary central nervous system infection: A multicentre study.” PLoS neglected tropical diseases (2026). PMID: 41945620 ↗
L5OTHERCited in: Pathophysiology, Diagnosis and Workup, Differential Diagnosis, Supportive Care and Complication Management - [99]
Molloy CT, Alwarawrah Y, Cohen JA et al.. “Irgm1 Restrains CD8+ T Cell Cytokine Production and Apoptosis via Cell-Extrinsic Regulation of Type I Interferon Signaling.” European journal of immunology (2026). PMID: 41906618 ↗
L5OTHERCited in: Pathophysiology - [100]
Matmat K, Guéant-Rodriguez RM, Darcq E et al.. “IFNγ-associated immune-metabolic remodeling is linked to serotonin-kynurenine imbalance and cortical vulnerability in lupus-prone mice.” Frontiers in immunology (2026). PMID: 41869319 ↗
L5OTHERCited in: Pathophysiology - [101]
Onita T, Ikawa K. “Cerebrospinal Pharmacokinetic and Pharmacodynamic Evaluation of Sulbactam: Dosing Considerations for Acinetobacter baumannii Meningitis in Pediatric Patients.” Journal of the Pediatric Infectious Diseases Society (2026). PMID: 41810872 ↗
L5OTHERCited in: Pathophysiology, Diagnosis and Workup, Management, Special Populations - [102]
Yovel G, Packard JE, Wang JC et al.. “Neonatal CNS Human Parechovirus Infections in Western Pennsylvania in the 2024 Season.” Journal of medical virology (2026). PMID: 41810583 ↗
L5OTHERCited in: Pathophysiology, Diagnosis and Workup, Special Populations - [103]
Chen J, Cui C, Xu F et al.. “ShenQi DiHuang Decoction (SQDHD) Ameliorates Neuroinflammation and Neuropsychiatric Manifestations in Pristane Induced Lupus Mice via Blocking JAK1-STAT3 Pathway.” CNS neuroscience & therapeutics (2026). PMID: 41795136 ↗
L5OTHERCited in: Pathophysiology - [104]
Shean RC, Tardif KD, Rangel A et al.. “Evaluation of the Ultima Genomics UG 100 sequencer for low-cost, high-sensitivity metagenomic pathogen detection from cerebrospinal fluid.” Microbiology spectrum (2026). PMID: 41778823 ↗
L5OTHERCited in: Pathophysiology, Diagnosis and Workup, Differential Diagnosis - [105]
Twito NA, Röthlisberger AB. “Retrospective evaluation of leflunomide as second-line immunosuppressive therapy in dogs with meningoencephalomyelitis of unknown origin: 18 cases (2018-2025).” Journal of veterinary internal medicine (2026). PMID: 41742594 ↗
L5OTHERCited in: Pathophysiology, Prognosis and Long-term Outcomes - [106]
Aguilera C, Subah GD, Bogle C et al.. “Utility of Bone Cement for Cranioplasty Following Retrosigmoid or Translabyrinthine Craniectomy: A Systematic Review and Meta-Analysis.” Neurosurgical review (2025). PMID: 41254416 ↗
L2aSR_OBSCited in: History and Physical Examination - [107]
Khan K, Wilson P, Patel MS et al.. “A Systematic Review and Meta-Analysis of Meningitis Risk Reduction After Repair of Spontaneous Lateral Skull Base Cerebrospinal Fluid Leaks.” Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2025). PMID: 41039648 ↗
L2aSR_OBSCited in: History and Physical Examination - [108]
Julio PR, Capello CH, de Amorim JC et al.. “Chorea associated with systemic lupus erythematosus- a systematic review.” Lupus (2025). PMID: 40390391 ↗
L2aSR_OBSCited in: History and Physical Examination - [109]
Deniz M, Erat T, Arı HF et al.. “Evaluation of children with acute central nervous system infections admitted to the pediatric intensive care unit and pediatric ward: a retrospective study.” BMC pediatrics (2024). PMID: 39587526 ↗
L2bCOHORTCited in: History and Physical Examination - [110]
Pantalone MR, De Luca F, Terling L et al.. “Candida meningitis in three patients who underwent transsphenoidal surgery from a single-institution case series.” Acta neurochirurgica (2026). PMID: 41826722 ↗
L4CASE_REPORTCited in: History and Physical Examination - [111]
Yuan X, Fang M, Lan W et al.. “From urinary tract infection to deafness: community-acquired meningitis in an adult caused by hypervirulent Klebsiella pneumoniae-a case report.” BMC infectious diseases (2025). PMID: 41390369 ↗
L4CASE_REPORTCited in: History and Physical Examination - [112]
Goh WGW, Ng IKS, Tan MKX et al.. “Clinical Reasoning: A 26-Year-Old Woman With Headache and Eosinophilia.” Neurology (2025). PMID: 39983059 ↗
L4CASE_REPORTCited in: History and Physical Examination - [113]
Willis ZI, Buonsenso D. “Management of Young Infants With Incomplete Evaluation for Meningitis.” Journal of the Pediatric Infectious Diseases Society (2026). PMID: 41670340 ↗
L5REVIEW_NARRATIVECited in: History and Physical Examination, Special Populations - [114]
Lovund IK, Mjelle AB, Thaulow CM et al.. “Bacterial Meningitis in Norwegian Children 2010-2023: Low Incidence but Still a Major Threat in Neonates.” Acta paediatrica (Oslo, Norway : 1992) (2026). PMID: 41273196 ↗
L5OTHERCited in: History and Physical Examination - [115]
Krongsut S, Srithanabout P, Pansaksiri S et al.. “A new diagnostic model for the early differentiation of tuberculous and bacterial meningitis to guide timely diagnosis and treatment: Model development and internal validation.” Journal of infection and public health (2025). PMID: 41076850 ↗
L5OTHERCited in: History and Physical Examination - [116]
Nguyen THP, Young BR, Bornstein LM et al.. “Prevalence of Serious Infection Among Hypothermic Young Infants Across Medical Settings.” Hospital pediatrics (2025). PMID: 40947113 ↗
L5OTHERCited in: History and Physical Examination - [117]
Tang R, Mao S, Gu Y et al.. “A Nomogram Model to Predict Meningitis Occurrence in Cerebrospinal Fluid Leak Patients.” The Laryngoscope (2026). PMID: 40923621 ↗
L5OTHERCited in: History and Physical Examination - [118]
Aronson PL, Mahajan P, Meeks HD et al.. “Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections.” Pediatrics (2025). PMID: 40854562 ↗
L5OTHERCited in: History and Physical Examination - [119]
Tang Y, Huang P, Xu J et al.. “Comprehensive analysis of disease activity, neuropsychiatric symptoms, imaging features and risk factors for seizure in hospitalized patients with juvenile-onset neuropsychiatric systemic lupus erythematosus.” Seminars in arthritis and rheumatism (2025). PMID: 40784140 ↗
L5OTHERCited in: History and Physical Examination - [120]
Fischer JL, Gallagher TJ, Lin ME et al.. “Complications in Endoscopic Sinus Surgery: A TriNetX Network Analysis.” International forum of allergy & rhinology (2025). PMID: 40782144 ↗
L5OTHERCited in: History and Physical Examination - [121]
Doka Hélène KS, Ignatius E, Berinyuy M et al.. “Nonsurgical Neurological Emergencies in Children: A Cross-Sectional Study of Prevalence, Diagnosis, and Management.” Pediatric neurology (2025). PMID: 40609287 ↗
L5OTHERCited in: History and Physical Examination - [122]
Urmenyi LG, Vinhaes CL, Villalva-Serra K et al.. “Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study.” Frontiers in public health (2025). PMID: 40589807 ↗
L5OTHERCited in: History and Physical Examination - [123]
Aronson PL, Mahajan P, Nielsen B et al.. “Risk of Bacterial Infections in Febrile Infants 61 to 90 Days Old With Respiratory Viruses.” Pediatrics (2025). PMID: 40506050 ↗
L5OTHERCited in: History and Physical Examination - [124]
Steele JL, Smith HJ, Takkoush S et al.. “Long-Term Outcomes of Adult Temporal Bone Fractures With Hearing Loss: Results of a Multinational Database Analysis.” The Laryngoscope (2025). PMID: 40202220 ↗
L5OTHERCited in: History and Physical Examination - [125]
Yaeger JP, Hill EL, Ertefaie A et al.. “A Population-Based Study of Rates of Invasive Bacterial Infection (IBI) and Missed IBI in Febrile Infants 8-90 Days of Age.” The Journal of pediatrics (2025). PMID: 40199453 ↗
L5OTHERCited in: History and Physical Examination - [126]
Kameda S, Yamana H, Sasabuchi Y et al.. “Early Corticosteroid Use and Short-Term Outcomes in Pediatric Bacterial Meningitis: A Nationwide Study in Japan, 2014 to 2022.” Pediatric neurology (2025). PMID: 39892022 ↗
L5OTHERCited in: History and Physical Examination - [127]
Liu H, Kong X, Zeng Y et al.. “From pain to meningitis: bacteria hijack nociceptors to promote meningitis.” Frontiers in immunology (2024). PMID: 39877376 ↗
L5REVIEW_NARRATIVECited in: History and Physical Examination - [128]
Yaeger JP, Fiscella KA. “Variability in Invasive Bacterial Infection Proportions Among Febrile Infants Aged 8-90 Days Using Administrative Data.” Academic pediatrics (2025). PMID: 39577560 ↗
L5OTHERCited in: History and Physical Examination - [129]
Chessa E, Congiu F, Rizzo G et al.. “Rationale for investigating the use of anifrolumab in neuropsychiatric systemic lupus erythematosus: a combined narrative and case-based systematic literature review.” Frontiers in immunology (2026). PMID: 41756273 ↗
L2aSR_OBSCited in: Diagnosis and Workup, Supportive Care and Complication Management, Prognosis and Long-term Outcomes - [130]
Nouroozi F, Kazemi HS, Alinezhad A et al.. “Artificial Intelligence-based detection of neuropsychiatric lupus: an exploratory meta-analysis of neuroimaging and multimodal biomarker models.” Clinical and experimental medicine (2026). PMID: 41627551 ↗
L2aSR_OBSCited in: Diagnosis and Workup - [131]
Uawithya E, Siriphiphatcharoen P, Benjapibal B et al.. “Clinical, imaging, and immunological features of GFAP astrocytopathy: a systematic review with regional comparison.” Multiple sclerosis and related disorders (2026). PMID: 41576641 ↗
L2aSR_OBSCited in: Diagnosis and Workup, Differential Diagnosis - [132]
Zhao L, He J, Mei C et al.. “The efficacy of rituximab plus telitacicept in neuropsychiatric systemic lupus erythematosus: A retrospective study.” Clinical immunology (Orlando, Fla.) (2026). PMID: 41708039 ↗
L2bCOHORTCited in: Diagnosis and Workup, Management, Prognosis and Long-term Outcomes - [133]
Wang W, Tang S, Yang J et al.. “Individualized immunotherapy for immune reconstitution-associated cortical encephalitis in an HIV-positive cryptococcal meningitis patient: a case report.” Frontiers in immunology (2026). PMID: 41983125 ↗
L4CASE_REPORTCited in: Diagnosis and Workup, Differential Diagnosis, Management, Prognosis and Long-term Outcomes, Special Populations - [134]
Ogawa T, Yamashiro K, Tsutsumi S et al.. “IgG4-related hypertrophic pachymeningitis presenting with marked dural thickening, widespread white matter changes, and rectus gyrus transdiaphragmatic herniation into the sella turcica: a case report.” Frontiers in immunology (2026). PMID: 41756303 ↗
L4CASE_REPORTCited in: Diagnosis and Workup - [135]
Jain S, Dayal R, Kamal R et al.. “Comparative analysis of diagnostic efficacy of loop-mediated isothermal amplification (LAMP) and CBNAAT in children with suspected tubercular meningitis: a cross-sectional study.” BMJ paediatrics open (2026). PMID: 41850741 ↗
L5OTHERCited in: Diagnosis and Workup - [136]
Gao X, Guo Y, Luo P et al.. “Central nervous system infection caused by Mycoplasma hominis in an adult: a case report and literature review.” European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2025). PMID: 40788590 ↗
L2aSR_OBSCited in: Differential Diagnosis - [137]
Chaúque BJM, Chagas LB, da Silva TCB et al.. “Promising Drug Repurposing Candidates Targeting Free-Living Amoebae: A Systematic and Critical Review of Laboratory-Based Evidence.” Pathogens (Basel, Switzerland) (2026). PMID: 41901747 ↗
L2aSR_OBSCited in: Differential Diagnosis - [138]
Bogovič P, Kastrin A, Trampuš Bakija A et al.. “Cerebrospinal fluid findings and their temporal pattern in patients with different clinical presentations of tick-borne encephalitis; a cohort study.” Infection (2026). PMID: 41307887 ↗
L2bCOHORTCited in: Differential Diagnosis - [139]
López N, Cuesta G, Puerta-Alcalde P. “Viral meningoencephalitis: a focus on diagnostics.” Current opinion in infectious diseases (2025). PMID: 40990729 ↗
L5REVIEW_NARRATIVECited in: Differential Diagnosis - [140]
Di Maria S, Bolcato M, Concato M et al.. “Hospital-Acquired Citrobacter Meningitis Complicated by Pneumocephalus in a Neonate.” Pediatrics (2026). PMID: 41734809 ↗
L4CASE_REPORTCited in: Differential Diagnosis, Supportive Care and Complication Management, Special Populations - [141]
Marín-Cruz I, López-Lobato M, Falcón-Neyra D et al.. “Emergence of Pediatric West Nile Virus Neuroinvasive Disease in Spain: An Expanding Threat in a Changing Climate-A Case Series.” The Pediatric infectious disease journal (2026). PMID: 41361685 ↗
L4CASE_REPORTCited in: Differential Diagnosis, Prognosis and Long-term Outcomes - [142]
Nguyen LCA, Nguyen PMA, Nguyen THN. “Human herpesvirus 7 induced aseptic meningitis in an immunocompetent adult presenting with unusual neurological symptoms: a case report.” Virology journal (2025). PMID: 41299705 ↗
L4CASE_REPORTCited in: Differential Diagnosis, Supportive Care and Complication Management - [143]
Lin Y, Diao Z, Low J et al.. “Therapeutic efficacy of telitacicept in a patient with GFAP autoimmune astrocytopathy: a case report.” Frontiers in immunology (2025). PMID: 41181139 ↗
L4CASE_REPORTCited in: Differential Diagnosis, Prognosis and Long-term Outcomes - [144]
Zhang Y, Zheng S, Li Y et al.. “Case Report: A case of neuropsychiatric lupus with primary central nervous system diffuse large B-cell lymphoma.” Frontiers in immunology (2025). PMID: 40918104 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [145]
Yang J, Zhang F, Guo X et al.. “Human herpesvirus type 4 combined with Brucella abortus meningitis case report.” BMC infectious diseases (2025). PMID: 40855467 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [146]
El-Baba M, Austin E. “Thunderclap headache in a patient with Salmonella Enterica meningitis.” The American journal of emergency medicine (2025). PMID: 40603211 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [147]
Lopez C, Sanchez-Sanchez R, Corona D et al.. “A Fatal Case of Monkeypox-Associated Encephalitis in a Non-HIV-Infected Patient.” Critical care explorations (2025). PMID: 40505032 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [148]
Ramirez J, Furmanek S, Chandler T et al.. “A Ten-Year Retrospective Review of Medical Records of Patients Admitted with Meningitis or Encephalitis at Five Hospitals in the United States Highlights the Potential for Under-Ascertainment of Invasive Meningococcal Disease.” Pathogens (Basel, Switzerland) (2025). PMID: 41156573 ↗
L5REVIEW_NARRATIVECited in: Differential Diagnosis - [149]
Shahrivar F, Moghimi A, Hosseinzadeh R et al.. “A comprehensive review on the neurological impact of parasitic infections.” Microbial pathogenesis (2025). PMID: 40446972 ↗
L5REVIEW_NARRATIVECited in: Differential Diagnosis - [150]
Pang L, Xu X, Liu Y et al.. “A case report and literature review of neuropsychiatric lupus presenting with coma as the initial symptom.” Medicine (2026). PMID: 41560092 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [151]
Gao P, Chen X, Li Y et al.. “Anti-CASPR2 meningoencephalitis with thickened dura mater induced by various infections: A case report and literature review.” Medicine (2025). PMID: 40550065 ↗
L4CASE_REPORTCited in: Differential Diagnosis - [152]
Veljanoska E, Szende A, McGill F et al.. “Cost implications of introducing the BIOFIRE FILMARRAY meningitis/encephalitis panel vs. real-time PCR in adult and pediatric populations in the UK.” Journal of medical economics (2026). PMID: 41608961 ↗
L5OTHERCited in: Differential Diagnosis - [153]
Yakubovsky M, Kadar L, Katchman E et al.. “Cat scratch disease encephalitis: New insights into rate, clinical features, and long-term outcomes.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41544843 ↗
L5OTHERCited in: Differential Diagnosis, Supportive Care and Complication Management - [154]
Nassur JA, Schnell KM, Dolon CD et al.. “Epidemiology of healthcare-associated ventriculitis and meningitis (HCAVM) and community-acquired meningitis/encephalitis and evaluation of an off-label PCR panel for HCAVM diagnosis.” Microbiology spectrum (2026). PMID: 41451990 ↗
L5OTHERCited in: Differential Diagnosis - [155]
Ellis J, Hale G, Nsangi LJ et al.. “Inpatient initiation of tuberculosis preventive therapy with 1 month of isoniazid and rifapentine for adults with advanced HIV disease and cryptococcal meningitis (IMPROVE): a non-inferiority, randomised controlled trial.” The lancet. HIV (2026). PMID: 41662846 ↗
L1bRCTCited in: Management, Landmark Trials and Key Evidence, Special Populations - [156]
Chandu M, Bhatia R, Modi M et al.. “Patterns and Factors Associated With Cerebral Infarction on MRI in Tuberculous Meningitis: Secondary Analysis of the ACT-TBM Trial.” Stroke (2026). PMID: 41521897 ↗
L1bRCTCited in: Management, Prognosis and Long-term Outcomes, Landmark Trials and Key Evidence - [157]
Yuan R, Peng H, Wang Y et al.. “Prognostic nomogram for predicting postoperative meningitis duration in skull base tumor surgery: a retrospective cohort study.” Journal of neurosurgery (2026). PMID: 41349019 ↗
L2bCOHORTCited in: Management, Prognosis and Long-term Outcomes - [158]
Peng H, Yuan R, Zheng Y et al.. “Delayed diagnosis in postoperative bacterial meningitis: A retrospective study in the skull base neoplasm surgery.” Clinical neurology and neurosurgery (2026). PMID: 41317437 ↗
L2bCOHORTCited in: Management - [159]
Smith D, Garikipati R, Bastug K et al.. “Paenibacillus dendritiformis as a Cause of Destructive Meningitis in Infants.” NEJM evidence (2026). PMID: 41632684 ↗
L4CASE_REPORTCited in: Management - [160]
Wang L, Bi Y, Zhou Y et al.. “Meningitis due to pandrug resistant Chryseobacterium gleum: microbiological cure and clinical response with linezolid-based combination therapy.” European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2026). PMID: 41483390 ↗
L4CASE_REPORTCited in: Management, Prognosis and Long-term Outcomes - [161]
Ariza-Varón M, Jaramillo-Arrázola MJ, Riveros L et al.. “Meningitis caused by Fusobacterium nucleatum complicated with cavernous sinus thrombosis: A case report.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41330476 ↗
L4CASE_REPORTCited in: Management, Prognosis and Long-term Outcomes - [162]
Liu W, He T, Qin H et al.. “Concentration of contezolid in cerebrospinal fluid and serum in a patient with renal allograft tuberculosis and tuberculous meningoencephalitis.” BMC infectious diseases (2025). PMID: 41257614 ↗
L4CASE_REPORTCited in: Management - [163]
Maran K, Adams R, Khan A et al.. “Intravenous Liposomal Amphotericin as an Adjunct to Fluconazole in Pediatric Patients With Central Nervous System Coccidioidomycosis: A Single-Center Case Series.” Journal of the Pediatric Infectious Diseases Society (2025). PMID: 41217140 ↗
L4CASE_REPORTCited in: Management, Supportive Care and Complication Management, Prognosis and Long-term Outcomes - [164]
Jiang H, Hu Y, Cai J et al.. “Variations in ventricular distribution of polymyxin B following intraventricular administration in patients with central nervous system infections.” Antimicrobial agents and chemotherapy (2026). PMID: 41196281 ↗
L4CASE_REPORTCited in: Management - [165]
Diop S, Van Caenegem N, Troupel T et al.. “Combination of azathioprine and prednisolone as a treatment for meningoencephalomyelitis of unknown origin in dogs: 54 cases.” Journal of veterinary internal medicine (2026). PMID: 41742501 ↗
L5OTHERCited in: Management, Supportive Care and Complication Management - [166]
Kilgore MD, Carr C, Kuchar M et al.. “Utility of lumbar and external ventricular drainage in the management of meningitis: a systematic review.” Neurosurgical focus (2025). PMID: 41175399 ↗
L2aSR_OBSCited in: Supportive Care and Complication Management, Prognosis and Long-term Outcomes - [167]
Fagundes W, Ahmed AR, Silva YP et al.. “Endoscopic third ventriculostomy versus ventriculoperitoneal shunt for treating pediatric tuberculous meningitis hydrocephalus: a systematic review and meta-analysis.” Journal of neurosurgery. Pediatrics (2025). PMID: 40479834 ↗
L2aSR_OBSCited in: Supportive Care and Complication Management - [168]
Tang X, Zhang W, Zhou A et al.. “Clinical, imaging, and recurrence analysis of myelin oligodendrocyte glycoprotein antibody-associated disease with initial presentation as meningoencephalitis in children: a single-center retrospective study.” Pediatric radiology (2025). PMID: 40464908 ↗
L2bCOHORTCited in: Supportive Care and Complication Management - [169]
Liu L, Wang X, Guo L et al.. “Epidemiological characteristics and disease burden of bacterial meningitis in hospitalized children in China: a 6-year nationwide retrospective study.” BMC infectious diseases (2025). PMID: 40275150 ↗
L2bCOHORTCited in: Supportive Care and Complication Management - [170]
Hsu CH, Hsuan YT, Chan YJ et al.. “Clinical presentation of cytomegalovirus meningoencephalitis: a retrospective study of 12 adult patients with a variety of immunocompromised conditions.” BMC infectious diseases (2025). PMID: 40264020 ↗
L2bCOHORTCited in: Supportive Care and Complication Management - [171]
Aletayeb SMH, Dehdashtian M, Aramesh MR et al.. “Ten-year review of hospital-acquired neonatal meningitis in a tertiary-level NICU: the important role of acinetobacter species.” BMC infectious diseases (2025). PMID: 40259250 ↗
L5REVIEW_NARRATIVECited in: Supportive Care and Complication Management - [172]
Datta A, Vardhan MV, Srivastava C. “Paroxysmal sympathetic hyperactivity in tubercular meningitis: An underacknowledged association.” Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (2025). PMID: 41284088 ↗
L4CASE_REPORTCited in: Supportive Care and Complication Management - [173]
Li C, Liu M, Ji Y et al.. “Clinical characteristics and prognostic indicators in Listeria monocytogenes meningoencephalitis: A retrospective case series and literature review.” BMC neurology (2025). PMID: 41087940 ↗
L4CASE_REPORTCited in: Supportive Care and Complication Management - [174]
Sheng C, Wang M, Bao Q et al.. “Anti-tuberculosis therapy combined with ventriculoperitoneal shunt for tuberculous meningitis combined with hydrocephalus: A case report.” Journal of infection and public health (2025). PMID: 40763461 ↗
L4CASE_REPORTCited in: Supportive Care and Complication Management - [175]
Wu C, Han X, Yang F et al.. “Misdiagnosis of autoimmune glial fibrillary acidic protein astrocytopathy as infectious meningitis: a case report.” Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2025). PMID: 40439829 ↗
L4CASE_REPORTCited in: Supportive Care and Complication Management - [176]
Wang X, Liang L, Liang Y et al.. “A rare case of multiple brain abscesses caused by Nocardia abscessus co-infection with tuberculous meningitis in an immunocompetent patient.” BMC infectious diseases (2025). PMID: 40360973 ↗
L4CASE_REPORTCited in: Supportive Care and Complication Management - [177]
Sedgwick AK, Anderson S. “Acute Mastoiditis Complicated by Meningitis: A Case Report and Condition Overview.” Critical care nurse (2025). PMID: 41319997 ↗
L4CASE_REPORTCited in: Supportive Care and Complication Management - [178]
Plaatjie ON, van Furth AMT, Solomons R et al.. “Characterization of CSF tryptophan metabolites in South African children with tuberculous meningitis.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41260406 ↗
L5OTHERCited in: Supportive Care and Complication Management - [179]
Lempinen L, Saat R, Laulajainen-Hongisto A et al.. “Otogenic meningitis in children.” Infection (2026). PMID: 41247662 ↗
L5OTHERCited in: Supportive Care and Complication Management - [180]
Tianrui Y, Lingyun B, Jin G. “Establishment of a risk prediction model for hydrocephalus complicated by neonatal bacterial meningitis.” BMC infectious diseases (2025). PMID: 41013354 ↗
L5OTHERCited in: Supportive Care and Complication Management - [181]
Lin Q, Fang W, Fan K et al.. “A novel diagnostic strategy of differential diagnosis of tuberculous meningitis and non-tuberculous meningitis: a retrospective observational cohort study.” Microbiology spectrum (2026). PMID: 41313026 ↗
L2bCOHORTCited in: Prognosis and Long-term Outcomes - [182]
Ashwin JV, Verma R, Shahi MK et al.. “Cognitive impairment in tuberculous meningitis: Systematic review & meta-analysis.” The Indian journal of tuberculosis (2026). PMID: 41831920 ↗
L2aSR_OBSCited in: Prognosis and Long-term Outcomes - [183]
Wang H, Ye S, Sun F. “Comparison of obinutuzumab and rituximab for treating neuropsychiatric lupus: a retrospective case-control study.” Lupus science & medicine (2025). PMID: 41193185 ↗
L3bCASE_CONTROLCited in: Prognosis and Long-term Outcomes - [184]
Walker RS, Vallejos GB, Nurye T et al.. “An analysis of national guidelines for the prevention, diagnosis and treatment of cryptococcal meningitis in sub-Saharan African countries: gaps and opportunities.” BMJ global health (2026). PMID: 41714099 ↗
L5OTHERCited in: Prognosis and Long-term Outcomes - [185]
Tian C, Jin S, Zhao Z et al.. “Association of Corticosteroid Treatment With Outcomes in Pediatric Patients With Bacterial Meningitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” Clinical therapeutics (2022). PMID: 35272859 ↗
L1aSR_MA_RCTCited in: Landmark Trials and Key Evidence - [186]
Hodgson A, Haidara FC, Sow SO et al.. “Immunogenicity and safety of a meningococcal a conjugate vaccine administered with routine EPI vaccines in African infants and toddlers.” Vaccine (2025). PMID: 40966979 ↗
L1bRCTCited in: Landmark Trials and Key Evidence, Prevention and Screening - [187]
Calderin JM, Wasserman S, Resendiz-Galvan JE et al.. “Population pharmacokinetics of pyrazinamide and isoniazid in plasma and cerebrospinal fluid from South African adults with tuberculous meningitis.” Antimicrobial agents and chemotherapy (2025). PMID: 40590723 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [188]
Abdelgawad N, Wasserman S, Gausi K et al.. “Population Pharmacokinetics of Rifampicin in Plasma and Cerebrospinal Fluid in Adults With Tuberculosis Meningitis.” The Journal of infectious diseases (2025). PMID: 40295169 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [189]
Samuels THA, Molloy SF, Lawrence DS et al.. “Personalised risk-prediction tools for cryptococcal meningitis mortality to guide treatment stratification in sub-Saharan Africa: a prognostic modelling study based on pooled analysis of two randomised controlled trials.” The Lancet. Global health (2025). PMID: 40288401 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [190]
Diallo F, Haidara FC, Tapia MD et al.. “Safety and immunogenicity of a pentavalent meningococcal conjugate vaccine targeting serogroups A, C, W, Y, and X when co-administered with routine childhood vaccines at ages 9 months and 15 months in Mali: a single-centre, double-blind, randomised, controlled, phase 3, non-inferiority trial.” Lancet (London, England) (2025). PMID: 40086461 ↗
L1bRCTCited in: Landmark Trials and Key Evidence, Prevention and Screening - [191]
Chow FC, Kafeero P, Nakimbugwe M et al.. “Safety and Tolerability of a Short Course of Linezolid for the Treatment of Predominantly Moderate to Severe Tuberculous Meningitis in Adults With Human Immunodeficiency Virus.” The Journal of infectious diseases (2025). PMID: 39960851 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [192]
Ibnou Zekri Lassout N, Goyal V, Krantz E et al.. “Bioavailability of a novel sustained-release pellet formulation of 5-flucytosine in healthy-fed participants for use in patients with cryptococcal meningitis.” Clinical and translational science (2024). PMID: 39291723 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [193]
Meya DB, Nalintya E, Skipper CP et al.. “Adjunctive Single-Dose Liposomal Amphotericin to Prevent Cryptococcal Meningitis in People With HIV-Associated Cryptococcal Antigenemia and Low Plasma Cryptococcal Antigen Titers.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2025). PMID: 39044381 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [194]
Ahmed T, Tauheed I, Hoque S et al.. “A phase 3 non-inferiority trial of locally manufactured Meningococcal ACWY vaccine 'Ingovax ACWY' among Bangladeshi adults.” Vaccine (2024). PMID: 38897895 ↗
L1bRCTCited in: Landmark Trials and Key Evidence, Prevention and Screening - [195]
Asante KP, Mathanga DP, Milligan P et al.. “Feasibility, safety, and impact of the RTS,S/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of cluster-randomised introduction of the vaccine in Ghana, Kenya, and Malawi.” Lancet (London, England) (2024). PMID: 38583454 ↗
L1bRCTCited in: Landmark Trials and Key Evidence, Prevention and Screening - [196]
Donovan J, Bang ND, Imran D et al.. “Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults.” The New England journal of medicine (2023). PMID: 37819954 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [197]
Boulware DR, Atukunda M, Kagimu E et al.. “Oral Lipid Nanocrystal Amphotericin B for Cryptococcal Meningitis: A Randomized Clinical Trial.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2023). PMID: 37606364 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [198]
Haidara FC, Umesi A, Sow SO et al.. “Meningococcal ACWYX Conjugate Vaccine in 2-to-29-Year-Olds in Mali and Gambia.” The New England journal of medicine (2023). PMID: 37224196 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [199]
Davis AG, Wasserman S, Stek C et al.. “A Phase 2A Trial of the Safety and Tolerability of Increased Dose Rifampicin and Adjunctive Linezolid, With or Without Aspirin, for Human Immunodeficiency Virus-Associated Tuberculous Meningitis: The LASER-TBM Trial.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2023). PMID: 36482216 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [200]
Kelentse N, Moyo S, Choga WT et al.. “High concordance in plasma and CSF HIV-1 drug resistance mutations despite high cases of CSF viral escape in individuals with HIV-associated cryptococcal meningitis in Botswana.” The Journal of antimicrobial chemotherapy (2022). PMID: 36322466 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [201]
Jarvis JN, Lawrence DS, Meya DB et al.. “Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis.” The New England journal of medicine (2022). PMID: 35320642 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [202]
Paradkar MS, Devaleenal D B, Mvalo T et al.. “Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2022). PMID: 35291004 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [203]
Ngan NTT, Thanh Hoang Le N, Vi Vi NN et al.. “An open label randomized controlled trial of tamoxifen combined with amphotericin B and fluconazole for cryptococcal meningitis.” eLife (2021). PMID: 34581270 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [204]
Wasserman S, Davis A, Stek C et al.. “Plasma Pharmacokinetics of High-Dose Oral versus Intravenous Rifampicin in Patients with Tuberculous Meningitis: a Randomized Controlled Trial.” Antimicrobial agents and chemotherapy (2021). PMID: 33972248 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [205]
Cresswell FV, Meya DB, Kagimu E et al.. “High-Dose Oral and Intravenous Rifampicin for the Treatment of Tuberculous Meningitis in Predominantly Human Immunodeficiency Virus (HIV)-Positive Ugandan Adults: A Phase II Open-Label Randomized Controlled Trial.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2021). PMID: 33693537 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [206]
Pett SL, Spyer M, Haddow LJ et al.. “Benefits of enhanced infection prophylaxis at antiretroviral therapy initiation by cryptococcal antigen status.” AIDS (London, England) (2021). PMID: 33306556 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [207]
Soul JS, Bergin AM, Stopp C et al.. “A Pilot Randomized, Controlled, Double-Blind Trial of Bumetanide to Treat Neonatal Seizures.” Annals of neurology (2021). PMID: 33201535 ↗
L1bRCTCited in: Landmark Trials and Key Evidence - [208]
Dixon S, Ashby S, Kuhne C et al.. “The motor optimality of infants who have had Meningitis in the first months of life: A retrospective study.” Early human development (2026). PMID: 41506216 ↗
L2bCOHORTCited in: Special Populations - [209]
Govender NP, Greene GS, Hullsiek KH et al.. “Effectiveness of a National Reflex Laboratory Cryptococcal Antigen Screening Program for People With Advanced HIV Disease in South Africa: A Nationwide-Sampled Cohort Study (CAST-NET).” Journal of acquired immune deficiency syndromes (1999) (2025). PMID: 40663428 ↗
L2bCOHORTCited in: Special Populations - [210]
Krishnegowda VK, Bandiya P, Nanda D et al.. “Cerebrospinal Procalcitonin for Diagnosing Meningitis in Infants Less Than 90 Days: A Systematic Review and Meta-analysis.” Indian pediatrics (2025). PMID: 41060555 ↗
L2aSR_OBSCited in: Special Populations - [211]
Falconer J, Mmotsa TM, Govender NP et al.. “Diagnosis of cryptococcal meningitis in people living with HIV in low-income countries: barriers and strategies.” Expert review of anti-infective therapy (2025). PMID: 40874873 ↗
L5REVIEW_NARRATIVECited in: Special Populations - [212]
Kitaya S, Otani H, Yanagi M et al.. “Campylobacter fetus meningitis and bacteremia: A case report in a post-liver transplant and post-splenectomy patient and a restructured literature review.” Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (2025). PMID: 41241280 ↗
L4CASE_REPORTCited in: Special Populations - [213]
Kay AW, Madison M, Scandrett K et al.. “Xpert MTB/RIF Ultra assay for tuberculosis disease and rifampicin resistance in children.” The Cochrane database of systematic reviews (2025). PMID: 41128098 ↗
L2aSR_OBSCited in: Special Populations - [214]
Al Reesi MS, Muttawa LAA, Albolushi MA et al.. “Elizabethkingia Infections - An Important Emerging Cause of Sepsis and Meningitis in Neonates and Infants: Case Series from North Batinah Region, Oman, and literature review.” Sultan Qaboos University medical journal (2025). PMID: 40979593 ↗
L4CASE_REPORTCited in: Special Populations - [215]
Clark D, Barranco-Trabi J, Goo I et al.. “Single-Dose Liposomal Amphotericin Plus Fluconazole and Flucytosine for Cryptococcal Meningitis at a US Public Hospital.” JAMA network open (2026). PMID: 41563759 ↗
L5OTHERCited in: Special Populations - [216]
Mwamba TM, Blasich NP, Coetzee LM et al.. “Cryptococcal antigen titers and semi-quantitative assay scores among people with HIV-associated cryptococcal antigenemia.” Journal of clinical microbiology (2026). PMID: 41537580 ↗
L5OTHERCited in: Special Populations - [217]
Atefi A, Ghanaatpisheh A, Ghasemi A et al.. “Meningitis after COVID-19 vaccination, a systematic review of case reports and case series.” BMC infectious diseases (2024). PMID: 39390499 ↗
L2aSR_OBSCited in: Prevention and Screening - [218]
Ramachandran P, Grose C. “Serious neurological adverse events in immunocompetent children and adolescents caused by viral reactivation in the years following varicella vaccination.” Reviews in medical virology (2024). PMID: 38658176 ↗
L2aSR_OBSCited in: Prevention and Screening - [219]
Taiyeb Khosroshahi M, Hamidi S, Kangari P et al.. “Post-COVID-19 Vaccination Meningitis and Meningoencephalitis: A Systematic Review of Case Series and Case Reports.” The American journal of tropical medicine and hygiene (2025). PMID: 39437771 ↗
L2aSR_OBSCited in: Prevention and Screening - [220]
Tripathi N, Mukherjee S. “Efficacy and Prolonged Safety of Haemophilus influenzae Type b Conjugate Vaccines.” Infectious disorders drug targets (2024). PMID: 38231056 ↗
L2aSR_OBSCited in: Prevention and Screening - [221]
Truong HC, Phan TV, Nguyen HT et al.. “Clinical features and antibiotic resistance in pediatric pneumococcal meningitis in Southern Vietnam, 2012-2023: A multicenter retrospective study.” Journal of infection and public health (2025). PMID: 40318609 ↗
L2bCOHORTCited in: Prevention and Screening - [222]
Asante KP, Bozonnat MC, Savic M et al.. “Incidence rates of malaria, meningitis, and mortality in children younger than 5 years: a prospective cohort study in Ghana and Kenya before the roll-out of the RTS,S/AS01E malaria vaccine from 2016 to 2022.” The Lancet. Global health (2025). PMID: 40288396 ↗
L2bCOHORTCited in: Prevention and Screening - [223]
Bjar N, Hermansson A, Gisselsson-Solen M. “How common is otogenic meningitis? A retrospective study in southern Sweden over 18 years.” Infection (2024). PMID: 38416397 ↗
L2bCOHORTCited in: Prevention and Screening - [224]
Anosike C, Ojiakor IM, Etiaba EI et al.. “Cost-effectiveness and budget impact of malaria, measles, and meningitis vaccines in Africa: a scoping review.” Vaccine (2025). PMID: 41110197 ↗
L5REVIEW_NARRATIVECited in: Prevention and Screening - [225]
Ewing A, Haldeman S, Ratner AJ. “Clinical progress note: Haemophilus influenzae type b.” Journal of hospital medicine (2025). PMID: 40205699 ↗
L5REVIEW_NARRATIVECited in: Prevention and Screening - [226]
Alexander NG, Cutts WD, Hooven TA et al.. “Mechanisms and Manifestations of Group B Streptococcus Meningitis in Newborns.” Journal of the Pediatric Infectious Diseases Society (2025). PMID: 39927629 ↗
L5REVIEW_NARRATIVECited in: Prevention and Screening - [227]
Xu Y, Wang J, Qin X et al.. “Advances in the pathogenesis and treatment of pneumococcal meningitis.” Virulence (2024). PMID: 39192572 ↗
L5REVIEW_NARRATIVECited in: Prevention and Screening - [228]
Gil-Prieto R, Hernandez-Barrera V, Marín-García P et al.. “Hospital burden of pneumococcal disease in Spain (2016-2022): A retrospective study.” Human vaccines & immunotherapeutics (2025). PMID: 39786144 ↗
L2bCOHORTCited in: Prevention and Screening - [229]
Park JJ, Tiefenbach J, Anwar MM et al.. “Estimating the Global and Regional Burden of Streptococcus pneumoniae Meningitis in Children: Protocol for a Systematic Review and Meta-Analysis.” JMIR research protocols (2024). PMID: 39012685 ↗
L2aSR_OBSCited in: Prevention and Screening - [230]
Mikami S, Ishii M, Yano T et al.. “Multifocal meningoencephalitis after vaccination against COVID-19.” Pathology international (2024). PMID: 39570102 ↗
L4CASE_REPORTCited in: Prevention and Screening - [231]
Kim JH, Yoon D, Ko HY et al.. “Risk of encephalitis and meningitis after COVID-19 vaccination in South Korea: a self-controlled case series analysis.” BMC medicine (2024). PMID: 38486297 ↗
L4CASE_REPORTCited in: Prevention and Screening - [232]
Alderson MR, Regan K, Martellet L et al.. “Development of MenFive®, an affordable pentavalent meningococcal conjugate vaccine (ACYWX) for Africa and beyond.” Human vaccines & immunotherapeutics (2025). PMID: 40968077 ↗
L5REVIEW_NARRATIVECited in: Prevention and Screening - [233]
Kato Y, Osada T, Araki N et al.. “Aseptic Meningitis after BNT-162b2 COVID-19 Vaccination: Case Report and Literature Review.” The Keio journal of medicine (2023). PMID: 37743529 ↗
L4CASE_REPORTCited in: Prevention and Screening - [234]
Carnalla-Barajas MN, Soto-Noguerón A, Solórzano-Santos F et al.. “Pneumococcal meningitis in Mexico. Serotype distribution and antimicrobial resistance before and after the introduction of pneumococcal conjugate vaccines in pediatric patients. Results from the GIVEBPVac group.” Journal of infection and public health (2026). PMID: 41223711 ↗
L5OTHERCited in: Prevention and Screening - [235]
Abad R, Navarro C, García-Amil C et al.. “Outbreak of invasive meningococcal disease caused by a meningococcus serogroup B expressing a rare porA genosubtype (19-54, 15), Spain, March to April 2024.” Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2025). PMID: 41199706 ↗
L5OTHERCited in: Prevention and Screening - [236]
Kang MS, Lee SH, Jung SI et al.. “Shift from Streptococcus pneumoniae to Klebsiella pneumoniae: a 15-year nationwide study of bacterial meningitis in Korea.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2025). PMID: 41076061 ↗
L5OTHERCited in: Prevention and Screening - [237]
Campbell H, Lucidarme J, Clark SA et al.. “Increase in serogroup W invasive meningococcal disease in England associated with pilgrimage to Saudi Arabia, January 2024 to June 2025.” Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2025). PMID: 40776896 ↗
L5OTHERCited in: Prevention and Screening - [238]
Lee IG, Lee J, Kim HR et al.. “Galectin-4 potentiates CD8+ T cell immunity by enhancing MHC-I expression on dendritic cells.” Molecular therapy : the journal of the American Society of Gene Therapy (2025). PMID: 40589087 ↗
L5OTHERCited in: Prevention and Screening - [239]
Donovan J, Cresswell FV, Tucker EW et al.. “A clinical practice guideline for tuberculous meningitis.” The Lancet. Infectious diseases (2026). PMID: 40840485 ↗
L1cGUIDELINECited in: Guidelines and Resources - [240]
Malmgren A, Orfanos I, Smedbäck J et al.. “The Swedish Society of Paediatric Infectious Diseases' 2025 Recommendations for the Initial Management of Suspected Paediatric Sepsis With or Without Shock.” Acta paediatrica (Oslo, Norway : 1992) (2025). PMID: 40719519 ↗
L1cGUIDELINECited in: Guidelines and Resources - [241]
Silverstein M, Wong JB, Davis EM et al.. “Screening for Syphilis Infection During Pregnancy: US Preventive Services Task Force Reaffirmation Recommendation Statement.” JAMA (2025). PMID: 40358930 ↗
L1cGUIDELINECited in: Guidelines and Resources - [242]
Chang CC, Harrison TS, Bicanic TA et al.. “Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.” The Lancet. Infectious diseases (2024). PMID: 38346436 ↗
L1cGUIDELINECited in: Guidelines and Resources - [243]
Cook AM, Morgan Jones G, Hawryluk GWJ et al.. “Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients.” Neurocritical care (2020). PMID: 32227294 ↗
L1cGUIDELINECited in: Guidelines and Resources - [244]
Beier AD, Nikas DC, Assassi N et al.. “Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Closure of Myelomeningocele Within 48 Hours to Decrease Infection Risk.” Neurosurgery (2019). PMID: 31418041 ↗
L1cGUIDELINECited in: Guidelines and Resources - [245]
. “Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection.” Obstetrics and gynecology (2017). PMID: 28742677 ↗
L1cGUIDELINECited in: Guidelines and Resources - [246]
. “Committee Opinion No. 712 Summary: Intrapartum Management of Intraamniotic Infection.” Obstetrics and gynecology (2017). PMID: 28742671 ↗
L1cGUIDELINECited in: Guidelines and Resources - [247]
Vergnano S, Buttery J, Cailes B et al.. “Neonatal infections: Case definition and guidelines for data collection, analysis, and presentation of immunisation safety data.” Vaccine (2016). PMID: 27491687 ↗
L1cGUIDELINECited in: Guidelines and Resources - [248]
McGill F, Heyderman RS, Michael BD et al.. “The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults.” The Journal of infection (2016). PMID: 26845731 ↗
L1cGUIDELINECited in: Guidelines and Resources - [249]
Bower WA, Hendricks K, Pillai S et al.. “Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident.” MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports (2015). PMID: 26632963 ↗
L1cGUIDELINECited in: Guidelines and Resources - [250]
Mazzola CA, Choudhri AF, Auguste KI et al.. “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants.” Journal of neurosurgery. Pediatrics (2014). PMID: 25988778 ↗
L1cGUIDELINECited in: Guidelines and Resources - [251]
. “Committee Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes.” Obstetrics and gynecology (2014). PMID: 25411758 ↗
L1cGUIDELINECited in: Guidelines and Resources - [252]
Solomon T, Michael BD, Smith PE et al.. “Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines.” The Journal of infection (2012). PMID: 22120595 ↗
L1cGUIDELINECited in: Guidelines and Resources - [253]
Kneen R, Michael BD, Menson E et al.. “Management of suspected viral encephalitis in children - Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group national guidelines.” The Journal of infection (2012). PMID: 22120594 ↗
L1cGUIDELINECited in: Guidelines and Resources - [254]
. “Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23).” MMWR. Morbidity and mortality weekly report (2010). PMID: 20814406 ↗
L1cGUIDELINECited in: Guidelines and Resources - [255]
Bertsias GK, Ioannidis JP, Aringer M et al.. “EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs.” Annals of the rheumatic diseases (2010). PMID: 20724309 ↗
L1cGUIDELINECited in: Guidelines and Resources - [256]
Wright JG, Quinn CP, Shadomy S et al.. “Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.” MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports (2010). PMID: 20651644 ↗
L1cGUIDELINECited in: Guidelines and Resources - [257]
Mygland A, Ljøstad U, Fingerle V et al.. “EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.” European journal of neurology (2010). PMID: 19930447 ↗
L1cGUIDELINECited in: Guidelines and Resources - [258]
Thwaites G, Fisher M, Hemingway C et al.. “British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children.” The Journal of infection (2009). PMID: 19643501 ↗
L1cGUIDELINECited in: Guidelines and Resources - [259]
Chaudhuri A, Martinez-Martin P, Kennedy PG et al.. “EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults.” European journal of neurology (2008). PMID: 18582342 ↗
L1cGUIDELINECited in: Guidelines and Resources - [260]
Halperin JJ, Shapiro ED, Logigian E et al.. “Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology [RETIRED].” Neurology (2007). PMID: 17522387 ↗
L1cGUIDELINECited in: Guidelines and Resources - [261]
. “Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine.” Pediatrics (2006). PMID: 16382131 ↗
L1cGUIDELINECited in: Guidelines and Resources - [262]
Rauer S, Kastenbauer S, Dersch R et al.. “Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis.” German medical science : GMS e-journal (2025). PMID: 41195425 ↗
L1cGUIDELINECited in: Guidelines and Resources - [263]
Schwarz Chavarri G, Sánchez Hernández C, Moreno Millán N et al.. “[Infectious Disease Prevention Group. Update on vaccines, 2020].” Atencion primaria (2020). PMID: 33388119 ↗
L1cGUIDELINECited in: Guidelines and Resources - [264]
Rauer S, Kastenbauer S, Hofmann H et al.. “Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis.” German medical science : GMS e-journal (2020). PMID: 32341686 ↗
L1cGUIDELINECited in: Guidelines and Resources - [265]
Tanaka Y, Kuwana M, Fujii T et al.. “2019 Diagnostic criteria for mixed connective tissue disease (MCTD): From the Japan research committee of the ministry of health, labor, and welfare for systemic autoimmune diseases.” Modern rheumatology (2021). PMID: 31903831 ↗
L1cGUIDELINECited in: Guidelines and Resources - [266]
Truffert E, Fournier Charrière E, Treluyer JM et al.. “Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version.” European annals of otorhinolaryngology, head and neck diseases (2019). PMID: 31420238 ↗
L1cGUIDELINECited in: Guidelines and Resources - [267]
Risser A, Donovan D, Heintzman J et al.. “NSAID prescribing precautions.” American family physician (2009). PMID: 20000300 ↗
L1cGUIDELINECited in: Guidelines and Resources - [268]
Martins B, Canelas G, Dias R et al.. “[Diagnostic, Therapeutic and Monitoring Approach in Suspected Neurosyphilis: Proposal for a Clinical Guideline].” Acta medica portuguesa (2024). PMID: 39622197 ↗
L1cGUIDELINECited in: Guidelines and Resources - [269]
Guzmán JJ, Duffey MM, Weatherhead J et al.. “Effect of different management strategies on outcomes in subarachnoid neurocysticercosis: a descriptive, multicentre, retrospective cohort study in the USA.” EClinicalMedicine (2026). PMID: 42005930 ↗
L4Cited in: Definition, Synonyms, and Classification - [270]
Maphosa T, Denoeud-Ndam L, Chilikutali L et al.. “Impact of an optimized care model for advanced HIV disease: a non-randomized cluster study in Malawi.” BMC public health (2025). PMID: 40819079 ↗
L2bCited in: Definition, Synonyms, and Classification - [271]
Sun X, Jing R, Zhuang Z et al.. “A nomogram to predict probable meningitis in very preterm and/or very low birth weight infants with early-onset sepsis: a multicenter retrospective study.” BMC pregnancy and childbirth (2026). PMID: 42226150 ↗
L3bCited in: Definition, Synonyms, and Classification - [272]
Snaith AE, van der Putten B, Bril-Keijzers W et al.. “Lineage dynamics of invasive Escherichia coli isolates in the Netherlands from 1975 to 2021: a retrospective longitudinal genomic analysis.” The Lancet. Microbe (2026). PMID: 41864215 ↗
L3bCited in: Definition, Synonyms, and Classification - [273]
de Gier B, Vlaminckx BJM, van Roon A et al.. “Risk of Household Secondary Invasive Group A Streptococcal Infections After a Prophylaxis Policy Change.” JAMA network open (2026). PMID: 41505128 ↗
L4Cited in: Definition, Synonyms, and Classification - [274]
Aizawa Y, Tachikawa J, Ikuse T et al.. “Parechovirus-A3 Infection in Neonates and Young Infants from the Pre-Coronavirus Disease 2019 Pandemic Period to the Post-Restriction Era from the Pediatric Parechovirus Surveillance Group in Japan.” Journal of the Pediatric Infectious Diseases Society (2025). PMID: 41206097 ↗
L3bCited in: Definition, Synonyms, and Classification - [275]
Shinohara K, Tsuda Y, Tsuchido Y et al.. “An 11-year multicentre clinical and genomic surveillance of listeriosis across Japan.” The Journal of infection (2025). PMID: 40684886 ↗
L4Cited in: Definition, Synonyms, and Classification - [276]
Alhan Ö, Koç MM, Batırel A et al.. “Emerging West Nile virus infections in Türkiye.” European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2025). PMID: 40293623 ↗
L4Cited in: Definition, Synonyms, and Classification - [277]
Briciu V, Ionicǎ AM, Mureşan S et al.. “Experience of a Romanian Lyme Borreliosis Centre in the Multidisciplinary Management of Patients Evaluated for Suspected Lyme Neuroborreliosis.” Microorganisms (2026). PMID: 41753551 ↗
L4Cited in: Definition, Synonyms, and Classification - [278]
Veyrenche N, Boluda S, Pérot P et al.. “One Health Investigation into Fatal Encephalitis Caused by Pigeon Paramyxovirus Type 1, France.” Emerging infectious diseases (2026). PMID: 42116534 ↗
L4Cited in: Definition, Synonyms, and Classification - [279]
Al Safar M, Alguydi HB, Marglani O. “Skull base CSF leak repair in the outpatient Arena: Pushing the boundaries of modern endoscopic surgery.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 41832320 ↗
L4Cited in: Definition, Synonyms, and Classification - [280]
Okethwangu D, Ahirirwe S, Venkateswaran M et al.. “Resilience of health systems in Africa to infectious disease shocks: A qualitative evidence synthesis.” PLOS global public health (2026). PMID: 42566489 ↗
L5Cited in: Definition, Synonyms, and Classification - [281]
Parperis K, Zis P, Evangelou M et al.. “Psychosis in patients with systematic lupus erythematosus: A systematic literature review and meta-analysis.” Lupus (2026). PMID: 41805380 ↗
L1aCited in: Epidemiology and Risk Factors - [282]
Dionisopoulos Z, Sabhaney V, D'Arienzo D et al.. “Prevalence of Invasive Bacterial Infections Among Febrile Infants Aged 60 to 90 Days: A Systematic Review and Meta-Analysis.” JAMA pediatrics (2026). PMID: 42189531 ↗
L2aCited in: Epidemiology and Risk Factors - [283]
Chouksey SS, Jain A, Singh VK et al.. “Unmasking the cognitive burden of adult tuberculous meningitis: A systematic review and meta analysis.” Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2026). PMID: 41629635 ↗
L2aCited in: Epidemiology and Risk Factors - [284]
Magnerou AM, Gams Massi D, Maidawa VP et al.. “HIV-related neurological complications in Cameroon in the era of Test and Treat strategy: prevalence and mortality.” BMC infectious diseases (2026). PMID: 42056892 ↗
L2bCited in: Epidemiology and Risk Factors - [285]
The NT, Lam NX, Luan ND et al.. “Predictors of mortality and clinical outcomes in adult bacterial meningitis in Northern Vietnam: A seven-year cohort analysis.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41864265 ↗
L4Cited in: Epidemiology and Risk Factors - [286]
Luan M, Chen X. “Efficacy and safety of drug therapies for treating tuberculous meningitis: a network meta-analysis.” Journal of infection in developing countries (2026). PMID: 42112729 ↗
L1aCited in: Epidemiology and Risk Factors - [287]
Dutta AK, Dass Hazarika R, Ravikumar KL et al.. “Meningococcal meningitis in India: An expert consensus on use of MCVs.” Human vaccines & immunotherapeutics (2026). PMID: 42446494 ↗
L2aCited in: Epidemiology and Risk Factors - [288]
Wang Y, Dong F, Li C et al.. “Bacterial spectrum and antimicrobial resistance of cerebrospinal fluid pathogens in pediatric bacterial meningitis: a 7-year study in Southwest China with emphasis on post-neurosurgical cases.” Frontiers in cellular and infection microbiology (2026). PMID: 42499543 ↗
L3bCited in: Epidemiology and Risk Factors - [289]
Price M, Farthing S, Wong SH et al.. “Stroke Complicating Pediatric Bacterial Meningitis: A Retrospective Case-Controlled Cohort Analysis.” Pediatric neurology (2026). PMID: 42161222 ↗
L3bCited in: Epidemiology and Risk Factors - [290]
Li H, Li J, Wu Q et al.. “Machine learning-based analysis of prognostic factors in patients with tuberculous meningitis.” BMC infectious diseases (2026). PMID: 41857719 ↗
L3bCited in: Epidemiology and Risk Factors - [291]
Czupryna P, Grygorczuk S, Trojan G et al.. “Clinical characteristics, laboratory findings, and risk factors for severe tick-borne encephalitis (TBE) in northeastern Poland: Analysis of 1654 hospitalized cases between 1993 and 2023.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41850626 ↗
L3bCited in: Epidemiology and Risk Factors - [292]
Ye D, Fei ZT, Wang MJ et al.. “Clinical characteristics of childhood tuberculous meningitis and risk factors for severe neurological sequelae disaggregated by age group.” BMC infectious diseases (2026). PMID: 41639788 ↗
L3bCited in: Epidemiology and Risk Factors - [293]
Ferraris G, Tazzoli S, Folisi C et al.. “Machine Learning to Identify Bacteremia and Meningitis in Febrile Infants: A Systematic Review.” Pediatrics (2026). PMID: 42419745 ↗
L2aCited in: Etiology and Triggering Factors - [294]
Zhang Y, Liang A, Li X et al.. “Cerebrospinal fluid procalcitonin and neutrophil percentage: a combined biomarker for differentiating bacterial from tuberculous meningitis in antibiotic-pretreated patients.” Frontiers in cellular and infection microbiology (2026). PMID: 42416277 ↗
L2bCited in: Etiology and Triggering Factors - [295]
Gadelha Farias LAB, Neto OMV, Sobrinho EPL et al.. “Leptospirosis-associated meningitis in an urban tropical endemic setting in northeastern Brazil: Three New cases and a meta-summary of 176 reported cases.” PLoS neglected tropical diseases (2026). PMID: 42113872 ↗
L4Cited in: Etiology and Triggering Factors - [296]
Szeto CH, Chavez-Morales A, Garza J et al.. “Disseminated Coccidioidomycosis and Coccidioidal Meningitis Hospitalization, Texas, USA, 2016-20231.” Emerging infectious diseases (2026). PMID: 42230324 ↗
L3bCited in: Etiology and Triggering Factors - [297]
Tang CM, Li HC, Su LH et al.. “Pneumococcal meningitis in children and adults before and after implementation of PCV13 into national pediatric immunization program: A cohort study in Taiwan.” Journal of infection and public health (2026). PMID: 42202671 ↗
L4Cited in: Etiology and Triggering Factors - [298]
Jiang H, Wang D, Zhang Q et al.. “Diagnostic accuracy of NGAL and HBP for the diagnosis of acute bacterial meningitis.” Clinica chimica acta; international journal of clinical chemistry (2026). PMID: 42142693 ↗
L3bCited in: Etiology and Triggering Factors - [299]
Nicolau-Guillaumet N, Moutel M, Plouzeau-Jayle C et al.. “Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy.” Microbiology spectrum (2026). PMID: 42089636 ↗
L3bCited in: Etiology and Triggering Factors - [300]
Du H, Tan C, Liu J et al.. “Diagnostic accuracy of serum procalcitonin for intracranial infection in adults: A systematic review and meta-analysis.” Medicine (2026). PMID: 42566625 ↗
L2aCited in: Etiology and Triggering Factors - [301]
Dixit S, Kumar A, Datta A et al.. “Postoperative meningitis in pediatric posterior fossa tumors: risk stratification and the role of early CSF cytology.” Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (2026). PMID: 42550272 ↗
L3bCited in: Etiology and Triggering Factors - [302]
Gürler M, Karaoğlu Ç, Yurtcu EE et al.. “Utility and clinical relevance of multiplex PCR panels for diagnosis of central nervous system infections.” The Indian journal of medical research (2026). PMID: 42237827 ↗
L4Cited in: Etiology and Triggering Factors - [303]
Khan AU, Shah SA. “Clinical and laboratory predictors of in hospital mortality in adult bacterial meningitis: A tertiary care study from Pakistan.” Clinical neurology and neurosurgery (2026). PMID: 42097013 ↗
L3bCited in: Etiology and Triggering Factors - [304]
Zhong Q, Bathaiian LS, Liu Y et al.. “Development and validation of a diagnostic nomogram for post-neurosurgical bacterial meningitis.” BMC neurology (2026). PMID: 42067788 ↗
L3bCited in: Etiology and Triggering Factors - [305]
Liu A, Liu Y, Shi L et al.. “Guillain-Barré syndrome following Escherichia coli meningitis after cupping therapy: a case report.” Frontiers in immunology (2026). PMID: 42254014 ↗
L4Cited in: Etiology and Triggering Factors - [306]
Kozák M, Majoros L, Bodnár F et al.. “When the meningitis-encephalitis panel is negative: off-label joint infection PCR detects CTX-M ESBL-producing Proteus mirabilis in adult meningoencephalitis.” BMC infectious diseases (2026). PMID: 42082938 ↗
L4Cited in: Etiology and Triggering Factors - [307]
Abraham A, Linn RL, Flannery DD et al.. “Placental Vascular Pathology Associated with Congenital Lymphocytic Choriomeningitis Virus Infection, Philadelphia, Pennsylvania, USA.” Emerging infectious diseases (2026). PMID: 42066794 ↗
L4Cited in: Etiology and Triggering Factors - [308]
Puppalla P, Farhadi DS, Smetanick D et al.. “Coccidioidomycosis-related hydrocephalus: A case control study.” Medical mycology (2026). PMID: 42500965 ↗
L3bCited in: Etiology and Triggering Factors - [309]
Skipper CP, Dai B, Borges B et al.. “Investigation of human leukocyte antigen alleles as risk factors for cryptococcal disease in Ugandan individuals with HIV.” Human immunology (2026). PMID: 42289175 ↗
L3bCited in: Etiology and Triggering Factors - [310]
Zhang F, Zhao F, Fan C et al.. “Diagnostic value of cerebrospinal fluid antisuprabasin antibody in neuropsychiatric systemic lupus erythematosus.” Lupus science & medicine (2026). PMID: 42562427 ↗
L2bCited in: Pathophysiology - [311]
Donovan J, Thanh NT, Ngoc LHB et al.. “The cause, treatment and outcome of hyponatraemia associated with tuberculous meningitis: An observational study nested within two clinical trials of corticosteroids.” The Journal of infection (2026). PMID: 42167495 ↗
L3bCited in: Pathophysiology - [312]
Garg RK, Kumar N, Suresh V et al.. “Neurocysticercosis-Associated Meningitis: A Systematic Review.” Neurology India (2026). PMID: 42087630 ↗
L4Cited in: Pathophysiology - [313]
Iyer S, Briggs RG, Dallas J et al.. “Coccidioides meningitis as a cause of low-pressure hydrocephalus: A contemporary case series and management strategy.” Clinical neurology and neurosurgery (2026). PMID: 42424789 ↗
L4Cited in: Pathophysiology - [314]
Mayer É, Velay A, Cazorla C et al.. “Tick-borne encephalitis emergence as the third leading cause of encephalitis/meningoencephalitis in western Auvergne-Rhône-Alpes, France.” Infectious diseases now (2026). PMID: 42086146 ↗
L4Cited in: Pathophysiology - [315]
Erdeniz EH, Üdürgücü M, Çoban Y et al.. “Listeria monocytogenes meningitis beyond the neonatal period: a multicenter case series of previously unpublished pediatric cases from Türkiye.” European journal of pediatrics (2026). PMID: 42570017 ↗
L4Cited in: Pathophysiology - [316]
Geng Q, Wang Y, Fan Y et al.. “First reported survival of anthrax meningoencephalitis in a low-incidence region: successful management with mNGS-guided combination therapy.” Frontiers in cellular and infection microbiology (2026). PMID: 42553304 ↗
L4Cited in: Pathophysiology - [317]
Wei W, Jin T, Zhang L et al.. “Case Report: Overlapping multiple sclerosis and neuropsychiatric systemic lupus erythematosus with positive MOG-IgG: a case initially misdiagnosed as depression.” Frontiers in immunology (2026). PMID: 42548805 ↗
L4Cited in: Pathophysiology - [318]
Deng Y, Bao Z, Zhuang S et al.. “Tuberculous meningoencephalitis concurrent with autoimmune glial fibrillary acidic protein astrocytopathy: a case report.” Frontiers in immunology (2026). PMID: 42548599 ↗
L4Cited in: Pathophysiology - [319]
Prasad M, Kumar A, Couban R et al.. “Duration of anti-seizure medicines started for acute symptomatic seizures due to acute meningitis: a systematic review and meta-analysis.” BMC medicine (2026). PMID: 42021346 ↗
L1aCited in: History and Physical Examination - [320]
Charlier C, Vijayaratnam S, Jeanton-Seybel C et al.. “Specificities of pediatric listeriosis beyond the neonatal period: A national prospective study.” Med (New York, N.Y.) (2026). PMID: 41605203 ↗
L4Cited in: History and Physical Examination - [321]
Alrushaydan D, Alsufyani AA, Alhussainan K et al.. “Trans-impedance matrix heatmap patterns in cochlear implant patients with different cochlear pathologies: meningitis, otosclerosis, and temporal bone fractures.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 42026295 ↗
L3bCited in: History and Physical Examination - [322]
Luo Y, Ma M, Tong M et al.. “Machine learning and meningitis prediction in pediatric invasive pneumococcal disease: a retrospective single-center study.” BMC infectious diseases (2026). PMID: 42015065 ↗
L3bCited in: History and Physical Examination - [323]
Player B, Havens PL, Mitchell ML et al.. “Utility of the meningoencephalitis panel in management of neonates with temperature instability.” BMC infectious diseases (2025). PMID: 41430581 ↗
L3bCited in: History and Physical Examination - [324]
Lino GM, Galvão PVM, Magalhães JJF et al.. “Adjunctive linezolid in patients with tuberculous meningitis for the prevention of mortality or neurologic disability: a meta-analysis of randomized controlled trials.” BMC infectious diseases (2026). PMID: 42157129 ↗
L1aCited in: Diagnosis and Workup - [325]
Nasiri MJ, Hamzelouee G, Rezaeinasab M et al.. “A systematic review and meta-analysis of steroid use for treatment of TB meningitis.” The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (2026). PMID: 42374702 ↗
L2aCited in: Diagnosis and Workup - [326]
Qian MY, He LY, Lan P et al.. “Clinical and neuroimaging predictors of outcome and impact of surgical intervention in cryptococcal meningitis: An observational study.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 42361959 ↗
L3bCited in: Diagnosis and Workup - [327]
Wang J, Chae Y, Koo Y et al.. “Platelet-to-lymphocyte ratio as an indicator of idiopathic epilepsy in dogs.” Journal of veterinary internal medicine (2026). PMID: 42207577 ↗
L3bCited in: Diagnosis and Workup - [328]
Luo Y, Guo Y, Liao X et al.. “Post-EV71 vaccination outcomes in meningoencephalitis: no increased clinical severity compared with other enterovirus subtypes in a single-center retrospective study.” Frontiers in cellular and infection microbiology (2026). PMID: 42205485 ↗
L3bCited in: Diagnosis and Workup - [329]
Anderson FE, De Decker S, Bentley RT et al.. “Clinical presentation, prognostic factors, and outcomes of meningoencephalitis of unknown origin in older dogs.” Journal of veterinary internal medicine (2026). PMID: 42117719 ↗
L3bCited in: Diagnosis and Workup - [330]
Chen G, Yu C, Yang Y et al.. “Quantitative mapping of prefrontal oxygenation dysfunction and neuropsychiatric symptoms in patients with systemic lupus erythematosus: a multichannel functional near-infrared spectroscopy study.” Lupus science & medicine (2026). PMID: 42386272 ↗
L3bCited in: Diagnosis and Workup - [331]
Thampy A, Alexander H, John JM et al.. “Early vs. delayed empiric antimicrobial treatment for suspected acute meningitis - a systematic review and meta-analysis.” BMC infectious diseases (2026). PMID: 41688940 ↗
L1aCited in: Supportive Care and Complication Management - [332]
Mahdavi J, Pirayeshfar S, Shariati A et al.. “Fatal brain infection in early life: primary amoebic meningoencephalitis caused by Naegleria fowleri in neonates and infants.” BMC infectious diseases (2026). PMID: 42426619 ↗
L4Cited in: Supportive Care and Complication Management - [333]
Araújo RD, Diniz LMO, Teixeira DC et al.. “Long-Term Outcomes Following Bacterial Meningitis in Childhood: A Systematic Review and Meta-Analysis.” Journal of paediatrics and child health (2026). PMID: 42267426 ↗
L2aCited in: Supportive Care and Complication Management - [334]
Miraclin T A, Rima S, Vanjare HA et al.. “Cryptococcal Choroid Plexitis with Trapped Ventricle in an Immunocompetent Individual: An Autopsy Case with Systematic Review of Reported Cases.” The American journal of tropical medicine and hygiene (2026). PMID: 41916271 ↗
L2aCited in: Supportive Care and Complication Management - [335]
Kapmaz M, Başaran S, Menemenlioğlu D et al.. “The first outbreak of neuroinvasive West Nile virus infection in Istanbul area within 2019.” BMC infectious diseases (2026). PMID: 41826887 ↗
L4Cited in: Supportive Care and Complication Management - [336]
Fayaz M, Khursheed A, Chavda V et al.. “A multivariate prediction model to predict delayed CSF sterilization in paediatric post-meningitic hydrocephalus.” Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (2026). PMID: 41917470 ↗
L2bCited in: Supportive Care and Complication Management - [337]
Birbeck GL, Bositis CM, Ume-Ezeoke I et al.. “New onset seizure etiologies and outcomes among adults with HIV in the era of broadly available antiretroviral therapies.” Seizure (2026). PMID: 41830651 ↗
L2bCited in: Supportive Care and Complication Management - [338]
Donovan J, Hung TT, Hiep NTT et al.. “A randomised comparison of management strategies for drug-induced liver injury associated with tuberculous meningitis treatment.” The Journal of infection (2026). PMID: 42309188 ↗
L1bCited in: Prognosis and Long-term Outcomes - [339]
Kumar M, Singh A, Singh R et al.. “Comparison of ethambutol versus streptomycin during the intensive phase in treatment of tuberculous meningitis: an open-label randomized clinical trial.” Postgraduate medical journal (2026). PMID: 41989851 ↗
L1bCited in: Prognosis and Long-term Outcomes - [340]
Grosa DP, Zavadska D, Freimane Z et al.. “Long-Term Outcomes in Adult Patients with Tick-Borne Encephalitis in Latvia.” Pathogens (Basel, Switzerland) (2026). PMID: 42514999 ↗
L2bCited in: Prognosis and Long-term Outcomes - [341]
Younas A, Noor R, Shaukat MT et al.. “Efficacy and Safety of Corticosteroids in Tuberculous Meningitis: Systematic Review, Meta-Analysis, and Meta-Regression.” Brain and behavior (2026). PMID: 42517870 ↗
L1aCited in: Prognosis and Long-term Outcomes - [342]
Mathias S, North K, Santana A et al.. “Efficacy of Antibiotic Regimens for Meningitis in Young Infants Aged 0-59 Days: A Systematic Review.” Pediatrics (2024). PMID: 39087804 ↗
L1aCited in: Landmark Trials and Key Evidence - [343]
Sudo RYU, Câmara MCC, Kieling SV et al.. “Shorter versus longer duration of antibiotic treatment in children with bacterial meningitis: a systematic review and meta-analysis.” European journal of pediatrics (2023). PMID: 37870611 ↗
L1aCited in: Landmark Trials and Key Evidence - [344]
Papachristos DA, Oon S, Hanly JG et al.. “Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review.” Seminars in arthritis and rheumatism (2020). PMID: 33360230 ↗
L1aCited in: Landmark Trials and Key Evidence - [345]
Calderin JM, Resendiz-Galvan JE, Abdelgawad N et al.. “Pharmacokinetics of Dexamethasone in Tuberculous Meningitis.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2026). PMID: 41408415 ↗
L1bCited in: Landmark Trials and Key Evidence - [346]
Bloch J, El Rhali L, Vissing N et al.. “The Spectrum of CNS Infections in Children and Adolescents in Denmark 2017-2023: A Multicenter Population-based Cohort Study.” The Pediatric infectious disease journal (2026). PMID: 41941117 ↗
L3bCited in: Special Populations - [347]
Duffy N, Koirala A, Williams PCM. “Epidemiology and Outcomes of Culture-proven Neonatal Meningitis in Australian Tertiary Hospitals: A Multicenter Retrospective Cohort Study.” The Pediatric infectious disease journal (2026). PMID: 41543078 ↗
L3bCited in: Special Populations - [348]
Hameed TK, Aljarbou TM, Altuwaym AA et al.. “Etiology of invasive bacterial infections in infants 90 days and younger presenting to the emergency department in a children's hospital in Saudi Arabia.” BMC infectious diseases (2026). PMID: 41820864 ↗
L4Cited in: Special Populations - [349]
Aemiro A, Girma A, Setew S et al.. “Prevalence of opportunistic fungal infections (candidiasis and cryptococcal meningitis) among HIV-positive individuals in Ethiopia: A systematic review and meta-analysis (PRISMA compliant).” Medicine (2026). PMID: 42629665 ↗
L2aCited in: Special Populations - [350]
Jiang N, Zhu M, Xiao X et al.. “Clinical characteristics and outcomes of early-onset neonatal bacterial meningitis: a 20-year retrospective comparison of preterm and full-term infants.” BMC pediatrics (2026). PMID: 42661190 ↗
L3bCited in: Special Populations - [351]
Zhang F, Yu Z, Pan J et al.. “Risk factors for acute neurological complications in neonatal bacterial meningitis: a retrospective cohort study.” Jornal de pediatria (2026). PMID: 41864622 ↗
L3bCited in: Special Populations - [352]
Wakutsu T, Inoue E, Nakamoto T et al.. “Recurrent herpes simplex virus type 2 Mollaret meningitis in a man living with HIV: A case report and patient-initiated episodic valacyclovir strategy.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 42031293 ↗
L4Cited in: Special Populations - [353]
Martin NG, Defres S, Willis L et al.. “Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology.” The Journal of infection (2024). PMID: 38552719 ↗
L2bCited in: Prevention and Screening - [354]
Fafi I, Cohen R, Levy C et al.. “High Mortality Due to Pneumococcal Meningitis in Children With Sickle Cell Disease: A French Multicenter Observational Study From 2001 to 2021.” The Pediatric infectious disease journal (2025). PMID: 40063777 ↗
L4Cited in: Prevention and Screening - [355]
Mahtab S, Madewell ZJ, Baillie V et al.. “Etiologies and comorbidities of meningitis deaths in children under 5 years in high-mortality settings: Insights from the CHAMPS Network in the post-pneumococcal vaccine era.” The Journal of infection (2024). PMID: 39521254 ↗
L3bCited in: Prevention and Screening - [356]
Cooper LV, Djedanem M, Nasser AA et al.. “Effectiveness of NmCV-5 vaccine against meningococcal meningitis in an outbreak setting in Niger: results from a case-control study.” Vaccine (2026). PMID: 42585809 ↗
L4Cited in: Prevention and Screening - [357]
Diallo MB, Youa IF, Wann A et al.. “Trends in bacterial meningitis in Guinea in the post-MenAfriVac era: a retrospective cross-sectional study (2021-2024).” BMC infectious diseases (2026). PMID: 41667987 ↗
L3bCited in: Prevention and Screening - [358]
Garcia-Carretero R, Gil-Prieto R, Hernandez-Barrera V et al.. “Epidemiological and clinical impact of pneumococcal disease in Spain in 2023: A nationwide retrospective analysis.” Human vaccines & immunotherapeutics (2025). PMID: 41207664 ↗
L3bCited in: Prevention and Screening