Meningococcal disease is a leading cause of bacterial meningitis and sepsis in children in the UK. It can progress rapidly and carries significant mortality and morbidity, including hearing loss, neurological impairment, and limb loss. Early recognition and immediate treatment are critical to survival.

Paediatric Meningitis & Sepsis Pathway🚨
👶 Fever / unwell child 🔍 ABCDE assessment – obs (HR, RR, BP, SpO₂, CRT, AVPU), look for red flags ⚠️ Red flags → treat as sepsis: rash, ↓ consciousness, seizures, limb pain, cold peripheries, bulging fontanelle 🚨 Suspect meningitis / meningococcal sepsis 💉 Immediate action: senior help, IV/IO access, bloods + cultures (no delay), IV antibiotics ≤1 hr 💊 Antibiotics: <3 m → cefotaxime + amoxicillin \| >3 m → ceftriaxone ± vancomycin 💧 Support: fluids 10–20 mL/kg, O₂, treat seizures, monitor urine + lactate 🧠 LP only if stable (avoid: shock, ↓GCS, focal signs, papilloedema, coagulopathy) 💉 Dexamethasone: consider pneumococcal, give before/with antibiotics 🏥 Escalate: PICU if shock / resp failure / raised ICP 🛡️ Public health: notify + prophylaxis contacts 💡 Key: treat first, confirm later

Paediatric Meningitis & Sepsis Pathway🚨

👶 Fever / unwell child
🔍 ABCDE assessment – obs (HR, RR, BP, SpO₂, CRT, AVPU), look for red flags
⚠️ Red flags → treat as sepsis: rash, ↓ consciousness, seizures, limb pain, cold peripheries, bulging fontanelle
🚨 Suspect meningitis / meningococcal sepsis
💉 Immediate action: senior help, IV/IO access, bloods + cultures (no delay), IV antibiotics ≤1 hr
💊 Antibiotics: <3 m → cefotaxime + amoxicillin | >3 m → ceftriaxone ± vancomycin
💧 Support: fluids 10–20 mL/kg, O₂, treat seizures, monitor urine + lactate
🧠 LP only if stable (avoid: shock, ↓GCS, focal signs, papilloedema, coagulopathy)
💉 Dexamethasone: consider pneumococcal, give before/with antibiotics
🏥 Escalate: PICU if shock / resp failure / raised ICP
🛡️ Public health: notify + prophylaxis contacts
💡 Key: treat first, confirm later

💉 Acute Bacterial Meningitis in Children

A medical emergency involving infection of the meninges and often concurrent sepsis.
Presentation may be non-specific early - do not wait for classical meningeal signs.
Start IV antibiotics immediately - do not delay for lumbar puncture or imaging.

🦠 Common Causative Organisms (Age-Dependent)

Neonates: Group B Streptococcus, Escherichia coli, Listeria monocytogenes.
1–3 months: Streptococcus pneumoniae, Neisseria meningitidis, GBS.
>3 months: Neisseria meningitidis, Streptococcus pneumoniae.
Haemophilus influenzae type b is now rare due to vaccination.

🚨 Red Flags (NICE Sepsis Features)

Non-blanching rash (late sign).
Altered consciousness or reduced responsiveness.
Bulging fontanelle (infants).
Neck stiffness, photophobia (often absent early).
Limb pain, cold hands/feet, pale or mottled skin.
Tachycardia, tachypnoea, hypotension (late).
Seizures.

⚠️ Do not rely on rash or neck stiffness - early meningococcal disease often presents with fever, lethargy, and poor feeding. Think sepsis first in any unwell child.

🧪 Diagnosis

Bloods: FBC, CRP, U&E, lactate, blood cultures (before antibiotics if no delay).
PCR: for meningococcus/pneumococcus.
Lumbar puncture: only if safe and will not delay treatment.
- Contraindications: shock, reduced GCS, focal neurology, papilloedema, coagulopathy.
Imaging: not routine - only if signs of raised ICP or focal deficit.

💊 Pre-Hospital Antibiotics (UK NICE)

Give IM benzylpenicillin if meningococcal disease suspected, unless it delays urgent transfer.
Penicillin allergy → cefotaxime IM.

🏥 In-Hospital Management

🚨 Follow paediatric sepsis protocols: ABCDE, senior review, IV access, and antibiotics within 1 hour.

<3 months: IV cefotaxime + amoxicillin (Listeria cover).
>3 months: IV ceftriaxone (or cefotaxime).
Add vancomycin if concern for resistant pneumococcus (local guidance).

💉 Adjunctive Treatment

Dexamethasone: consider in suspected pneumococcal meningitis (give before or with first antibiotics).
Fluids: cautious boluses (10–20 mL/kg) - reassess frequently (risk of cerebral oedema).
Seizure control: benzodiazepines first-line.
PICU referral: shock, respiratory failure, raised ICP.

🛡️ Prevention

Vaccination: MenB, MenACWY, pneumococcal, Hib.
Close contacts: give prophylaxis (e.g. rifampicin or ciprofloxacin) within 24 hours.

📈 Prognosis & Complications

Mortality ~5–10% despite treatment.
Complications: hearing loss, epilepsy, cognitive impairment, hydrocephalus, limb loss.

💡 Key Learning Point: In any unwell febrile child, treat for sepsis early and consider meningococcal disease. Delays in antibiotics are the biggest modifiable risk factor for death.

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Acute Bacterial Meningitis in Children ✅

🧠 Introduction