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 should be classified by both syndrome and evidentiary certainty; culture-negative, inflammatory CSF may support probable meningitis. [271]
- ▸Important related terms include aseptic meningitis, tuberculous meningitis, Lyme neuroborreliosis, neurolisteriosis, meningoencephalitis, and subarachnoid neurocysticercosis. [3][9][12][269][275][277]
- ▸TBM and West Nile infection use explicit certainty categories such as definite/probable/possible or confirmed/probable. [3][276]
- ▸SANCC definitions incorporate histopathology, characteristic subarachnoid cyst locations, serology, Del Brutto criteria, inflammatory CSF, antigen or quantitative PCR, and exclusion of alternative pathogens. [269]
- ▸Meningitis-associated syndromes span bacterial, viral, mycobacterial, parasitic, and opportunistic infections, including emerging and zoonotic pathogens. [6][8][9][10][11][12][269][270][272][274][275][276][278]
Definition
Meningitis is best treated as a clinical syndrome of meningeal inflammation, usually assessed through cerebrospinal-fluid (CSF) findings and microbiological, molecular, serological, or histopathological evidence. In very preterm and/or very-low-birth-weight infants with early-onset sepsis, “probable meningitis” was operationally defined as meningitis-consistent CSF abnormalities without culture confirmation, including culture-negative CSF with pleocytosis and neutrophil predominance. [271] This distinction is important because a negative CSF culture does not exclude meningitis when CSF inflammation and other compatible evidence are present. [271]
Meningitis may occur alone or with parenchymal brain involvement. The terms meningoencephalitis and neurolisteriosis describe clinically overlapping or extended central-nervous-system infection phenotypes rather than interchangeable diagnostic categories: fatal Angiostrongylus cantonensis infection in non-human primates produced eosinophilic and/or histiocytic meningoencephalitis, while Japanese surveillance classified 43 of 195 listeriosis cases as neurolisteriosis. [12]C[275]C West Nile virus infection was classified using European Centre for Disease Prevention and Control definitions as confirmed or probable infection; the reported cohort included neuroinvasive presentations, demonstrating that viral disease classification may depend on case-definition certainty as well as neurological involvement. [276]C
Synonyms and related terms
“Aseptic meningitis” generally denotes a meningitis syndrome in which routine bacterial evidence is absent or a non-bacterial cause is identified. Lymphocytic choriomeningitis virus is specifically described as an important cause of aseptic meningitis, including severe disease in an immunocompetent adult. [9]C A daycare-associated cluster of aseptic meningitis was linked to a recombinant enterovirus containing echovirus 6- and coxsackievirus B1-derived genomic segments. [11]C These reports support using aseptic meningitis as a syndromic term, not as a synonym for viral meningitis in every patient. [9]C[11]C
Neuroborreliosis or Lyme neuroborreliosis refers to neurological infection associated with Borrelia burgdorferi; a Romanian specialist-centre study evaluated suspected cases using neurological manifestations, two-tier serology, lumbar puncture, and the European Lyme neuroborreliosis definition. [277]C Tuberculous meningitis (TBM) identifies meningitis attributed to Mycobacterium tuberculosis and remains the most severe manifestation of tuberculosis. [3] Subarachnoid neurocysticercosis (SANCC) identifies Taenia solium infection involving subarachnoid spaces; it is an uncommon and severe form of neurocysticercosis. [269]C
Classification by cause and anatomic pattern
A practical classification is etiologic: bacterial, viral, mycobacterial, fungal, parasitic, or other infectious meningitis. The supplied evidence includes invasive Escherichia coli CSF infections in newborns, with K1-positive strains historically regarded as common although longitudinal genomic surveillance questioned assumptions of K1 dominance. [272] Invasive group A streptococcal disease is epidemiologically relevant to household transmission and prophylaxis policy, although the cited study does not establish group A streptococcus as a meningitis-specific pathogen. [273]C Neisseria meningitidis remains associated with invasive meningococcal disease and meningitis; recent evidence describes serogroup W, ST-11/CC11 infections after travel to Saudi Arabia and emerging ST-1466 and ST-11026 urogenital strains in China. [8]C[10]C
Listerial disease may be classified as bacteremia, neurolisteriosis, perinatal infection, or other infection; these categories were used in a multicentre Japanese cohort. [275]C Viral categories in the evidence include parechovirus-A3 infection in neonates and infants younger than 4 months, enterovirus-associated aseptic meningitis, West Nile neuroinvasive disease, lymphocytic choriomeningitis, and rare zoonotic viral encephalitis caused by pigeon paramyxovirus type 1. [274][11]C[276]C[9]C[278]C Bat-borne orthoreovirus was identified in patients with Nipah-like illness and encephalitis, illustrating that encephalitic presentations may require broad viral classification beyond conventional meningitis panels. [6]C
Parasitic and granulomatous categories include SANCC, TBM, and angiostrongyliasis-associated meningoencephalitis. [269]C[3][12]C SANCC may be classified as definite by histopathology; as probable or clinically supported when cysts occupy basilar subarachnoid spaces, Sylvian fissures, or the spine with T. solium antibody positivity or fulfillment of Del Brutto criteria; or through inflammatory CSF with positive T. solium antigen or quantitative PCR after exclusion of viral, fungal, and bacterial causes. [269]C
Classification by diagnostic certainty
TBM was categorized as definite, probable, or possible according to a uniform case definition in a Thai adult cohort. [3] Similar certainty-based terminology is used for probable meningitis in preterm or VLBW infants and for confirmed versus probable West Nile virus infection. [271][276]C Accordingly, classification should record both the suspected cause and the evidentiary level: microbiologically or histologically confirmed, probable based on compatible clinical and CSF findings, or possible when evidence is incomplete. This approach avoids equating a syndrome-level diagnosis with pathogen confirmation. [3][269]C[271][276]C
Related conditions and risk context
Advanced HIV disease is not synonymous with meningitis, but it increases the importance of systematic screening for opportunistic diseases, including tuberculosis and cryptococcosis; an optimized Malawi care model incorporated enhanced CD4 testing, TB screening, and cryptococcal-antigen screening. [270] A skull-base CSF leak is likewise not meningitis, but it is a predisposing structural condition because CSF leakage carries risks of meningitis, pneumocephalus, and intracranial abscess. [279]C The broader evidence also demonstrates that infectious neurological syndromes may arise from unexpected animal-associated pathogens, including pigeon paramyxovirus type 1 and bat reovirus, reinforcing the need for exposure-informed classification. [6]C[278]C Health-system resilience is a contextual rather than diagnostic classification, but it influences the capacity to detect and manage infectious disease shocks, including severe CNS infections. [280]D
| Dimension | Categories or examples | Evidence |
|---|---|---|
| Diagnostic certainty | Definite, probable, possible; confirmed or probable; probable meningitis without culture confirmation | [3][271][276]C |
| Bacterial | E. coli, N. meningitidis, Listeria monocytogenes, group A streptococcal disease | [8]C[10]C[272][273]C[275]C |
| Viral | Enterovirus, parechovirus-A3, West Nile virus, LCMV, pigeon paramyxovirus type 1, bat reovirus | [6]C[9]C[11]C[274][276]C[278]C |
| Mycobacterial | Tuberculous meningitis | [3] |
| Parasitic | SANCC; A. cantonensis-associated meningoencephalitis | [12]C[269]C |
| Structural or host context | CSF leak; advanced HIV disease and opportunistic-infection risk | [270][279]C |
Epidemiology and Risk Factors
- ▸Meningococcal disease in India varies substantially between epidemic and endemic settings: reported prevalence was 12.1% versus 0.76%, with case-fatality ratios of 12.8% versus 3.0%. [287]
- ▸Children younger than 5 years and adolescents are prominent age groups for invasive meningococcal disease, while pediatric bacterial meningitis cohorts are dominated by infants and young children. [287][288][289]
- ▸CSF leakage, meningeal breach, and cochlear implantation are important clinical risk contexts for bacterial meningitis. [51]
- ▸HIV is an important context for neurological infection and mortality, although the supplied study does not provide a meningitis-specific adjusted risk estimate. [284]
- ▸Brain abscess complicated 1.9% of episodes in a Dutch community-acquired bacterial meningitis cohort, and stroke occurred in 13% of a pediatric cohort. [41][289]
- ▸TBM evidence in the supplied references primarily concerns treatment, complications, cognition, and prognosis rather than population incidence. [31][156][283][286][290][292]
Scope and interpretation
The available updated evidence is heterogeneous: it includes population and surveillance data, prospective and retrospective cohorts, and systematic reviews of particular meningitis etiologies or complications. Consequently, estimates cannot be combined into a single global incidence figure. Several cited studies address prognosis, treatment, or neurological sequelae rather than incidence; these findings are presented as modifiers of disease burden or outcome rather than as established causes of meningitis.
Age, geography, and etiologic patterns
Meningococcal disease in India demonstrates marked geographic and outbreak-related variation. The reported prevalence was 12.1% in epidemic settings, compared with 0.76% in endemic settings; corresponding case-fatality ratios were 12.8% and 3.0%, respectively. The burden is probably underestimated where surveillance is weak. Serogroup A has historically predominated, although serogroups C, W, and Y are emerging. The age distribution is bimodal, with the greatest burden in children younger than 5 years and in adolescents; children younger than 5 years accounted for 61.8% in the cited synthesis. [287]
In a seven-year pediatric study from Southwest China, culture-positive bacterial meningitis affected predominantly young children: the median age was 17 months, and 58.1% were male. The study specifically evaluated pathogen distribution, antimicrobial resistance, refractory disease, intensive-care admission, and post-neurosurgical cases, supporting substantial regional and healthcare-associated heterogeneity in pediatric bacterial meningitis. [288]
Among febrile, previously healthy, well-appearing infants aged 60–90 days, invasive bacterial infection was evaluated in emergency or outpatient settings in a systematic review. The review specifically included bacteremia and bacterial meningitis, indicating that this age group represents an important diagnostic-risk population, although the supplied evidence does not provide the pooled prevalence estimate. [282]
Established or clinically important risk factors
A cerebrospinal-fluid (CSF) leak is a recognized risk factor for bacterial meningitis. In a nationwide prospective French cohort of children older than 3 months, 251 of 5,879 bacterial meningitis cases (4.3%) occurred in children with known CSF leakage, defined as a meningeal breach and/or a cochlear implant associated with meningitis. The cohort evaluated the epidemiology of meningitis in this high-risk group and the effect of 13-valent pneumococcal conjugate vaccination. [51]D Thus, persistent CSF leakage, an anatomic meningeal breach, and cochlear implantation should be treated as clinically important risk contexts, although the supplied abstract does not quantify their independent effect or vaccine effectiveness.
HIV infection is associated with neurological complications that may occur at any stage of infection. A retrospective cohort from two hospitals in Douala, Cameroon, evaluated people living with HIV who developed HIV-related neurological complications between 2016 and 2023 and examined demographic, laboratory, imaging, treatment, and mortality-associated factors. The supplied evidence supports HIV as an important context for neurological infection and adverse outcomes, but does not provide a meningitis-specific prevalence or adjusted risk estimate. [284]
Etiology-specific burden and complications
Antimicrobial resistance is an epidemiologically relevant determinant of bacterial meningitis management. A global systematic review covering microbiologically confirmed meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae during 2010–2024 estimated meningitis-specific resistance patterns and time trends by WHO region, with particular emphasis on low- and middle-income countries where disease burden is highest. The supplied abstract does not include the pooled resistance estimates; therefore, resistance should be interpreted as region- and pathogen-dependent rather than assigned a universal rate. [35]
Complications also vary by pathogen and host factors. In a Dutch national cohort of 2,918 community-acquired bacterial meningitis episodes, brain abscess complicated 56 cases (1.9%; 95% CI, 1.5–2.5%). The study confirmed abscesses by re-evaluating cranial imaging and assessed pathogen-specific prevalence, clinical characteristics, treatment, and outcomes. [41] In a New Zealand pediatric cohort, stroke occurred in 72 of 540 patients (13%) with laboratory-confirmed bacterial meningitis; the cohort had a median age younger than 1 year and was 62% male. [289] In TBM, cerebral infarction was investigated in a secondary analysis of 237 participants from the ACT-TBM randomized trial, reflecting the importance of vascular complications in this disease, although the supplied abstract does not report the associated predictors. [156]
Tuberculous and noninfectious meningitis contexts
Tuberculous meningitis (TBM) evidence is dominated by treatment and outcome studies rather than population epidemiology. A systematic review of seven randomized trials included 1,296 TBM patients when assessing high-dose rifampicin, while a network meta-analysis included 29 randomized trials and 4,640 patients evaluating drug therapies, mortality, neurological events, and adverse events. These data describe enrolled treatment populations and should not be interpreted as incidence estimates or general-population risk factors. [31][286]
Childhood TBM remains a major risk context for severe neurological outcomes. A Chinese study of patients younger than 15 years compared children aged younger than 5 years with those aged 5–14 years and evaluated age-disaggregated clinical, laboratory, imaging, treatment, and 12-month outcome factors. [292] Adult TBM studies similarly examined one-year prognosis and cognitive impairment; one systematic review found reported cognitive impairment ranging from 12% to more than 90%, reflecting substantial methodological heterogeneity. [283][290]
Systemic lupus erythematosus (SLE) is relevant to the differential diagnosis of meningitis-like neurological disease but the supplied studies concern neuropsychiatric lupus and psychosis rather than infectious meningitis. A meta-analysis evaluated psychosis prevalence and clinical or immunological associations in adults with SLE, while another systematic review synthesized 120 NPSLE case reports. These findings should not be used to estimate infectious meningitis risk. [281][32]
Follow-up burden
Neurological sequelae after acute meningitis may be underdetected because of inadequate follow-up, limited healthcare access, and diagnostic challenges. Systematic reviews examined the timing of clinical review and formal audiological testing for detecting post-meningitis sequelae, including sensorineural hearing loss, in adults and children. [33][34] These studies support structured follow-up, but the supplied evidence does not establish a specific incidence threshold or universal testing schedule.
| Population or context | Evidence | Estimate or finding |
|---|---|---|
| Meningococcal disease in India | Expert consensus and literature synthesis | 12.1% prevalence in epidemics; 0.76% in endemic settings; case-fatality ratios 12.8% and 3.0%, respectively [287] |
| Children with CSF leakage or cochlear implant, France | Nationwide prospective cohort | 251/5,879 pediatric bacterial meningitis cases (4.3%) [51]D |
| Community-acquired bacterial meningitis, Netherlands | National cohort | Brain abscess in 56/2,918 episodes (1.9%; 95% CI, 1.5–2.5%) [41] |
| Pediatric bacterial meningitis, New Zealand | Retrospective case-control cohort | Stroke in 72/540 patients (13%) [289] |
| Pediatric bacterial meningitis, Southwest China | Seven-year culture-positive cohort | Median age 17 months; 58.1% male [288] |
| Tuberculous meningitis treatment trials | Systematic review/network meta-analysis | 1,296 patients in 7 RCTs; 4,640 patients in 29 RCTs [31][286] |
Etiology and Triggering Factors
- ▸Bacterial meningitis risk evaluation is particularly important in febrile infants aged up to 90 days, including those aged 60–90 days. [282][293]
- ▸Recent neurosurgery, especially posterior-fossa tumor surgery, is a major healthcare-associated context for meningitis. [301][304]
- ▸Pneumococcal vaccination reduces vaccine-serotype disease, but non-vaccine serotypes remain an etiologic concern. [297]
- ▸Immunosuppression and HIV predispose to opportunistic fungal meningitis, especially cryptococcosis. [309]
- ▸Geography and exposure matter: Coccidioides is associated with the southwestern United States, whereas Leptospira causes rare zoonotic meningitis worldwide. [295][296][308]
- ▸Negative multiplex molecular testing does not exclude meningitis caused by organisms outside the panel’s target spectrum. [299][302][306]
Overview
Meningitis is an inflammatory syndrome caused by infection or, less commonly, noninfectious inflammation. The supplied evidence primarily addresses infectious causes, particularly bacterial, fungal, zoonotic, congenital, and post-procedural meningitis. Etiology varies with age, immune status, geography, vaccination history, and recent neurosurgical or other invasive procedures. [282][288][297]C[301][304][309]
Bacterial meningitis
Bacterial meningitis may occur as community-acquired disease or as a healthcare-associated infection after neurosurgery. In a seven-year pediatric study from Southwest China, cerebrospinal-fluid culture-positive cases demonstrated a region-specific and changing pathogen spectrum, with antimicrobial-resistance patterns differing according to clinical context, including post-neurosurgical disease. [288] Pneumococcus remains an important cause in both children and adults. After implementation of a national PCV13 program in Taiwan, vaccine-serotype disease declined, while non-vaccine serotypes remained an emerging concern, illustrating that vaccination changes—but does not eliminate—the pneumococcal etiology of meningitis. [297]C
Infancy is a particularly important risk period for invasive bacterial infection. A systematic review evaluated machine-learning models for identifying bacteremia and meningitis in febrile infants aged up to 90 days, reflecting the high clinical priority of distinguishing invasive bacterial disease in this population. [293] A separate systematic review and meta-analysis specifically assessed the prevalence of bacteremia and bacterial meningitis among previously healthy, well-appearing febrile infants aged 60–90 days, an age group for which international management guidance has varied or been incomplete. [282] These studies concern risk identification and prevalence rather than a new etiologic classification, but they support young age and fever as important triggers for evaluation of possible bacterial meningitis. [282][293]
Spontaneous Gram-negative meningitis is uncommon but may be severe, particularly in older adults with substantial comorbidity. A reported case involved Proteus mirabilis meningoencephalitis with septic deterioration, neutrophilic cerebrospinal-fluid inflammation, and high protein despite a negative multiplex meningitis–encephalitis panel; blood cultures subsequently identified the organism. [306]C Another case described Escherichia coli meningitis after cupping and acupuncture in a woman with systemic lupus erythematosus and chronic renal failure, suggesting that invasive or poorly controlled exposure-related infection can precede meningitis in a vulnerable host. [305]C
Postoperative and healthcare-associated triggers
Recent neurosurgery is a major triggering context for bacterial meningitis. Pediatric posterior-fossa tumor surgery has been specifically associated with postoperative meningitis, which can increase morbidity, prolong hospitalization, and delay adjuvant treatment; the study also examined perioperative risk factors, microbiology, and cerebrospinal-fluid characteristics. [301] In adults and mixed neurosurgical populations, post-neurosurgical bacterial meningitis remains sufficiently difficult to recognize that investigators developed and externally validated a diagnostic nomogram for clinically suspected cases in a neurosurgical intensive-care setting. [304] These studies support recent cranial surgery and intensive-care exposure as important clinical contexts, although the available abstracts do not establish a single universal operative risk factor. [301][304]
Tuberculous, fungal, and opportunistic causes
Tuberculous meningitis is an important alternative to acute bacterial meningitis, particularly when empirical antibiotics have already been given. A prospective cohort enrolled 125 bacterial-meningitis and 56 tuberculous-meningitis patients regardless of prior antibiotic exposure and evaluated cerebrospinal-fluid procalcitonin and neutrophil percentage to distinguish the two diseases. [294] The study highlights antibiotic pretreatment as a factor that can complicate etiologic classification rather than as a cause of meningitis itself. [294]
Coccidioidal meningitis is associated with disseminated coccidioidomycosis, a fungal infection endemic to the southwestern United States. Hospitalization data from Texas showed 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 and may cause hydrocephalus requiring shunt placement and lifelong antifungal therapy. [308] The coccidioidomycosis-related hydrocephalus study further examined long-term shunt outcomes and imaging characteristics in affected patients. [308]
Cryptococcal meningitis is strongly linked to impaired cellular immunity, especially HIV-associated disseminated cryptococcosis. In Uganda, cryptococcal disease was investigated in people with HIV, and the study specifically evaluated human-leukocyte-antigen variation as a possible host susceptibility factor. [309] Thus, advanced or otherwise compromised immunity is an important predisposing context for cryptococcal meningitis. [309]
Zoonotic and congenital infections
Leptospirosis is a globally distributed zoonosis with a broad clinical spectrum; central-nervous-system involvement is uncommon and under-recognized. A Brazilian cohort and meta-summary of 176 reported cases characterized leptospiral-associated meningitis and its cerebrospinal-fluid findings, supporting exposure to Leptospira as a rare but established infectious trigger. [295]C Congenital lymphocytic choriomeningitis virus infection can be associated with major neurologic malformations and fetal demise. Reported congenital cases included chorioretinitis, cerebral ventriculomegaly, and placental vascular pathology, making transplacental infection during pregnancy an important congenital trigger. [307]C
Interpretation of recent diagnostic evidence
Several supplied studies evaluate diagnostic tools rather than causes. Cerebrospinal-fluid NGAL, heparin-binding protein, procalcitonin, and classical biomarkers were studied for distinguishing acute bacterial meningitis from other central-nervous-system infections and inflammatory disorders in adults. [298] Serum procalcitonin was assessed in a meta-analysis of adult intracranial infections, including meningitis and brain abscess. [300] Multiplex molecular panels were evaluated in tertiary-care practice, while the French FAMOuS study reported results in 783 suspected meningitis/encephalitis cases; these tests can identify pathogens rapidly but a negative panel does not exclude infection caused by organisms outside the panel’s target range. [299][302]C[306]C Pediatric bacterial meningitis may also lead to cerebrovascular complications, with stroke reported in 72 of 540 laboratory-confirmed cases in one cohort; this is a complication rather than a triggering cause. [289] Mortality studies likewise describe prognostic clinical, laboratory, and microbiological factors rather than new etiologies. [303]
Key triggering contexts
Important triggers and predispositions supported by the supplied evidence include very young age with fever, incomplete or changing pneumococcal vaccine protection, recent neurosurgery, invasive healthcare exposure, immunosuppression or HIV infection, geographic exposure to Coccidioides, zoonotic exposure to Leptospira, congenital or transplacental viral infection, and unusual exposure-associated inoculation such as reported after cupping and acupuncture. [282][293][295]C[296][297]C[301][304][305]C[307]C[309]
| Category or context | Evidence-supported examples | References |
|---|---|---|
| Community-acquired bacterial | Pneumococcal meningitis; changing vaccine- and non-vaccine-serotype distribution | [288][297]C |
| Infancy | Febrile infants aged up to 90 days, including 60–90 days | [282][293] |
| Healthcare-associated | Post-neurosurgical and postoperative meningitis | [301][304] |
| Unusual Gram-negative infection | Escherichia coli after cupping/acupuncture; Proteus mirabilis meningoencephalitis | [305]C[306]C |
| Tuberculous meningitis | Differential diagnosis after antibiotic pretreatment | [294] |
| Fungal/opportunistic | Coccidioidal meningitis; HIV-associated cryptococcal disease | [296][308][309] |
| Zoonotic or congenital | Leptospiral meningitis; congenital LCMV infection | [295]C[307]C |
Pathophysiology
- ▸Meningitis reflects heterogeneous inflammatory injury involving infection, autoimmunity, postoperative change, vascular complications, and altered CSF dynamics rather than one uniform mechanism. [288][295][301][304]
- ▸Bacterial meningitis is typically associated with neutrophilic CSF inflammation and increased CSF procalcitonin, NGAL, and heparin-binding protein, although prior antibiotics may reduce culture yield. [294][298]
- ▸Tuberculous meningitis is associated with severe CSF inflammation, hyponatraemia, raised intracranial pressure, and potential overlap with autoimmune GFAP astrocytopathy. [311][318]
- ▸Meningitis-related vascular injury can cause stroke; pediatric bacterial meningitis was complicated by stroke in 13% of one 540-patient cohort. [289]
- ▸Chronic fungal and parasitic meningitis may obstruct CSF pathways and produce hydrocephalus or abnormal ventricular compliance. [312][313]
- ▸Autoimmune CNS disease, including NPSLE, multiple sclerosis, MOG-associated disease, and GFAP astrocytopathy, can mimic or coexist with infectious meningitis. [310][317][318]
Overview
Meningitis is an inflammatory syndrome involving the meninges and cerebrospinal fluid (CSF), produced by infection, immune-mediated disease, or postoperative and other noninfectious insults. The available evidence shows that its biological expression varies substantially with pathogen, host age, immune status, anatomical route of infection, and prior treatment, so meningitis is not a single pathophysiological entity. [288][295]C[301][304]
Infection, compartmental inflammation, and CSF abnormalities
In bacterial meningitis, invasion of the CSF produces an intense inflammatory response dominated by neutrophils. Increased CSF neutrophil percentage, procalcitonin, neutrophil gelatinase-associated lipocalin, and heparin-binding protein are associated with acute bacterial CNS infection and can help distinguish it from other CNS infections or inflammatory diseases. [294][298] Antibiotic exposure before lumbar puncture may reduce microbiological confirmation while leaving inflammatory and biochemical abnormalities detectable; this is particularly relevant when differentiating bacterial from tuberculous meningitis. [294] Serum procalcitonin has diagnostic value for adult intracranial infection, but its performance is insufficient to replace CSF evaluation and pathogen-directed testing. [300]
The pediatric pathogen spectrum is dynamic and region-specific. In a seven-year Southwest China study of culture-confirmed pediatric bacterial meningitis, pathogen distribution and antimicrobial resistance differed between children, including those with post-neurosurgical disease, supporting the concept that microbial factors shape the inflammatory phenotype and treatment response. [288] In very preterm or very-low-birth-weight infants with early-onset sepsis, meningitis may be culture-negative despite CSF pleocytosis and neutrophil predominance, indicating that systemic neonatal infection can extend into the CNS or produce meningitis-consistent CSF inflammation without recoverable organisms. [271]
Pathogen-specific patterns
Tuberculous meningitis generally produces a persistent inflammatory process that may involve the meninges, brain parenchyma, and CSF circulation. In adults with TBM, hyponatraemia was frequent at presentation (92.6% of those with measured plasma sodium), and lower plasma sodium was associated with greater disease severity and increased CSF inflammation. [311] These findings support an interaction between meningeal inflammation, systemic sodium-water regulation, and neurological injury, although the observational data do not establish a single mechanism for hyponatraemia. TBM can also coexist with autoimmune GFAP astrocytopathy; a reported patient had fever, cognitive slowing, limb weakness, leptomeningeal enhancement, raised intracranial pressure, CSF pleocytosis, increased protein, and reduced glucose and chloride, illustrating overlapping infectious and autoimmune inflammatory pathways. [318]C
Fungal and parasitic meningitides may cause prolonged inflammation and obstruction of CSF pathways. Coccidioidal meningitis was associated with hydrocephalus and, in a contemporary case series, low-pressure hydrocephalus related to impaired ventricular compliance and shunt-management difficulty. [313]C Neurocysticercosis-associated meningitis was uncommon but underdiagnosed; among 48 published cases, headache occurred in 94%, with fever and vomiting also reported, consistent with chronic meningeal irritation and disturbed CSF dynamics. [312]C
Leptospiral-associated meningitis represents an aseptic or culture-negative inflammatory presentation of systemic zoonotic infection. A Brazilian institutional cohort combined with 176 published cases to characterize its CSF profile, emphasizing that leptospirosis can produce meningeal inflammation even when the clinical syndrome is not initially recognized as CNS involvement. [295]C Viral neuroinvasion may likewise produce meningoencephalitis; in western France, tick-borne encephalitis became the third leading identified cause of encephalitis or meningoencephalitis in the studied regional cohort, demonstrating the changing epidemiology of inflammatory CNS infection. [314]C
Vascular and pressure-related injury
Meningeal inflammation can injure cerebral vessels, promote vasculopathy or thrombosis, and impair cerebral perfusion. In a pediatric bacterial meningitis cohort, stroke occurred in 13% of 540 patients, confirming that vascular complications are a substantial component of disease-related neurological injury. [289] Raised intracranial pressure and impaired CSF circulation are additional mechanisms of deterioration, particularly in TBM, coccidioidal meningitis, and meningoencephalitis with extensive leptomeningeal disease. [311][313]C[318]C Anthrax meningoencephalitis may include hemorrhagic CSF, high protein, and low glucose, illustrating severe blood-CSF barrier disruption and destructive inflammation. [316]C
Postoperative and immune-mediated meningitis
After neurosurgery, meningeal inflammation may result from bacterial inoculation, device-related infection, altered CSF flow, or sterile irritation by blood and surgical products. Pediatric posterior fossa tumor surgery is associated with postoperative meningitis that can be culture-positive or culture-negative, with CSF cytology and biochemical findings contributing to classification. [301] In postoperative neurosurgical patients, the diagnostic challenge reflects overlap between infection and postoperative inflammatory change; a validated diagnostic nomogram was developed specifically for post-neurosurgical bacterial meningitis. [304]
Immune-mediated meningeal or CNS inflammation can mimic infection. In neuropsychiatric systemic lupus erythematosus (NPSLE), CSF anti-suprabasin antibody is being evaluated as a biomarker to distinguish NPSLE from CNS infection and other SLE-related presentations, reflecting a disease process in which intrathecal autoimmunity may contribute to neurological symptoms. [310] A reported overlap of multiple sclerosis, NPSLE, and MOG-IgG positivity, with demyelinating MRI lesions and intrathecal immunoglobulin synthesis, further demonstrates that meningeal or CSF inflammatory abnormalities may arise from overlapping autoimmune mechanisms rather than infection alone. [317]C
Consequences for diagnosis and biological interpretation
Because pathogen burden, inflammation, vascular injury, and CSF-flow disturbance can coexist, no single CSF feature defines the mechanism in every patient. Multiplex PCR panels can rapidly detect multiple CNS pathogens directly from CSF, while metagenomic next-generation sequencing identified Bacillus anthracis when initial microscopy was misleading. [302]C[316]C Listeria meningitis beyond the neonatal period illustrates the importance of host and age-specific susceptibility: in a pediatric case series, 10 of 11 patients had positive CSF cultures and all 9 tested by CSF PCR were confirmed. [315]C Adult bacterial meningitis remains highly lethal in some settings; one cohort reported 25.3% in-hospital mortality, underscoring the potential for inflammation, vascular injury, raised intracranial pressure, and systemic complications to converge on fatal neurological disease. [303]
| Mechanistic process | Illustrative evidence |
|---|---|
| Neutrophilic CSF inflammation | Bacterial meningitis is associated with increased CSF neutrophil percentage, procalcitonin, NGAL, and heparin-binding protein. [294][298] |
| Chronic meningeal inflammation and systemic dysregulation | TBM is associated with increased CSF inflammation and hyponatraemia; lower sodium tracks with greater severity. [311] |
| CSF-flow obstruction and ventricular dysfunction | Coccidioidal meningitis may cause hydrocephalus and low-pressure hydrocephalus; neurocysticercosis-associated meningitis may present with headache, fever, and vomiting. [312]C[313]C |
| Vascular injury | Stroke occurred in 13% of children with bacterial meningitis in one cohort. [289] |
| Autoimmune inflammation | NPSLE, MS/MOG-associated disease, and GFAP astrocytopathy can produce inflammatory CNS syndromes that overlap clinically or radiologically with infection. [310][317]C[318]C |
| Blood-CSF barrier disruption and destructive inflammation | Anthrax meningoencephalitis may produce hemorrhagic CSF with high protein and low glucose. [316]C |
History and Physical Examination
- ▸In infants aged **28 days or younger**, fever may be the only sign of bacteremia or bacterial meningitis. [60]
- ▸Temperature **≤36 °C** or other temperature instability in young infants warrants consideration of invasive bacterial infection despite absent fever. [116][323]
- ▸Document altered consciousness, seizures, rash, focal deficits, cranial-nerve findings, and hearing abnormalities; these findings may influence prognosis and follow-up. [81][319][34]
- ▸Ask about CSF leak, cochlear implant, temporal-bone fracture, and recent cranial or otologic surgery because these are relevant meningitis-risk contexts. [51][106][107][124]
- ▸Arrange structured neurologic and audiologic follow-up because sequelae, particularly hearing loss, may be missed during routine review. [33][34]
Immediate assessment
Meningitis may present with nonspecific systemic illness, particularly in young infants. In infants aged 28 days or younger, fever may be the only clinical indication of bacteremia or bacterial meningitis; routine lumbar puncture is recommended in most international guidance discussed by the diagnostic literature. [60] In infants aged 60–90 days, invasive bacterial infection (IBI)—defined in the cited meta-analysis as bacteremia or bacterial meningitis—remains an important consideration even when the infant appears well. [282] Hypothermia or temperature instability should not be considered reassuring: among infants aged 0–60 days with a temperature of 36 °C or lower, IBI was identified in a retrospective cohort, although the absolute prevalence was low. [116]D Temperature instability in hospitalized infants aged 60 days or younger has also been evaluated with multiplex meningoencephalitis testing, underscoring that meningitis may be considered even without classic fever. [323]
Assess airway, breathing, circulation, mental status, perfusion, and seizures immediately. Altered level of consciousness is a clinically important feature in adults with varicella-zoster virus meningitis and was associated with outcome assessment in a two-center cohort. [81]D Acute symptomatic seizures are a recognized complication of meningitis and may be life-threatening; their occurrence should be documented by onset, duration, recurrence, focality, recovery, and current antiseizure treatment. [319] A seizure occurring during meningitis does not by itself establish epilepsy, but it identifies a patient requiring follow-up for subsequent seizure risk. [319]
History
Establish the time course of fever or hypothermia, headache, vomiting, photophobia, neck discomfort, confusion, drowsiness, irritability, reduced feeding, and behavioral change, while recognizing that the cited infant studies show that classic meningeal symptoms may be absent or unreported in early life. [60][282][116]D Ask specifically about witnessed seizures, focal neurologic symptoms, altered consciousness, rash, cranial-nerve symptoms, and hearing change. In VZV meningitis, document a current or preceding vesicular rash, immunosuppression, altered consciousness, and the timing of antiviral therapy because these variables were examined in relation to clinical outcome. [81]D
Review host factors and exposures: age, prematurity or young infancy, immune compromise, recent infection, vaccination status, known cerebrospinal-fluid (CSF) leak, cochlear implantation, head or temporal-bone trauma, and neurosurgical or otologic procedures. CSF leakage is a recognized risk factor for bacterial meningitis in children, and a national pediatric cohort specifically included meningeal breaches and cochlear implants as causes of leakage-associated meningitis. [51]D Spontaneous lateral skull-base CSF-leak repair has been studied because meningitis risk may occur before or after repair. [107] Temporal-bone fractures may be associated with CSF leak, meningitis, facial-nerve disorders, and hearing loss. [124]D Recent retrosigmoid or translabyrinthine craniectomy is relevant because postoperative CSF leak, surgical-site infection, and meningitis are recognized outcomes assessed in this setting. [106]
Ask about systemic or autoimmune disease when the presentation is atypical. Neuropsychiatric systemic lupus erythematosus can include chorea, and chorea was reported as an uncommon manifestation in a systematic review; therefore, abnormal involuntary movements should be characterized rather than automatically attributed to infection. [108] In suspected tuberculous meningitis, document HIV status and other immunosuppression because a national Brazilian study evaluated differences in clinical presentation, laboratory profile, and mortality according to HIV coinfection. [122]D In children beyond the neonatal period, listeriosis can manifest as neurolisteriosis, bacteremia, or less commonly abdominal infection; exposure, immune status, gastrointestinal symptoms, and age should therefore be reviewed when clinically appropriate. [320]C
Physical examination
Perform repeated examinations because neurologic status may evolve. Record temperature, heart rate, blood pressure, respiratory status, hydration, perfusion, and level of consciousness, using an age-appropriate mental-status description. Examine for meningism, focal neurologic deficits, cranial-nerve abnormalities, seizures or postictal state, and abnormal movements. Inspect the skin carefully for vesicular or other rash, including a zosteriform distribution, because rash and altered consciousness were specifically recorded in VZV meningitis. [81]D In infants, document feeding, consolability, tone, interaction, respiratory pauses, bulging fontanelle when present, and temperature pattern; these findings should be interpreted alongside age because fever may be the only sign of IBI in the youngest infants. [60]
Assess hearing and otologic findings at presentation. Meningitis-associated sensorineural hearing loss is an important sequela for which formal audiological testing is evaluated after acute infectious meningitis. [34] Hearing impairment may be particularly relevant in patients with cochlear implants or post-meningitis deafness; implant-related studies describe post-meningitis cochlear pathology and use trans-impedance imaging as an adjunct to conventional imaging, not as a replacement for clinical assessment. [321]
Follow-up examination
A normalizing examination at discharge does not exclude later disability. Neurologic sequelae after acute meningitis are frequently underdetected without structured clinical review, and the timing of health assessments has been studied in both adults and children. [33] Arrange formal audiological assessment after acute infectious meningitis because early detection of sensorineural hearing loss may enable intervention before permanent functional and developmental consequences. [34] Reassess cognition, communication, balance, motor function, cranial nerves, behavior, and seizure recurrence during follow-up. [33][319]
Machine-learning models for febrile infants and pediatric invasive pneumococcal disease have been investigated to predict bacteremia or meningitis, but these tools are adjuncts to history, examination, and definitive diagnostic testing rather than substitutes for clinical judgment. [293][60][322] A positive urinalysis may coexist with IBI in febrile infants, so urinary findings should not by themselves dismiss meningitis when neurologic or systemic features are concerning. [44]
| Domain | Findings or questions | Evidence |
|---|---|---|
| Infant presentation | Fever, hypothermia, temperature instability, feeding and interaction changes | [60][116]D[282][323] |
| Neurologic status | Consciousness, seizures, focal deficits, abnormal movements | [81]D[108][119]D[319] |
| Infection clues | Rash, headache, vomiting, neck discomfort, systemic illness | [60][81]D[122]D[320]C |
| Predisposing conditions | CSF leak, cochlear implant, temporal-bone trauma, recent cranial surgery, immunosuppression | [51]D[106][107][122]D[124]D |
| Sequelae assessment | Hearing, cognition, communication, behavior, balance, motor function, recurrent seizures | [33][34][319][321] |
Diagnosis and Workup
- ▸Use CSF examination, culture, blood cultures, and pathogen-directed molecular testing as the diagnostic foundation; multiplex PCR is adjunctive and requires clinical correlation [288][302].
- ▸Consider CSF-PCT, NGAL, HBP, and serum procalcitonin as supportive biomarkers, especially when antibiotics were given before presentation; no supplied study establishes a universal standalone threshold [294][298][300].
- ▸Evaluate sodium and volume status in suspected TBM because hyponatremia was common and associated with disease severity and CSF inflammation [311].
- ▸Obtain neuroimaging promptly for focal deficits, impaired consciousness, seizures, suspected stroke, hydrocephalus, or possible unsafe lumbar puncture [289][326][313].
- ▸Adapt testing to age, prematurity, neurosurgical status, vaccination, antimicrobial exposure, geography, and host immune status [271][288][295][297][326].
Clinical assessment and urgency
Meningitis should be evaluated as a time-critical central nervous system infection, with immediate assessment of consciousness, focal neurologic deficits, seizures, signs of raised intracranial pressure, and systemic instability. The supplied studies do not establish a new clinical decision rule for adults, but they show that meningitis cohorts are heterogeneous by age, host status, and likely pathogen; therefore, diagnostic testing should be tailored to these factors [288][297]C[326]. In children with laboratory-confirmed bacterial meningitis, stroke occurred in 13% of cases, supporting a low threshold for brain imaging when focal deficits, seizures, or unexplained deterioration occur [289].
Initial laboratory and microbiological workup
The diagnostic workup should obtain cerebrospinal fluid (CSF) for cell count and differential, protein, glucose, Gram stain, bacterial culture, and pathogen-directed molecular testing when lumbar puncture is safe; paired blood cultures and routine blood tests should be obtained when bacterial disease is suspected. The cited studies evaluate these modalities and biomarkers but do not replace culture or clinical assessment with a single test [288][298][302]C. Local epidemiology and recent antimicrobial exposure are important when interpreting results: a pediatric study from Southwest China found region-specific pathogen distribution and antimicrobial-resistance patterns, particularly in post-neurosurgical disease [288]. A Taiwanese cohort similarly demonstrated changing pneumococcal serotype and susceptibility patterns before and after national PCV13 implementation, emphasizing that empiric diagnostic interpretation should reflect vaccination and local resistance data [297]C.
Multiplex meningitis–encephalitis PCR panels can rapidly detect multiple pathogens directly from CSF, but their real-world diagnostic yield and clinical relevance vary by setting; positive results should therefore be interpreted with CSF findings, presentation, and conventional microbiology rather than in isolation [302]C. Enterovirus-associated pediatric meningoencephalitis may include EV71, EV-A6, EV-A16, EV-A10, and unclassified enterovirus infections; in a 160-child cohort, 46.0% were classified as EV-unclassified, illustrating the potential value of molecular typing when routine testing is nondiagnostic [328].
Distinguishing bacterial, tuberculous, and other aseptic meningitis
In patients pretreated with antibiotics, differentiating bacterial meningitis (BM) from tuberculous meningitis (TBM) is particularly difficult. A prospective cohort of 125 BM and 56 TBM patients evaluated CSF procalcitonin (CSF-PCT), neutrophil percentage, and related laboratory variables using receiver-operating-characteristic and multivariable analyses; these markers may support, but do not independently establish, the diagnosis [294]. CSF neutrophil gelatinase-associated lipocalin (NGAL), heparin-binding protein (HBP), procalcitonin, and conventional CSF biomarkers were assessed in a prospective study of 186 adults to distinguish acute BM from other CNS infections, inflammatory diseases, and non-inflammatory controls; such models are adjunctive and require external validation before routine substitution for standard testing [298].
Serum procalcitonin has also been evaluated in a systematic review and meta-analysis of 10 studies of adult intracranial infection. The evidence supports its potential as an adjunctive marker, but the supplied abstract does not provide sufficient performance estimates to define a diagnostic threshold; serum procalcitonin should not be used alone to confirm or exclude meningitis [300]. TBM workup should include CSF examination and testing directed at Mycobacterium tuberculosis according to local availability, while recognizing that the cited trials and meta-analyses primarily address adjunctive corticosteroids and linezolid rather than diagnostic accuracy [324][325]. In adults with TBM, hyponatremia was present at presentation in 176/190 (92.6%) individuals with available sodium measurements, and lower sodium was associated with more severe TBM and greater CSF inflammation; plasma sodium and assessment of volume status are therefore relevant components of severity assessment, not diagnostic substitutes [311].
Special clinical contexts
Leptospiral meningitis is an under-recognized cause of aseptic meningitis in tropical settings. A Brazilian institutional series combined with a meta-summary of 176 reported cases characterized clinical and CSF findings, supporting consideration of leptospirosis when epidemiologic exposure and an aseptic CSF profile are present [295]C.
In very preterm or very-low-birth-weight infants with early-onset sepsis, all infants in a multicenter study underwent lumbar puncture, and “probable meningitis” was operationally defined as culture-negative CSF with meningitis-consistent abnormalities, including pleocytosis and neutrophil predominance. This population requires age- and gestation-sensitive interpretation because culture confirmation may be absent [271]. After pediatric posterior fossa tumor surgery, early CSF cytology and CSF biochemical and microbiological characteristics were evaluated to distinguish postoperative meningitis, including culture-positive and culture-negative presentations [301].
Imaging and complications
Neuroimaging is indicated when focal neurologic findings, impaired consciousness, seizures, suspected stroke, hydrocephalus, or other features raise concern for complications or unsafe lumbar puncture. In pediatric bacterial meningitis, stroke was confirmed by neuroimaging in the case cohort [289]. In cryptococcal meningitis, impaired consciousness and motor deficits were associated with unfavorable outcome in a retrospective cohort of 181 patients, and HIV-negative patients had a higher unfavorable-outcome rate than HIV-positive patients (19.1% vs 5.0%); these findings support systematic neurologic examination, brain imaging, and host-status evaluation [326]. Coccidioidal meningitis may cause hydrocephalus and, in selected patients, low-pressure hydrocephalus related to ventricular compliance or shunt malfunction; ventricular imaging and assessment of CSF diversion should be considered when hydrocephalus is suspected [313]C.
Important differentials and nonhuman evidence
In patients with systemic lupus erythematosus and new neuropsychiatric symptoms, CSF anti-suprabasin antibody was studied prospectively by ELISA to distinguish neuropsychiatric SLE from CNS infection and other SLE presentations; this remains an investigational biomarker rather than a validated replacement for infection testing [310]. Functional near-infrared spectroscopy was also investigated for prefrontal oxygenation dysfunction and neuropsychiatric symptoms in SLE, but it is not established as a meningitis test [330]. Hematologic platelet-to-lymphocyte ratio findings in dogs with idiopathic epilepsy and meningoencephalitis of unknown etiology, and clinical data on older dogs with meningoencephalitis of unknown origin, are veterinary evidence and should not be extrapolated to human meningitis diagnosis [327][329].
| Clinical situation | Useful workup or interpretation | Evidence |
|---|---|---|
| Suspected acute bacterial meningitis | CSF profile, Gram stain, culture, blood cultures, and molecular testing; consider CSF NGAL/HBP/PCT as adjuncts | [288][298] |
| Antibiotic-pretreated patient | Interpret CSF results cautiously; CSF-PCT and neutrophil percentage may help distinguish BM from TBM | [294] |
| Suspected TBM | CSF TB-directed testing, severity assessment, and plasma sodium/volume evaluation | [311][324][325] |
| Suspected fungal or chronic meningitis | Assess immune status and obtain brain imaging for hydrocephalus or neurologic complications | [313]C[326] |
| Aseptic meningitis in a tropical exposure setting | Consider leptospirosis and perform exposure-directed testing | [295]C |
| Infant with early-onset sepsis | Lumbar puncture when clinically feasible; culture-negative pleocytosis may represent probable meningitis | [271] |
| Post-neurosurgical or post-tumor-surgery meningitis | Integrate CSF cytology, chemistry, culture, and operative context | [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 presence of altered mental status, focal neurological deficits, or seizures should shift the differential toward encephalitis or brain abscess rather than isolated meningitis.
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. While the classic triad of fever, neck stiffness, and altered mental status is well-known, it is often incomplete.
- Required Features: Evidence of meningeal inflammation, typically defined as a cerebrospinal fluid (CSF) white blood cell (WBC) count >5 cells/μL [138][152]D.
- Supportive Features: Positive Kernig’s or Brudzinski’s signs, photophobia, and systemic inflammatory markers (e.g., elevated C-reactive protein or procalcitonin) [146]C[150]C.
- Exclusion Criteria: Alternative explanations for meningismus, such as (confirmed by CT or xanthochromia) or cervical spine pathology [146]C.
Infectious Differentials
Viral Meningoencephalitis
Viral etiologies are the most common cause of aseptic meningitis. While enteroviruses and herpes simplex virus (HSV) predominate, clinicians must consider regional and emerging viruses. (TBE) should be suspected in endemic areas; CSF findings typically show moderate pleocytosis (median 63 cells/μL) and elevated protein (median 0.61 g/L) [138]. Toscana virus (TOSV) is a significant cause of summer meningitis in the Mediterranean, often presenting with a benign course but requiring serological confirmation [48]C. In North America, Snowshoe hare virus (SSHV) and West Nile virus (WNV) are critical considerations, particularly in children and the elderly, respectively [47]C[141]C. WNV neuroinvasive disease may uniquely present with extrapyramidal symptoms or flaccid paralysis [141]C.
Atypical Bacterial and Rare Pathogens
- (GAS): Though rare (0.02–0.07 per 100,000), GAS meningitis carries a high case-fatality rate of 19.4%, significantly higher than S. pneumoniae [53]D.
- Mycoplasma hominis: Usually seen in neonates, this can cause CNS infection in adults following neurosurgery or in immunocompromised states [136].
- Salmonella enterica: A rare cause that may present with a thunderclap headache, mimicking subarachnoid hemorrhage [146]C.
- : Neuroleptospirosis can mimic primary viral meningitis; diagnosis requires PCR or microscopic agglutination tests (MAT) [98]D.
Parasitic and Amoebic Infections
Free-living amoebae, such as Naegleria fowleri (Primary Amoebic Meningoencephalitis, PAM) and Acanthamoeba (Granulomatous Amoebic Encephalitis, GAE), are nearly universally fatal and must be considered in patients with rapid progression and warm freshwater exposure [137][149]D. Neurocysticercosis remains a leading cause of acquired epilepsy and can present with meningeal signs if cysts rupture into the subarachnoid space [149]D.
Non-Infectious Mimics
Autoimmune Astrocytopathy and Encephalitis
GFAP astrocytopathy is a major mimic of infectious meningoencephalitis. It typically presents with subacute fever, headache, and encephalopathy [131]. A hallmark imaging finding is linear perivascular radial enhancement in the white matter [131][143]C. Similarly, Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) can present with acute coma or delirium, often requiring the exclusion of secondary infections like EBV or lymphoma [144]C[150]C.
Immune Reconstitution Inflammatory Syndrome (IRIS)
In patients with HIV and prior cryptococcal meningitis, the initiation of antiretroviral therapy (ART) can trigger neurological IRIS. This presents as a recurrence of meningitis symptoms despite negative fungal cultures, often showing migratory MRI patterns [133]C.
Diagnostic Algorithm
To efficiently narrow the differential, a systematic approach is required:
- Step 1: Clinical Stabilization and Screening: Assess for signs of increased intracranial pressure (ICP). Perform a non-contrast CT if focal deficits, papilledema, or new-onset seizures are present to rule out mass lesions or (found in 1.9% of bacterial cases) [41][146]C.
- Step 2: Lumbar Puncture (LP): Obtain CSF for cell count, protein, glucose, and culture. Crucial: 44.4% of patients receive before LP, which significantly reduces culture sensitivity [148]D.
- Step 3: Rapid Molecular Testing: Utilize multiplex PCR panels (e.g., BioFire FilmArray ME Panel) for 14 common pathogens. These provide results in ~1 hour and are cost-effective by reducing hospital stay [66][152]D.
- Step 4: Advanced Diagnostics: If initial tests are negative and suspicion remains high, employ metagenomic Next-Generation Sequencing (mNGS) for hypothesis-free pathogen detection [139]D[104]D. For suspected autoimmune cases, order serum and CSF autoantibody panels (e.g., GFAP-IgG, CASPR2) [131][151]C.
Imaging and Electrodiagnostics
While meningitis is primarily a clinical and laboratory diagnosis, imaging is vital for identifying complications and mimics.
- MRI: Preferred for detecting leptomeningeal enhancement, brain abscesses, or the linear perivascular enhancement characteristic of GFAP astrocytopathy [41][131].
- CT: Essential for detecting pneumocephalus (a rare complication of Citrobacter koseri) or acute hemorrhage [140]C[146]C.
- EEG: Indicated if encephalitis is suspected (e.g., in Cat Scratch Disease or WNV) to evaluate for subclinical seizures or status epilepticus, which occurs in up to 68% of CSD encephalitis cases [153]D[141]C.
| Condition | Key Clinical Feature | CSF Finding | Diagnostic Tool |
|---|---|---|---|
| Bacterial Meningitis | Acute onset, high fever, rigors | Neutrophilic pleocytosis, low glucose | Culture, Gram stain, PCR [152]D |
| Viral Meningitis | Subacute, photophobia | Lymphocytic pleocytosis, normal glucose | Multiplex PCR [66] |
| GFAP Astrocytopathy | Subacute, encephalopathy | Lymphocytic pleocytosis, high protein | CSF GFAP-IgG [131] |
| Brain Abscess | Focal deficit, headache | Often normal or mild pleocytosis | Contrast MRI [41] |
| Neuroleptospirosis | Systemic symptoms (jaundice, renal) | Lymphocytic pleocytosis | MAT, Blood/CSF PCR [98]D |
| PAM (Amoebic) | Rapidly fatal, water exposure | Hemorrhagic pleocytosis | CSF wet mount, PCR [137] |
| Test | Sensitivity | Specificity | Timing | Note |
|---|---|---|---|---|
| CSF Culture | Variable | High | 24–72 hours | Reduced by pre-LP antibiotics [148]D |
| Multiplex PCR | High (>90%) | High | ~1 hour | Detects 14 common pathogens [152]D |
| mNGS | High | High | 24–48 hours | Hypothesis-free; detects rare pathogens [139]D |
| Head CT | Low (for meningitis) | N/A | Minutes | Used to rule out mass/hemorrhage [146]C |
| MRI (Contrast) | High | Moderate | Hours | Best for GFAP and abscess [131][41] |
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.
- ▸Tuberculous meningitis management may involve high-dose Rifampicin (35 mg/kg) and requires long-term steroid tapering based on clinical and potentially genetic factors.
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. In febrile infants ≤28 days, the PECARN prediction rule is utilized to identify those at low risk for invasive bacterial infection, though most guidelines still mandate routine lumbar puncture in this age group [60]. Severity is classified based on the Glasgow Coma Scale (GCS), presence of focal neurological deficits, and hemodynamic status. Patients with a GCS <12, respiratory distress, or rapidly progressing purpura should be managed in an Intensive Care Unit (ICU). Postoperative patients must be monitored closely; a delay in diagnosis beyond 7 days post-surgery is associated with significantly worse outcomes in postoperative bacterial meningitis (PBM) [158].
Step 2: Immediate Empiric Antimicrobial Therapy
Empiric therapy must be initiated within 60 minutes of arrival. Do not delay for neuroimaging if a lumbar puncture is deferred.
- Standard Bacterial Coverage: For most adults, Ceftriaxone 2 g IV every 12 hours plus Vancomycin 15-20 mg/kg IV every 8-12 hours is the standard.
- Listeria Coverage: Add Ampicillin 2 g IV every 4 hours for patients >50 years or those with immunocompromise.
- Neonatal Considerations: In neonates with invasive , regimens often require prolonged courses if complications like ventriculitis develop [86]C.
- Resistance Patterns: Global data indicate rising resistance in Streptococcus pneumoniae and Neisseria meningitidis, necessitating the inclusion of Vancomycin in empiric protocols until sensitivities are confirmed [35]. For pandrug-resistant organisms like Chryseobacterium gleum, Linezolid 600 mg IV every 12 hours has shown efficacy as an adjunctive option [160]C.
Step 3: Adjunctive Corticosteroid Administration
Dexamethasone 0.15 mg/kg IV every 6 hours should be administered 10-20 minutes before or concomitant with the first dose of antibiotics. This reduces the inflammatory response triggered by bacteriolysis [79]D. In (TBM), dexamethasone is recommended for 6-8 weeks, though its benefit may be genotype-specific. Research suggests that patients with the LTA4H TT genotype (hyperinflammatory) derive the most survival benefit, while those with CC or CT genotypes may have a more heterogeneous response [84].
Step 4: Pathogen-Specific Management
Once a pathogen is identified via culture or molecular methods (e.g., mNGS or tNGS), therapy should be narrowed [91]C[93]C.
- Tuberculous Meningitis (TBM): Standard therapy includes Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide. While high-dose Rifampicin (35 mg/kg/day) increases CNS penetration, meta-analyses of RCTs have not shown a definitive reduction in all-cause mortality compared to the standard 10 mg/kg/day dose, though it remains safe [31][59]. Novel oxazolidinones like Contezolid 800 mg PO twice daily are being evaluated as safer alternatives to Linezolid, showing adequate CSF penetration above the MIC for M. tuberculosis (0.5 μg/mL) [83][162]C.
- Fungal Meningitis: For cryptococcal meningitis in patients with advanced HIV, induction with Amphotericin B is standard. In pediatric CNS , adding IV Liposomal Amphotericin B (L-AmB) 5 mg/kg/day to Fluconazole 12 mg/kg/day is often necessary when fluconazole monotherapy fails [163]C.
- Viral and Aseptic: Viral meningoencephalitis (e.g., EBV) requires targeted antivirals like Acyclovir 10 mg/kg IV every 8 hours [91]C. If drug-induced aseptic meningitis (DIAM) is suspected (often due to NSAIDs or antibiotics), the offending agent must be discontinued immediately [61].
Step 5: Monitoring and Complication Management
Continuous monitoring for cerebral infarction is critical in TBM, as strokes significantly increase morbidity. Adjunctive antiplatelet therapy with Aspirin 75-150 mg daily or Clopidogrel 75 mg daily is often utilized to prevent ischemic events [156]. For refractory Gram-negative infections, intraventricular Polymyxin B (50,000 units daily) may be considered to achieve therapeutic CSF levels that systemic therapy cannot reach [164]C. In cases of immune reconstitution inflammatory syndrome (IRIS) following cryptococcal meningitis, individualized immunotherapy may be required [133]C.
| Drug | Typical Dose | Route | Key Indication | Evidence Level |
|---|---|---|---|---|
| Ceftriaxone | 2 g q12h | IV | Empiric bacterial coverage | 1a |
| Vancomycin | 15-20 mg/kg q8-12h | IV | Penicillin-resistant S. pneumoniae | 2a |
| Rifampicin | 10-35 mg/kg daily | PO/IV | Tuberculous meningitis | 1a [31] |
| Contezolid | 800 mg BID | PO | TBM (Linezolid alternative) | 1b [83] |
| Acyclovir | 10 mg/kg q8h | IV | Viral (HSV/EBV) meningitis | 4 [91]C |
| Polymyxin B | 50,000 units daily | Intraventricular | MDR Gram-negative pathogens | 4 [164]C |
Supportive Care and Complication Management
- ▸Treat suspected acute bacterial meningitis as time-critical; evidence supports concern about delayed empiric antimicrobials, but does not establish one universal time threshold. [331]
- ▸Use local pathogen and antimicrobial-resistance data, particularly in pediatric and post-neurosurgical meningitis. [288]
- ▸For meningitis-associated acute symptomatic seizures, the principal duration comparison is stopping antiseizure medicines within versus beyond **3 months**; discontinuation should be individualized because complete pooled results were not supplied. [319]
- ▸Consider specialist CSF diversion for selected patients with raised intracranial pressure, hydrocephalus, or impaired CSF circulation; no universal lumbar-drainage or external-ventricular-drainage standard is established. [166]
- ▸Arrange structured follow-up for neurological sequelae and formal audiological testing for hearing loss after infectious meningitis. [33][34]
Immediate priorities and empiric antimicrobial therapy
Acute bacterial meningitis is a medical emergency in which delays in empiric antimicrobial treatment may increase mortality and neurological sequelae; therefore, antimicrobial therapy should be treated as time-critical when acute bacterial meningitis is suspected. [331] A 2026 systematic review and meta-analysis evaluated early versus delayed empiric treatment using prospective cohort evidence, but the available evidence base was limited to three prospective cohorts and should not be interpreted as establishing a precise universally applicable treatment-time threshold. [331] Local epidemiology and resistance surveillance remain important when selecting empiric therapy because cerebrospinal-fluid pathogens and antimicrobial-resistance patterns vary by region and clinical setting. [288]
Pediatric pathogen distributions are particularly context dependent. In a seven-year study from Southwest China, pathogen spectrum and resistance differed between community-acquired and post-neurosurgical pediatric meningitis, supporting institution- and region-specific empiric protocols and subsequent narrowing according to microbiological results. [288] The study was retrospective and restricted to culture-positive pediatric cases, so its resistance findings should not be generalized to adults, culture-negative disease, or other regions. [288]
Seizures and antiseizure medicines
Acute symptomatic seizures are a frequent and potentially life-threatening complication of meningitis and may signal increased risk of later epilepsy. [319] Seizures should be promptly recognized and managed, with treatment decisions individualized according to seizure recurrence, electroclinical findings, structural brain injury, persistent inflammation, and the underlying meningitis syndrome; however, the supplied evidence does not support a single drug or dosing regimen. [319]
The key duration question is whether antiseizure medicines started for acute symptomatic seizures should be stopped within 3 months or continued beyond 3 months. [319] A 2026 systematic review and meta-analysis specifically compared these strategies in patients with meningitis-associated acute symptomatic seizures. [319] Because the available abstract does not provide the pooled effect estimates or complete certainty assessment, clinicians should avoid assuming that prolonged treatment universally prevents epilepsy or that early cessation is appropriate for every patient. [319] Reassessment before discontinuation is especially important when seizures persist, electroencephalography remains abnormal, neuroimaging shows structural injury, or the patient has ongoing encephalitis or other epileptogenic pathology; these clinical qualifiers are consistent with individualized decision-making but were not directly quantified in the supplied abstract. [319]
Status epilepticus represents a particularly severe seizure complication. In a comparative cohort of patients with status epilepticus associated with tuberculous meningitis or scrub typhus, 28 of 587 meningitis patients developed status epilepticus: 17 with tuberculous meningitis and 11 with scrub typhus. [337] The study recorded clinical, laboratory, EEG, MRI, treatment-response, and outcome data, and reported lower hemoglobin among scrub-typhus patients; the supplied abstract does not provide sufficient results to infer a superior treatment strategy. [337]
Raised intracranial pressure, hydrocephalus, and CSF diversion
Raised intracranial pressure and hydrocephalus are major complications of severe meningitis. [166] Lumbar drainage and external ventricular drainage have been used as adjuncts to antimicrobial treatment, including in some reports without established hydrocephalus, but there is no universally accepted standard for incorporating either technique into meningitis care. [166]
A systematic review identified 41 studies addressing lumbar and/or external ventricular drainage in meningitis and emphasized that the evidence is heterogeneous. [166] CSF diversion should therefore be considered in specialist settings for carefully selected patients with clinically important intracranial hypertension, hydrocephalus, impaired CSF circulation, or refractory disease, with the route determined by neuroimaging, anatomy, neurological status, and procedural risk. [166] Cryptococcal disease may cause choroid-plexus inflammation, ependymitis, synechiae, obstructive hydrocephalus, and trapped ventricles, including in immunocompetent individuals. [332] In cryptococcal meningitis, impaired consciousness and motor deficits were associated with unfavorable 12-month outcomes in an observational cohort, while the reported benefit of surgical intervention requires cautious interpretation because it was nonrandomized. [326]
In children with post-meningitic hydrocephalus managed with an Ommaya reservoir, delayed CSF sterilization was defined as failure to achieve two sterile CSF cultures obtained at least 48 hours apart within 14 days. [335] A retrospective pediatric cohort developed a multivariable prediction model for delayed clearance, but model performance and external applicability require validation before it is used to guide individual treatment. [335]
Follow-up and detection of sequelae
Neurological sequelae affect a substantial proportion of meningitis survivors and may be missed when follow-up is limited or assessments are not systematically performed. [33] Post-discharge review should therefore include structured assessment for neurological, cognitive, functional, psychiatric, and sensory consequences, with timing adapted to age, disease severity, and ongoing symptoms. [33]
Sensorineural hearing loss is an important potentially permanent complication of acute infectious meningitis. [34] Formal audiological testing is preferable to relying solely on bedside observation because early detection may permit timely rehabilitation and reduce downstream effects such as communication difficulty, cognitive decline, social isolation, and mental-health disorders. [34] The 2026 systematic review evaluated optimal testing time points in adults and children, but the supplied abstract does not state a single definitive schedule; local pediatric and adult audiology pathways should therefore be followed. [34]
Tuberculous meningitis in children carries a risk of death and severe neurological sequelae, with outcomes influenced by age and clinical severity. [292] Twelve-month outcome assessment and age-disaggregated evaluation are relevant when planning rehabilitation and surveillance. [292] Infants with parechovirus meningoencephalitis may develop complicated disease requiring intensive care or showing abnormal MRI or EEG findings, supporting close neurological monitoring in this vulnerable group. [334]
| Complication or issue | Evidence-informed management focus |
|---|---|
| Suspected acute bacterial meningitis | Immediate empiric antimicrobial treatment; incorporate local resistance and pathogen data. [331][288] |
| Acute symptomatic seizure | Prompt seizure management and individualized antiseizure-medicine duration; the studied threshold is 3 months. [319] |
| Status epilepticus | Treat as a severe neurological complication and monitor with clinical, EEG, and MRI assessment when indicated. [337] |
| Raised intracranial pressure or hydrocephalus | Specialist assessment for lumbar or external ventricular CSF diversion; evidence is heterogeneous and no universal standard exists. [166] |
| Cryptococcal hydrocephalus or trapped ventricle | Consider obstructive and choroid-plexus complications in diagnostic and neurosurgical planning. [332][326] |
| Post-meningitis sequelae | Structured clinical review and formal audiological assessment to detect neurological and hearing complications. [33][34] |
Prognosis and Long-term Outcomes
- ▸Meningitis remains a major global cause of neurological disability, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. [341]
- ▸Stroke complicated pediatric bacterial meningitis in 13% of patients in one 540-patient cohort and represents an important cause of additional neurological disability. [289]
- ▸Adult TBM mortality was reduced by adjunctive steroids in pooled evidence (RR 0.83, 95% CI 0.72–0.95), but benefit was not demonstrated in children or for pooled functional recovery. [325]
- ▸TBM-associated hyponatraemia was present in 92.6% of measured Vietnamese adults and was associated with greater disease severity and CSF inflammation. [311]
- ▸Adjunctive linezolid showed a potentially favorable mortality signal in TBM, but the evidence was low certainty and imprecise. [324]
- ▸In cryptococcal meningitis, impaired consciousness and motor deficits predicted unfavorable 12-month outcome; HIV-negative patients had a higher unfavorable-outcome rate than HIV-positive patients in one cohort. [326]
- ▸Survivors may experience persistent sensory, cognitive, motor, psychological, and functional sequelae requiring structured follow-up and rehabilitation. [338][339]
Overall prognosis and burden
Meningitis remains the leading infectious cause of neurological disability worldwide, with the greatest burden concentrated among children younger than 5 years and populations living in the African meningitis belt. The Global Burden of Disease 2023 analysis assessed mortality and health loss attributable to 17 pathogen categories from 1990 through 2023, underscoring substantial geographic, age-related, and etiologic variation in prognosis. [341] Qualitative evidence indicates that the consequences extend beyond acute survival: patients and caregivers may require prolonged rehabilitation, psychosocial support, and services for persistent neurological, sensory, cognitive, and functional sequelae, while access to follow-up is often limited by financial, geographic, and health-system barriers, particularly in low- and middle-income countries. [338]
Bacterial meningitis
Outcome is influenced by age, causative organism, neurological complications, and severity at presentation. In a cohort of 540 children with laboratory-confirmed bacterial meningitis, stroke occurred in 72 patients (13%); the study specifically evaluated its association with neurological outcome, highlighting cerebral infarction as an important mechanism of additional disability in survivors. [289] In adults with microbiologically confirmed bacterial meningitis, an elevated blood urea nitrogen-to-albumin ratio measured within 6 hours of admission was investigated as a predictor of an unfavorable 3-month modified Rankin Scale score of 3–6, compared with a favorable score of 0–2. [62]
Pneumococcal meningitis continues to cause substantial mortality and long-term morbidity despite pneumococcal conjugate vaccination. A Taiwanese cohort comparing the periods before and after incorporation of PCV13 into the national pediatric immunization programme evaluated changes in clinical characteristics, antimicrobial susceptibility, serotype distribution, and outcomes through 2025; the study also examined the continuing emergence of non-vaccine serotypes. [297]C Meningococcal disease can progress rapidly and is associated with high mortality and severe sequelae. Indian consensus evidence reported case-fatality ratios of 12.8% during epidemics and 3.0% in endemic settings, although weak surveillance may underestimate the true burden. [287]
Tuberculous meningitis
Tuberculous meningitis (TBM) has particularly poor outcomes in resource-limited settings, where reported case fatality may reach 50% despite standard antituberculosis therapy. [340] Adjunctive corticosteroid evidence remains relevant to prognosis. A 14-trial meta-analysis including 2,028 patients found that steroids reduced mortality in adults, but not significantly in children; pooled adult mortality was reduced with a risk ratio of 0.83 (95% CI 0.72–0.95), whereas the pediatric estimate was 0.68 (95% CI 0.36–1.29). Steroids did not significantly reduce neurological complications or improve functional recovery in the reported pooled analyses. [325] A separate systematic review and meta-analysis of randomized and quasi-randomized trials evaluated mortality, gastrointestinal bleeding, visual and auditory impairment, hydrocephalus, and joint disorders, emphasizing that benefits must be weighed against treatment-related adverse outcomes and that certainty varies across endpoints. [340]
Adjunctive linezolid may improve survival, although the certainty of evidence is low. Across three randomized trials involving 104 patients, linezolid had a 92% probability of preventing one death per 100 treated patients, with a relative risk of 0.55 (95% credible interval 0.23–1.31) and low heterogeneity (I²=13%); the credible interval includes no clear effect, so this finding should not be interpreted as definitive. [324] A network meta-analysis of 29 randomized trials involving 4,640 patients compared available TBM drug regimens with respect to mortality, neurological events, and adverse events, reflecting persistent uncertainty about the optimal regimen. [286]
Hyponatraemia is common in TBM and may identify patients with more severe disease. In Vietnamese adults enrolled in two corticosteroid trials, 176 of 190 (92.6%) with sodium measured at presentation were hyponatraemic; lower sodium concentrations were associated with greater TBM severity and increased cerebrospinal-fluid inflammation. [311]
Cryptococcal, fungal, parasitic, and viral meningitis
In a retrospective cohort of 181 patients with cryptococcal meningitis, the unfavorable 12-month outcome rate was higher among HIV-negative than HIV-positive patients (19.1% vs 5.0%). Impaired consciousness and motor deficits were independent clinical predictors of poor outcome, with reported odds ratios of 5.51 and 3.83, respectively. [326] Coccidioidal meningitis is frequently complicated by hydrocephalus and may require cerebrospinal-fluid diversion. In a series of 12 adults, prolonged subatmospheric external ventricular drainage was used before permanent shunt placement for low-pressure hydrocephalus and impaired ventricular compliance, illustrating the potential for complex, prolonged neurosurgical management. [313]C
Neurocysticercosis-associated meningitis is uncommon and underdiagnosed; a systematic review identified 48 published cases, predominantly presenting with headache (94%). The limited case-based evidence prevents reliable estimation of mortality or long-term disability. [312]C In children with enterovirus-associated meningoencephalitis studied after widespread EV71 vaccination, EV71 infection did not show greater clinical severity than infection with other enterovirus subtypes in the reported single-center cohort of 160 children. [328] Long-term sequelae are also important after encephalitic illness: a Latvian cohort followed 105 adults with laboratory-confirmed tick-borne encephalitis for at least 6 months, using structured neurological and neurocognitive assessments to characterize persistent deficits and predictors of post-encephalitic sequelae. [339]
Prognostic assessment and follow-up
Prognosis should be reassessed serially rather than inferred from a single admission variable. Consciousness level, focal motor deficits, stroke, hydrocephalus, inflammatory burden, hyponatraemia, nutritional or systemic status, and the infecting pathogen can all identify patients requiring intensified monitoring and rehabilitation. [289][311][326] In very preterm or very-low-birth-weight infants with early-onset sepsis, a multicentre study developed a nomogram for probable meningitis, defined by meningitis-consistent cerebrospinal-fluid abnormalities without culture confirmation; this population requires particular caution because developmental vulnerability may magnify later consequences. [271] Diagnostic discrimination may also remain difficult after antibiotic exposure: a prospective cohort evaluated cerebrospinal-fluid procalcitonin and neutrophil percentage for distinguishing bacterial from TBM and explored their prognostic utility in 125 bacterial and 56 tuberculous meningitis patients. [294]
Long-term care should therefore include hearing, vision, cognition, motor function, epilepsy, psychological health, school or occupational participation, and caregiver needs, with access to rehabilitation and social support. [338][341]
| Condition or population | Prognostic evidence |
|---|---|
| Global meningitis | Leading infectious cause of neurological disability; greatest burden in children younger than 5 years and the African meningitis belt. [341] |
| Pediatric bacterial meningitis | Stroke occurred in 72/540 patients (13%). [289] |
| Adult TBM | Steroids reduced mortality: RR 0.83 (95% CI 0.72–0.95). [325] |
| TBM | Hyponatraemia occurred in 176/190 (92.6%) measured adults and correlated with severity. [311] |
| Cryptococcal meningitis | Unfavorable 12-month outcome: 19.1% in HIV-negative versus 5.0% in HIV-positive patients; impaired consciousness and motor deficits were adverse predictors. [326] |
| Meningococcal disease in India | Reported CFR: 12.8% in epidemics and 3.0% in endemic settings. [287] |
Landmark Trials and Key Evidence
- ▸High-dose rifampin has strong pharmacologic rationale but did not reduce all-cause mortality in the supplied 2026 meta-analysis of 7 randomized trials and 1,296 patients. [31]
- ▸Adjunctive linezolid may reduce death or neurologic disability in tuberculous meningitis, but the estimated benefit remains low-certainty and imprecise. [324]
- ▸Dexamethasone response in tuberculous meningitis may vary by LTA4H genotype, although the supplied phase 3 report does not provide complete numerical results. [84]
- ▸Evidence for empiric antibiotic timing, shortened pediatric antibiotic courses, corticosteroids in pediatric bacterial meningitis, and antiseizure-medicine duration remains dependent on heterogeneous or incompletely reported data in the supplied abstracts. [331][343][185][319]
- ▸Meningococcal conjugate vaccine trials support evaluation of broader serogroup coverage, including serogroup X, and locally manufactured vaccine alternatives. [190][194]
- ▸Cryptococcal meningitis research increasingly incorporates prevention of progression, mortality-risk stratification, coinfection assessment, and simplified treatment delivery. [38][155][189][193]
Evidence overview
Recent evidence in meningitis is dominated by systematic reviews, randomized trials, pharmacokinetic studies, and prevention studies addressing bacterial, tuberculous, cryptococcal, and meningococcal disease. The certainty and applicability of evidence vary substantially by pathogen, age group, HIV status, and clinical setting. [324][319][331]
Acute bacterial meningitis: timing, duration, and adjunctive corticosteroids
A systematic review and meta-analysis evaluated early versus delayed empiric antimicrobial treatment for suspected acute bacterial meningitis. The search covered studies from 1946 through January 2024 and included randomized trials and prospective cohort studies with comparator groups; three prospective cohort studies were included in the available report. [331] Because the available abstract does not provide the pooled effect estimates, it supports the principle that treatment timing remains an evidence question but does not establish a definitive threshold for “early” treatment from the supplied data. [331]
In children with bacterial meningitis caused principally by Streptococcus pneumoniae, Haemophilus influenzae, or Neisseria meningitidis, a systematic review compared antibiotic courses of up to 7 days with longer regimens, defined as 10 days or twice the duration of the shorter course. Outcomes included treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, and nosocomial infection. [343] The review therefore directly addresses whether selected pediatric bacterial meningitis cases can be treated with shorter courses, although the supplied abstract does not report the pooled outcome estimates. [343]
A systematic review of randomized trials assessed adjunctive corticosteroids in pediatric bacterial meningitis, with hearing loss and neurologic sequelae as primary outcomes and fever resolution, mortality, secondary fever, and reactive arthritis as secondary outcomes. [185] The review was designed to clarify the balance between benefit and potential harm, but the supplied evidence does not provide numerical pooled results or pathogen-specific conclusions. [185]
Tuberculous meningitis: intensified and adjunctive therapy
The 2025 double-blind randomized trial of high-dose oral rifampin enrolled adults with tuberculous meningitis in Indonesia, South Africa, and Uganda, including participants with and without HIV coinfection. Standard therapy comprised isoniazid, rifampin 10 mg/kg daily, ethambutol, and pyrazinamide, with additional rifampin increasing the cumulative dose to 35 mg/kg or matched placebo. [59] The rationale was limited central nervous system penetration of standard-dose rifampin and the persistently high mortality and disability associated with tuberculous meningitis despite antimicrobial and glucocorticoid treatment. [59]
A 2026 meta-analysis pooled 7 randomized trials involving 1,296 patients to assess high-dose rifampin for tuberculous meningitis, using all-cause mortality at the longest reported follow-up as the primary outcome and serious adverse events as a safety outcome. [31] The supplied abstract states that high-dose rifampin did not reduce all-cause mortality; therefore, dose escalation should not be assumed to improve survival solely on the basis of pharmacologic rationale. [31] Pharmacokinetic analyses from a randomized trial compared standard rifampin 10 mg/kg with oral 35 mg/kg or intravenous 20 mg/kg regimens, with CSF and plasma sampling on days 3 and 28. [188] A nested pharmacokinetic study also evaluated dexamethasone exposure during high-dose rifampin therapy and highlighted the concern that rifampin induction may reduce dexamethasone concentrations, potentially more strongly at higher rifampin doses. [345]
Adjunctive linezolid has been evaluated in randomized trials as an addition to standard therapy for clinically diagnosed tuberculous meningitis. A Bayesian meta-analysis included 3 randomized trials and estimated a 92% probability that linezolid prevents one death per 100 treated patients, with a pooled risk ratio of 0.55 and a 95% credible interval of 0.23–1.31; heterogeneity was low (I²=13%), but certainty was low. [324] These findings suggest a possible mortality or neurologic-disability benefit while retaining substantial statistical uncertainty. [324]
A randomized prospective study in 10 patients compared CSF penetration and safety of contezolid-containing (n=5) versus linezolid-containing (n=5) regimens. Contezolid CSF concentrations exceeded the Mycobacterium tuberculosis minimum inhibitory concentration of 0.5 μg/mL at 2 hours, with a median concentration of 1.0806 μg/mL, and declined by 6 hours to a median of 0.7920 μg/mL. [83] The very small sample supports pharmacokinetic feasibility rather than comparative clinical efficacy. [83]
A phase 3 placebo-controlled trial in 613 HIV-negative Vietnamese adults with LTA4H CC or CT genotypes tested genotype-stratified dexamethasone. Participants received 6–8 weeks of dexamethasone or placebo, with a prespecified hazard-ratio noninferiority margin of 0.75 for placebo. [84] The trial was motivated by evidence that hyperinflammatory TT-genotype patients may derive greater benefit from corticosteroids, whereas benefit in CC and CT genotypes was uncertain; the supplied report states that significant survival findings were observed but does not provide the final numerical estimates. [84]
The ACT-TBM randomized trial evaluated adjunctive aspirin or clopidogrel with standard antituberculous therapy for stroke or cerebral infarction. A secondary MRI analysis included 237 patients and examined infarct patterns, associated factors, and predictors. [156]
Cryptococcal meningitis and HIV-associated disease
The AMBITION-cm randomized trial provided the cohort for a post-hoc analysis of Epstein–Barr virus and cytomegalovirus coinfections in HIV-associated cryptococcal meningitis; the parent trial’s primary endpoint was all-cause mortality at 10 weeks, and samples were obtained across seven sites in five African countries. [38] Pooled individual-level data from the ACTA and AMBITION-cm trials were also used to develop and validate mortality risk-prediction tools for HIV-associated cryptococcal meningitis in sub-Saharan Africa. [189]
Among people with HIV-associated cryptococcal antigenemia without meningitis and low plasma cryptococcal antigen titers, a randomized trial compared single-dose liposomal amphotericin B 10 mg/kg once plus fluconazole with fluconazole alone through 24 weeks, assessing meningitis-free survival. [193] In adults with advanced HIV disease hospitalized for cryptococcal meningitis, the IMPROVE phase 3 noninferiority strategy trial evaluated inpatient initiation of 1 month of daily rifapentine plus isoniazid (1HP) after screening for active tuberculosis. [155]
Seizures and special populations
A systematic review and meta-analysis examined cessation of antiseizure medicines after acute symptomatic seizures caused by meningitis, comparing discontinuation within 3 months of initiation with continuation beyond 3 months. Outcomes included development of epilepsy and seizure-related outcomes, but the supplied abstract does not provide pooled estimates. [319]
In infants aged 0–59 days, a systematic review of randomized trials compared antibiotic regimens for meningitis using mortality and other critical clinical outcomes; searches included MEDLINE, Embase, CINAHL, WHO Global Index Medicus, and CENTRAL. [342] The evidence addresses a population with high mortality risk in whom the optimal regimen remains uncertain. [342]
Prevention and noninfectious mimics
A phase 3 trial in Mali compared a pentavalent meningococcal conjugate vaccine targeting serogroups A, C, W, Y, and X with quadrivalent MenACWY-TT in children aged 9–11 months receiving routine immunizations; the study assessed safety and immunogenicity. [190] A separate phase 3 noninferiority trial in 88 adults aged 18–45 years compared locally manufactured Ingovax ACWY with an approved quadrivalent meningococcal polysaccharide vaccine, with follow-up to 3 months after vaccination. [194]
A systematic review of inflammatory neuropsychiatric systemic lupus erythematosus manifestations included 90 studies from 7,222 identified records and evaluated treatment evidence from clinical trials, observational studies, and case series. [344] This evidence concerns an important noninfectious meningitis mimic or alternative inflammatory diagnosis rather than routine treatment of infectious meningitis. [344]
| Clinical question | Evidence base | Main finding or implication |
|---|---|---|
| High-dose rifampin in TBM | 7 RCTs; 1,296 patients | No reduction in all-cause mortality reported in the supplied abstract. [31] |
| Adjunctive linezolid in TBM | 3 RCTs; 104 patients | RR 0.55; 92% probability of preventing one death per 100 treated; low-certainty evidence. [324] |
| Genotype-stratified dexamethasone in TBM | Phase 3 RCT; 613 HIV-negative adults | Tested 6–8 weeks of dexamethasone versus placebo in LTA4H CC/CT genotypes. [84] |
| Short versus long pediatric antibiotic therapy | RCT systematic review | Compared courses up to 7 days with 10 days or twice the short-course duration. [343] |
| Pediatric corticosteroids | RCT meta-analysis | Primary outcomes were hearing loss and neurologic sequelae. [185] |
| Antiseizure-medicine duration | Systematic review/meta-analysis | Compared cessation within 3 months with continuation beyond 3 months after meningitis-related acute symptomatic seizures. [319] |
Special Populations
- ▸Evaluate febrile infants aged **≤90 days** for invasive bacterial infection, including meningitis; machine-learning tools remain investigational [293].
- ▸Very preterm or very-low-birth-weight infants are at risk for probable culture-negative meningitis; the relevant thresholds are gestational age **<32 weeks** and/or birth weight **<1,500 g** [271].
- ▸Neonatal meningitis is associated with mortality, stroke, acute neurological complications, and later developmental impairment, warranting structured neurological and developmental follow-up [208][289][346][348].
- ▸In advanced HIV with cryptococcal meningitis, inpatient initiation of **1 month of daily rifapentine plus isoniazid (1HP)** has been formally evaluated as a tuberculosis-prevention delivery strategy [155].
- ▸In tuberculous meningitis, rifampicin dose can affect CNS pharmacology and dexamethasone exposure; pharmacokinetic monitoring and clinical vigilance are important when higher rifampicin doses are used [59][345].
- ▸Cryptococcal meningitis in HIV may be followed by neurological IRIS, while recurrent HSV-2 Mollaret meningitis can occur despite virological suppression [133][350].
Infants and neonates
Infants aged ≤90 days with fever require assessment for invasive bacterial infection (IBI), including bacteremia and meningitis; a 2026 systematic review evaluated machine-learning models intended to identify IBI in this age group, but the available evidence supports these tools as an area under evaluation rather than as replacements for clinical assessment and diagnostic testing [293]. A retrospective study of infants aged ≤60 days hospitalized for temperature instability found that use of a multiplex meningoencephalitis panel was evaluated for its effects on length of stay, antimicrobial duration, and additional molecular testing; the cohort included 2,076 infants with negative blood and CSF bacterial cultures [323].
Very preterm and/or very-low-birth-weight infants are a distinct high-risk group. In a multicenter cohort, probable meningitis was defined as culture-negative CSF with meningitis-consistent abnormalities, including pleocytosis; all included infants with early-onset sepsis underwent lumbar puncture [271]. A nomogram was developed to predict probable meningitis in infants with gestational age <32 weeks and/or birth weight <1,500 g, but its retrospective design means that external validation is required before routine clinical adoption [271].
Culture-proven neonatal meningitis remains associated with substantial mortality and neurological morbidity. In Australian tertiary hospitals, a five-year cohort of infants aged 0–180 days identified Streptococcus agalactiae, Staphylococcus aureus, and Escherichia coli as the leading organisms; 19% (4/21) died, including three infants with neurosurgical meningitis, and neurological sequelae were common among survivors [346]. In a Chinese cohort of neonates aged 0–28 days, acute neurological complications—including subdural effusion or empyema, ventriculitis, hydrocephalus, brain abscess, and encephalomalacia—were specifically assessed; 20/68 developed such complications [348].
Neurodevelopmental follow-up is important after meningitis in early life. A retrospective infant study assessed the Motor Optimality Score–Revised at 3–4 months’ corrected age and later development with the Bayley Scales at 12 or 24 months, reflecting the need for early screening and intervention planning after neonatal or early-infancy meningitis [208]. Stroke is another important pediatric complication: in a tertiary-center cohort of children aged 0–15 years with bacterial meningitis, stroke occurred in 13% (72/540) and was confirmed by neuroimaging; the study examined presentation, investigations, treatment, and neurological outcomes [289].
Children beyond the neonatal period
Listeria meningitis is uncommon beyond the neonatal period but should remain in the differential diagnosis when compatible clinical and CSF findings are present. A Turkish multicenter case series included children aged 1 month–18 years with microbiologically confirmed Listeria monocytogenes meningitis; CSF culture was positive in 10/11 (90.9%), and CSF PCR confirmed infection in all nine children who underwent PCR testing [315]C.
People with HIV
HIV-associated meningitis may occur with advanced immunosuppression, opportunistic infection, treatment-related inflammation, or other neurological complications. In a Cameroonian retrospective cohort of people living with HIV and neurological complications, demographic, clinical, laboratory, neuroimaging, and treatment factors were analyzed in relation to mortality; the study covered 2016–2023 and was conducted in two hospitals in Douala [284]. New-onset seizures are also clinically relevant: in a prospective cohort of adults with HIV, only 25/64 (39%) participants receiving ART were virally suppressed at presentation, and 12/89 (13%) had status epilepticus; seizure recurrence and mortality were followed for two years [336].
For adults with advanced HIV disease hospitalized with cryptococcal meningitis, the IMPROVE phase-3 randomized strategy trial evaluated inpatient initiation of tuberculosis preventive therapy using 1 month of daily rifapentine plus isoniazid (1HP) after active tuberculosis screening during hospitalization. The trial was conducted in three Ugandan tertiary referral hospitals and was designed to assess safety, feasibility, and non-inferiority of strategies to increase preventive-therapy uptake [155].
Cryptococcal meningitis treatment may be complicated by immune reconstitution inflammatory syndrome (IRIS). A reported patient with advanced HIV and a CD4 count of 11/μL developed recurrent, steroid-dependent cortical encephalitis after antifungal induction and initiation of effective ART; serial MRI showed sequential migrating bilateral frontal, cingulate, and occipital T2/FLAIR abnormalities despite negative infectious and autoimmune evaluations [133]C. Recurrent HSV-2 Mollaret meningitis has also been reported in a man with HIV despite sustained virological suppression and a preserved CD4 count, emphasizing that recurrent aseptic meningitis can occur even when HIV is controlled [350]C.
Tuberculous meningitis
Adults with HIV-associated tuberculous meningitis may require attention to rifampicin dose, drug penetration, and adjunctive corticosteroid exposure. A randomized trial compared standard-dose rifampicin (10 mg/kg) with a cumulative high-dose regimen of 35 mg/kg, alongside standard isoniazid, ethambutol, and pyrazinamide, in adults with and without HIV coinfection [59]. A nested pharmacokinetic study evaluated dexamethasone exposure during standard- and high-dose rifampicin treatment; participants received dexamethasone every 12 hours, beginning at 0.4 mg/kg/day, because rifampicin induction may reduce dexamethasone concentrations, potentially more substantially at higher rifampicin doses [345].
| Population | Evidence-based consideration |
|---|---|
| Febrile infants ≤90 days | Assess for bacteremia and meningitis; ML diagnostic models are under evaluation [293]. |
| Very preterm/VLBW infants | Consider probable meningitis when CSF is culture-negative but shows meningitis-consistent abnormalities; thresholds are <32 weeks’ gestation and/or <1,500 g [271]. |
| Neonates and young infants | Monitor for neurological complications, stroke, death, and developmental sequelae [208][289][346][348]. |
| Advanced HIV with cryptococcal meningitis | Hospital-based 1HP tuberculosis-prevention strategies have been studied after active-TB screening [155]. |
| HIV-associated TBM | Higher-dose rifampicin regimens may alter dexamethasone exposure; dexamethasone PK is clinically relevant [59][345]. |
Prevention and Screening
- ▸Use age- and region-appropriate meningococcal conjugate vaccination; NmCV-5 targets serogroups A, C, W, Y, and X and has been studied with routine vaccines at 9 and 15 months [190].
- ▸MenA vaccination markedly reduced serogroup A epidemics in the African meningitis belt, but surveillance must monitor serogroups C, W, Y, X and non-meningococcal pathogens [186][190][354].
- ▸Pneumococcal vaccination is particularly important in children with sickle-cell disease and should be accompanied by indicated antibiotic prophylaxis [352].
- ▸Assess children with CSF leakage, meningeal breach, cochlear implants, or sickle-cell disease as high-risk groups [51][352].
- ▸No universal asymptomatic meningitis screening strategy is established by the supplied evidence; prevention relies on vaccination, risk assessment, outbreak control, and surveillance [190][186][51][354].
- ▸Reported meningitis after COVID-19 or varicella vaccination is rare case-report evidence and should be evaluated through pharmacovigilance rather than interpreted as common vaccine toxicity [217][218][219].
Vaccination as the central prevention strategy
Vaccination remains the principal evidence-supported method for preventing vaccine-preventable meningitis. Prevention must address multiple pathogens because meningitis epidemiology changes after introduction of conjugate vaccines, with declining vaccine-targeted disease but persistent or emerging disease caused by non-vaccine serotypes and other organisms [236]D[297]C[354].
In the African meningitis belt, the pentavalent meningococcal conjugate vaccine NmCV-5, targeting serogroups A, C, W, Y, and X, was evaluated against licensed MenACWY-TT in children aged 9–11 months who had completed local infant EPI vaccines. The phase 3 trial specifically assessed co-administration at the 9-month and 15-month vaccination visits, supporting integration of broad meningococcal protection into routine childhood immunisation [190]. Earlier randomized trials evaluated MenA conjugate vaccine PsA-TT formulations administered with EPI vaccines at 14–18 weeks, 9–12 months, and 12–18 months, including one- and two-dose schedules in African infants and toddlers [186].
MenA conjugate vaccination has been used in preventive campaigns for people aged 1–29 years across the African meningitis belt since 2010. Post-MenAfriVac surveillance indicates a sharp reduction in serogroup A epidemics, but also highlights the need to monitor replacement or emerging disease caused by serogroups C, W, and Y, pneumococcus, and Haemophilus influenzae [186][354]. The newer pentavalent strategy is therefore relevant where serogroup X and other non-A serogroups contribute to risk [190].
A locally manufactured ACWY polysaccharide vaccine, Ingovax ACWY, was compared with Quadri Meningo in a randomized 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 three months [194]. These data support evaluation of locally produced meningococcal vaccines, although the study population and product type should be distinguished from infant conjugate-vaccine programmes [194]. An Indian expert consensus reports that MenACWY conjugate vaccines achieved 95.7–99.5% seroprotection in the evidence it reviewed and identifies children younger than 5 years and adolescents as important age groups; it also describes serogroup A predominance with emerging C, W, and Y disease in India [287].
Pneumococcal conjugate vaccination is also an important meningitis-prevention measure. In children with sickle-cell disease, pneumococcal immunisation combined with antibiotic prophylaxis reduced invasive pneumococcal disease, although risk remained higher than in the general population; pneumococcal meningitis in this group continued to have high mortality [352]C. Surveillance from Taiwan examined pneumococcal meningitis before and after PCV13 implementation and emphasised the continuing concern of non-vaccine serotype emergence [297]C. In southern Sweden, a retrospective study evaluated otogenic meningitis and trends after introduction of conjugate pneumococcal vaccines, reflecting the role of vaccination in reducing complications of pneumococcal disease [223].
Programme implementation and safety surveillance
The RTS,S/AS01E malaria vaccine was introduced through national immunisation programmes in Ghana, Kenya, and Malawi beginning in 2019. A cluster-randomised evaluation assessed feasibility, impact, and previously observed safety signals involving meningitis, cerebral malaria, and possible sex differences in mortality; the programme experience was designed to inform wider implementation rather than to establish RTS,S as a meningitis vaccine [195]. Pre-roll-out surveillance in Ghana and Kenya measured baseline rates of malaria, meningitis, mortality, and hospitalisation in children younger than 5 years, providing a comparator for vaccine-safety and impact assessment [222]. CHAMPS post-mortem surveillance in six sub-Saharan African countries and Bangladesh investigated meningitis and other causes of death in children younger than 5 years during the post-pneumococcal-vaccine era, helping identify pathogen-specific prevention priorities [353].
Rare inflammatory or infectious events reported after vaccination should be interpreted through pharmacovigilance rather than assumed to represent common vaccine effects. Systematic reviews identified 35 cases of meningitis after COVID-19 vaccination in 33 articles and 31 patients across 27 case reports or series; headaches and fever were frequent presentations, and reported cases included both proven viral infections and cases considered vaccine-induced [217][219]. A separate review found 15 cases of varicella vaccine meningitis in apparently immunocompetent children and adolescents, with a median age of 11 years, while noting the established excellent overall safety record of live varicella vaccine and greater risk in inadvertently vaccinated immunocompromised individuals [218]. These reports warrant clinical evaluation and reporting of suspected adverse events but do not quantify population-level risk [217][218][219].
Risk-based prevention and surveillance
Children with cerebrospinal-fluid leakage, meningeal breach, or cochlear implants are a recognized high-risk group for bacterial meningitis; a French nationwide cohort specifically examined the epidemiology of meningitis in children older than 3 months with these conditions and assessed the role of PCV13 [51]D. Prevention in such patients requires active identification of the underlying risk and confirmation that indicated vaccines and other specialist measures are up to date [51]D. Sickle-cell disease is another high-risk condition because of susceptibility to invasive pneumococcal disease and persistent risk despite vaccination and prophylaxis [352]C.
The supplied evidence does not establish a universal laboratory-screening test for asymptomatic people. Instead, it supports risk-based assessment, vaccination according to age, location, outbreak status, and underlying disease, and surveillance capable of identifying changing serogroups and pathogens [190][186][287][354]. Clinical decision models may help distinguish bacterial from viral meningitis among symptomatic children, but this is diagnostic triage rather than preventive screening; in a UK prospective cohort, 1,101 of 3,002 hospitalised children with suspected meningitis or encephalitis met the study definition of meningitis, including bacterial, viral, and pathogen-negative cases [351].
Post-vaccine epidemiology requires continued monitoring. Adult bacterial meningitis surveillance in Korea documented a decline in Streptococcus pneumoniae and a significant rise in Klebsiella pneumoniae, while Vietnamese paediatric surveillance described pneumococcal meningitis predominantly in children younger than 1 year and assessed serotypes and resistance determinants [236]D[221]. Spanish national data showed that pneumococcal disease hospitalisation and mortality increased with age and peaked among people aged 90 years or older [355]. These findings reinforce that prevention programmes should be paired with pathogen, serotype, age-specific, and antimicrobial-resistance surveillance [221][236]D[297]C[354][355].
| Population or setting | Prevention and screening implication | Evidence |
|---|---|---|
| African meningitis belt | MenA vaccination and broader MenACWY/meningococcal conjugate strategies; monitor emerging serogroups | [186][190][354] |
| Infants and toddlers | Integrate meningococcal conjugate vaccination with EPI visits, including schedules studied at 9–15 months | [186][190] |
| Children with CSF leakage or cochlear implant | Identify high-risk status and optimise indicated pneumococcal prevention | [51]D |
| Children with sickle-cell disease | Combine pneumococcal immunisation with indicated antibiotic prophylaxis | [352]C |
| Adults and older adults | Maintain age- and risk-based pneumococcal prevention; monitor age-related disease burden | [194][287][355] |
| Post-vaccine surveillance | Track meningitis incidence, pathogens, serotypes, serogroups, resistance, and suspected adverse events | [195][217][219][221][222][236]D[297]C[353][354] |
Guidelines and Resources
- ▸Treat suspected bacterial meningitis as a hospital-based neurological emergency; investigation and imaging must not cause clinically important delays in empiric antimicrobials [248][259].
- ▸Start empiric antituberculosis treatment promptly when TBM is suspected rather than waiting for microbiological or molecular confirmation [239][258].
- ▸Use the 2025 international TBM guideline as the primary current resource for TBM diagnosis, chemotherapy, adjunctive anti-inflammatory therapy, neurocritical care, and neurosurgery [239].
- ▸Consider herpes simplex encephalitis in overlapping meningitis–encephalitis presentations and avoid aciclovir delays beyond 48 hours after admission when clinically indicated [252][253].
- ▸For Lyme neuroborreliosis, definite disease requires neurological symptoms, CSF pleocytosis, and intrathecal Borrelia-specific antibodies; two criteria support possible disease [257].
- ▸Use pregnancy screening and infection-prevention guidance to reduce congenital syphilis and neonatal listerial or intraamniotic-infection complications [241][245][246][251].
- ▸Interpret older Lyme, pneumococcal-vaccine, encephalitis, and bacterial-meningitis documents in the context of their publication dates and current local protocols [248][252][253][254][260].
Scope and emergency principles
Meningitis is a time-critical syndrome requiring rapid assessment, appropriate cerebrospinal-fluid (CSF) investigation when safe, and early cause-directed treatment; suspected acute bacterial meningitis should be managed in hospital, with lumbar puncture (LP) considered promptly and antimicrobial therapy not delayed beyond the guideline-defined emergency window by imaging or other investigations [248][259]. The UK joint specialist-societies guideline provides an evidence-based approach to acute meningitis and meningococcal sepsis in immunocompetent adults, while the EFNS guideline addresses community-acquired bacterial meningitis in older children and adults [248][259]. Suspected viral encephalitis, which may overlap clinically with meningitis, requires prompt investigation and empiric intravenous aciclovir when herpes simplex encephalitis is a concern; delays beyond 48 hours after hospital admission are associated with poorer prognosis in the cited adult and paediatric guidance [252][253].
Tuberculous meningitis
Tuberculous meningitis (TBM) is the most severe form of tuberculosis and causes death or disability in approximately half of affected patients [239]. The 2025 Tuberculous Meningitis International Research Consortium guideline is the most current reference in this set and was developed after a systematic review using PICO questions covering diagnosis, antituberculosis chemotherapy, adjunctive anti-inflammatory therapy, neurocritical care, and neurosurgical management [239]. It was produced by an international consortium representing 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 but predates the 2025 international guideline [258]. It emphasizes that TBM is a medical emergency, that treatment delay is strongly associated with death, and that empiric antituberculosis therapy should begin promptly when TBM is suspected rather than waiting for microbiological or molecular confirmation [258]. LP with CSF examination is described as the preferred diagnostic approach, while the guideline also covers intracerebral tuberculoma without meningitis and spinal-cord tuberculosis [258]. The newer international guideline should take precedence where recommendations differ or where contemporary evidence is available [239][258].
Acute cerebral oedema and neurocritical care
For patients with meningitis complicated by cerebral oedema or raised intracranial pressure, the Neurocritical Care Society guideline evaluates hyperosmolar therapy, corticosteroids, and selected non-pharmacological interventions [243]. It was developed by a multidisciplinary panel of neurocritical-care, nursing, and pharmacy experts and is intended to support selection and monitoring of initial therapies while balancing efficacy and safety [243]. Management should therefore be individualized to neurological status, imaging, renal function, serum sodium, volume status, and the suspected underlying cause; the cited guideline does not replace treatment of the infection itself [243].
Pathogen- and population-specific resources
Lyme neuroborreliosis guidance recommends diagnosis using the clinical neurological syndrome, CSF pleocytosis, and evidence of intrathecal Borrelia burgdorferi sensu lato antibodies: all three criteria support definite disease, whereas two criteria support possible disease [257]. PCR and CSF culture may be corroborative when symptom duration is less than 6 weeks, but PCR is otherwise not recommended; several other nonstandard tests lack sufficient evidence for routine diagnosis [257]. The retired American Academy of Neurology practice parameter reviewed antimicrobial treatment and duration for nervous-system Lyme disease in adults and children, but it should be interpreted as historical evidence rather than current guideline authority [260].
Syphilis screening during pregnancy is addressed by the 2025 US Preventive Services Task Force reaffirmation statement because untreated maternal infection can cause congenital syphilis, including neurological disease and meningitis [241]. The statement reports 3,882 congenital syphilis cases in the United States in 2023, including 279 stillbirths and neonatal or infant deaths, the highest annual number reported in more than 30 years [241]. Prevention of congenital infection requires adherence to current antenatal screening and treatment recommendations rather than relying on evaluation of the neonate after illness develops [241].
Pregnancy-associated listeriosis is covered by an American College of Obstetricians and Gynecologists committee opinion on presumptive exposure to Listeria monocytogenes. Pregnancy-associated listeriosis occurs approximately 13 times more often than in the general population and may present with nonspecific fever, myalgia, backache, headache, diarrhoea, or other gastrointestinal symptoms [251]. Fetal and neonatal consequences can include pregnancy loss, preterm labour, neonatal sepsis, meningitis, and death; the committee opinion specifically addresses management of a pregnant patient with compatible symptoms and fever above 38.1°C (100.6°F) after presumptive exposure [251]. Intrapartum intraamniotic infection guidance is relevant to neonatal-risk assessment because chorioamnionitis can cause neonatal pneumonia, meningitis, sepsis, and death, as well as substantial maternal morbidity [245][246]. Standardized Brighton Collaboration/GAIA definitions provide internationally comparable case definitions for neonatal bloodstream infection, meningitis, and lower respiratory-tract infection, particularly in maternal-vaccine safety research [247].
Prevention and special exposures
ACIP guidance on pneumococcal vaccination addresses prevention of invasive pneumococcal disease, including pneumococcal meningitis, through PPSV23 in adults aged 65 years or older and in adults aged 19–64 years with medical conditions that increase risk [254]. The cited document is from 2010 and should be supplemented by later vaccine schedules where available [254]. Anthrax resources describe clinical frameworks and medical-countermeasure use during a mass-casualty incident, including diagnosis, treatment, preparedness, and deployment of stockpiled countermeasures after a potential aerosolized release of Bacillus anthracis spores [249]. Separate ACIP recommendations address anthrax vaccine adsorbed for pre-event and pre-exposure use, including effectiveness, immunogenicity, safety, and supply considerations [256].
Related neurosurgical and autoimmune guidance
The Congress of Neurological Surgeons guideline on myelomeningocele evaluates whether closure within 48 hours reduces wound infection or ventriculitis; it concerns congenital spinal dysraphism rather than routine acquired meningitis [244]. Pediatric hydrocephalus guidance reviews management of posthaemorrhagic hydrocephalus in premature infants and reports evidence classified into Classes I–III; this is relevant to selected hydrocephalus and ventricular-management decisions, not to antimicrobial treatment of meningitis [250]. EULAR recommendations for neuropsychiatric systemic lupus erythematosus address diagnosis, prevention, monitoring, and treatment of inflammatory, vascular, seizure, cognitive, psychiatric, and peripheral neurological manifestations; they are relevant when autoimmune disease mimics or complicates infectious meningitis, but do not substitute for infection-focused evaluation [255].
| Clinical problem | Primary cited resource | Main scope |
|---|---|---|
| Acute bacterial meningitis in adults | UK joint specialist-societies guideline; EFNS guideline | Recognition, LP, investigations, antimicrobials, supportive care, meningococcal sepsis [248][259] |
| Tuberculous meningitis | 2025 international guideline | Diagnosis, antituberculosis therapy, adjunctive anti-inflammatory treatment, neurocritical and neurosurgical care [239] |
| Viral encephalitis overlap | ABN/BIA adult and paediatric guidelines | Early recognition and aciclovir-based emergency management [252][253] |
| Cerebral oedema or raised intracranial pressure | Neurocritical Care Society guideline | Hyperosmolar therapy, corticosteroids, monitoring, and non-pharmacological care [243] |
| Lyme neuroborreliosis | EFNS guideline; historical AAN parameter | Diagnostic criteria and antimicrobial treatment evidence [257][260] |
| Pregnancy and neonatal prevention | USPSTF, ACOG, and GAIA/Brighton resources | Syphilis screening, listeriosis exposure, intraamniotic infection, and neonatal case definitions [241][245][246][247][251] |
| Prevention and uncommon exposures | ACIP and CDC anthrax resources | Pneumococcal vaccination and anthrax preparedness or vaccination [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]
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 - [333]
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 - [334]
Shah N, Katragkou A, Fortin O et al.. “Predicting Severe Short-Term Neurologic Outcomes in Human Parechovirus Meningoencephalitis.” Pediatrics (2025). PMID: 40935385 ↗
L3bCited in: Supportive Care and Complication Management - [335]
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 - [336]
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 - [337]
Kalita J, Nizami FM, Pandey PC et al.. “Status epilepticus in scrub typhus versus tuberculous meningitis: A comparative study.” Epilepsy research (2026). PMID: 41558069 ↗
L2bCited in: Supportive Care and Complication Management - [338]
Andreeva M, Pyatnitskaya M, Kochneva K et al.. “Experiences and service-uptake factors of receiving and providing care for meningitis and its sequelae: a qualitative systematic review.” BMC medicine (2026). PMID: 41968310 ↗
L2aCited in: Prognosis and Long-term Outcomes - [339]
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 - [340]
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 - [341]
. “Global, regional, and national burden of meningitis, its risk factors, and aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.” The Lancet. Neurology (2026). PMID: 41911930 ↗
L3bCited 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]
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 - [347]
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 - [348]
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 - [349]
Montenegro-Idrogo JJ, Quispe-Gárate L, Salazar B et al.. “Mortality in first-episode HIV-associated cryptococcal meningitis in Peru.” Medical mycology (2026). PMID: 41432278 ↗
L3bCited in: Special Populations - [350]
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 - [351]
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 - [352]
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 - [353]
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 - [354]
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 - [355]
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