From the Guidelines
Meningitis symptoms include fever, severe headache, stiff neck, sensitivity to light, nausea, vomiting, confusion, and sometimes a rash that doesn't fade when pressed, and anyone experiencing these symptoms, especially in combination, should seek emergency medical care immediately. The symptoms of meningitis can vary depending on the age and immune status of the individual, but common presenting features include fever, headache, neck stiffness, and altered mental status, as identified in large European case series or prospective cohorts 1. According to the ESCMID guideline, these clinical characteristics are present in a significant proportion of patients with bacterial meningitis, although no single clinical sign is present in all patients 1.
The clinical features of meningitis can be similar to those of other conditions, making diagnosis challenging, and the "classic triad" of fever, neck stiffness, and altered mental status is only present in 41-51% of patients 1. A petechial rash is identified in 20-52% of patients and is indicative of meningococcal infection in over 90% of patients 1. The absence of typical symptoms, such as neck stiffness, Kernig sign, and Brudzinski sign, cannot be used to exclude the possibility of bacterial meningitis, as these clinical findings have low diagnostic accuracy for prediction of cerebrospinal fluid (CSF) pleocytosis 1.
Some key points to consider when evaluating symptoms of meningitis include:
- Fever, headache, and neck stiffness are common presenting features, but may not be present in all patients 1
- Altered mental status, such as confusion or altered consciousness, can be a significant symptom, particularly in older adults or those with compromised immune systems 1
- A petechial rash can be indicative of meningococcal infection, but is not always present 1
- The absence of typical symptoms does not rule out the possibility of bacterial meningitis, and further evaluation, including CSF analysis, may be necessary to confirm the diagnosis 1.
In terms of specific symptoms, the following can be associated with meningitis:
- Fever: present in 77-97% of patients 1
- Headache: present in 58-87% of patients 1
- Neck stiffness: present in 65-83% of patients 1
- Nausea and vomiting: present in 45-74% of patients 1
- Altered mental status: present in 54-69% of patients 1
- Rash: present in 20-52% of patients, often petechial in nature 1.
Overall, it is essential to seek emergency medical care immediately if symptoms of meningitis are suspected, as prompt treatment with appropriate antibiotics can significantly improve outcomes and prevent serious complications like brain damage, hearing loss, or death.
From the Research
Symptoms of Meningitis
The symptoms of meningitis can vary, but common signs include:
- Headache, which is typically severe and bilateral 2
- Fever, with 30 patients out of 41 being febrile in one study 2
- Stiff neck, reported in 25 patients out of 41 2
- Nausea and vomiting, experienced by 25 and 23 patients respectively out of 41 2
- Photophobia, or sensitivity to light, reported in 18 patients out of 41 2
- Back pain, experienced by 11 patients out of 41 2
- Altered mental status, with a decreased level of consciousness in 6 patients out of 41 2
- Seizures, although not reported in the provided studies, can also be a symptom of meningitis
Specific Symptoms of Bacterial Meningitis
Bacterial meningitis has a distinct set of symptoms, including:
- Headache, reported in 84% of cases 3
- Fever, reported in 74% of cases 3
- Stiff neck, reported in 74% of cases 3
- Altered mental status, with a median Glasgow Coma Scale score of 11 out of 15 3
- Nausea, reported in 62% of cases 3
Importance of Early Recognition
Early recognition of meningitis symptoms is crucial, as delays in diagnosis and treatment can have severe consequences, including high mortality rates and long-term disability 4, 3, 5