Red flags
- Non-blanching purpuric rash (meningococcal)
- GCS drop, focal neuro deficit, seizure
- Shock, DIC
First steps
- Ceftriaxone 2 g IV immediately (do not delay for LP)
- Dexamethasone 10 mg IV before/with first dose (esp pneumococcal)
- Blood cultures
- LP if no contraindications
Key investigations
- LP: cell count, protein, glucose, culture, PCR
- Blood cultures × 2
- CT before LP if focal deficit, GCS <13, seizure, immunocompromise
Differentials
- Viral meningitis, encephalitis (add aciclovir 10 mg/kg TDS)
- SAH
- Cerebral abscess
Initial management
- Add amoxicillin 2 g q4h if >50 y or immunocompromised (Listeria)
- Vancomycin if pneumococcal + travel/high resistance area
- Contact tracing + chemoprophylaxis (rifampicin/ciprofloxacin) for close contacts
Referral
- ID + neurology, public health for notifiable
AI clinical assessment
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