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Table 5 Differential diagnostic recommendations for suspected bacterial meningitis

From: A systematic review of clinical guidelines on the management of acute, community-acquired CNS infections

Pathogen Age group EFNS
Europe
ESCMID
Europe
DSI
Denmark
SPILF
France
DGN: BM^
Germany
HPSC
Ireland
NVN
Netherlands
NICE
UK
UKJSS^^
UK
IDSA
USA/Global
AEPED
Spain
MSF
Global
NNF^^ PHE: ME
S. pneumoniae Neonates   (very rare)     N   N     > 7 days   NS
Paediatric P P   P P NS 1–12 months ≥ 3 months   P P > 3 months > 2 years NS
Adults A A A A A NS A   A A   A A NS
N. meningitidis Neonates       N         NS
Paediatric P P   P P NS > 12 months ≥ 3 months   P P > 3 months > 2 years NS
Adults A (less common) A A A NS A   A A   A A NS
S. agalactiae Neonates   N    N N N N   N N ≤ 7 days   NS
Paediatric     < 3 months       < 24 months < 3 months    NS
Adults    A (rare)      A      NS
H. influenzae Neonates               NS
Paediatric P (unvaccinated)     NS   ≥ 3 months   < 24 months   3 months to 5 years   NS
Adults (rare) (rare) A (rare) A NS A   A      NS
L. monocytogenes Neonates   (rare)    N N   N   N N > 7 days   NS
Paediatric P            ≤ 3 months   NS
Adults A > 50 years A (rare) A   A   > 60 years > 50 years    > 50 years NS
E. coli Neonates   N     N N N   N N ≤ 7 days   NS
Paediatric P    < 3 months (rare)       < 24 months     NS
Adults A   A        > 50#     NS
Klebsiella spp. Neonates           N   ≤ 7 days   NS
Paediatric P              
Adults A         A^      
Enterobacter spp. Neonates               
Paediatric P              
Adults A     A     A      
Pseudomonas aeruginosa Neonates             ≤ 7 days   
Paediatric P              
Adults A   A   A^     A      
Proteus mirabilis Neonates               
Paediatric P              
Adults A              
Salmonella spp. Neonates             ≤ 7 days   
Paediatric               
Adults               
S. aureus Neonates       (very rare)         
Paediatric P              
Adults A A (rare) A   A          
  1. Abbreviations: N neonates, P paediatric populations, A adults, NS non-specified population, EFNS European Federation of Neurological Societies, ESCMID European Society of Clinical Microbiology and Infectious Diseases, DSI Dansk Selskab for Infektionsmedicin, SPILF Société de Pathologie Infectieuse de Langue Française, DGN: BM Deutsche Gesellschaft fur Neurologie: Bakterielle Meningoenzephalitis, HPSC Health Protection Surveillance Centre, NVN Nederlandse Vereniging voor Neurologie, NICE The National Institute for Health and Care Excellence, UKJSS UK Joint Specialist Societies, IDSA Infectious Diseases Society of America, AEPED Asociación Española de Pediatría, MSF Médicins Sans Frontiéres, NNF Norsk Nevrologisk Forening, PHE: ME Public Health England: Meningoencephalitis
  2. *Focused on invasive meningococcal disease only
  3. ^And other Gram-negative
  4. #Gram-negative bacteria in A > 50 years
  5. ^^Additional recommendations: B. burgdorferi, M. pneumoniae, Chlamydia trachomatis, M. tuberculosis. Two CMGs focused on N. meningitides only [20, 21] and are therefore not presented in the table