Meningitis and encephalitis: Viva

Branch 1: Recognising the time-critical problem

The candidate should state that fever with altered consciousness and a new seizure places bacterial meningitis and encephalitis jointly at the top of the differential. Confusion and drowsiness, rather than isolated headache, are the features that bring brain parenchyma into the working diagnosis. NICE's red-flag combination for bacterial meningitis is fever, headache, neck stiffness, and altered consciousness. ^[2][1]

Any febrile child with altered consciousness or a new seizure is treated as a central nervous system infection until proven otherwise. The first priority is resuscitation and empiric cover for bacterial meningitis. NICE does not routinely add aciclovir unless herpes simplex encephalitis is strongly suspected — here a new seizure plus confusion makes that suspicion reasonable. ^[2]