From the Guidelines
Meningitis is a medical emergency that presents with several key signs, including severe headache, stiff neck, high fever, sensitivity to light, confusion, nausea, and vomiting, and requires immediate attention to prevent life-threatening complications, as indicated by the most recent and highest quality study 1. The symptoms of meningitis often develop rapidly over hours to days, and in infants, signs may include irritability, poor feeding, unusual crying, and a bulging fontanelle (soft spot on the head) 1. Some key points to consider when diagnosing meningitis include:
- The classic triad of fever, neck stiffness, and altered mental status suggests meningitis, though not all symptoms may be present in every case 1.
- Rashes, particularly non-blanching ones that don't fade when pressed, can indicate bacterial meningitis, especially meningococcal infection 1.
- Other symptoms might include seizures, drowsiness, and difficulty waking up 1.
- The inflammation of the meninges (protective membranes covering the brain and spinal cord) causes these symptoms, with bacterial cases typically being more severe than viral ones 1.
- Anyone suspecting meningitis should seek emergency medical care immediately rather than waiting to see if symptoms improve, as prompt antibiotic treatment is crucial to prevent life-threatening complications 1. It is essential to note that the absence of certain clinical findings, such as neck stiffness, Kernig sign, and Brudzinski sign, cannot be used to exclude the possibility of bacterial meningitis, as these signs have low diagnostic accuracy for prediction of cerebrospinal fluid (CSF) pleocytosis 1. Therefore, it is crucial to prioritize the diagnosis and treatment of meningitis based on the most recent and highest quality evidence, and to seek emergency medical care immediately if suspected, to prevent life-threatening complications and improve patient outcomes 1.
From the Research
Signs of Meningitis
The signs of meningitis can vary, but common symptoms include:
- Headache
- Fever
- Neck stiffness
- Severely decreased consciousness
- New onset focal neurological signs
- Epileptic seizures
Clinical Presentation
The clinical presentation of meningitis can be severe and life-threatening, with a high mortality and morbidity rate if left untreated 2, 3, 4, 5. The typical clinical triad of headache, fever, and neck stiffness should alert the clinical practitioner to the possibility of a central nervous system infection 3.
Diagnosis
Diagnosis of meningitis relies on the examination of cerebrospinal fluid obtained from lumbar puncture, as clinical findings are often unreliable 2. A lumbar puncture can be done safely without prior imaging if clinical signs that point to contraindications of a lumbar puncture are absent 5.
Treatment
Treatment of meningitis should be started promptly, with empiric antibiotics directed toward the most likely pathogens and adjusted by patient age and risk factors 2, 5, 6. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics 2, 5. Vaccination against the most common pathogens that cause bacterial meningitis is also recommended 2.