A child with fever, irritability, and a bulging fontanelle requires urgent evaluation to rule out which condition?

• A. Viral meningitis
• B. Bacterial meningitis or other CNS infection
• C. Migraine
• D. Meningitis due to fungal infection

Answer: (B)

A fever with irritability and a bulging fontanelle in a young child points to possible meningitis, an infection of the membranes around the brain. The bulging fontanelle indicates increased pressure in the skull, which can occur with meningitis or other CNS infections. Because bacterial meningitis can progress rapidly and cause serious harm, the immediate priority is to evaluate for and rule out bacterial meningitis or other CNS infection and begin appropriate workup and treatment right away. Viral meningitis is possible but usually less severe, while fungal meningitis is much less common in healthy children. Migraines are unlikely in this age group and don’t explain the fever and bulging fontanelle.