From the Guidelines
Meningitis signs include fever, headache, neck stiffness, photophobia, phonophobia, altered mental status, nausea, vomiting, and sometimes a rash, particularly in meningococcal meningitis, and prompt recognition of these signs is crucial as meningitis is a medical emergency requiring immediate medical attention. The clinical features of meningitis can vary, and the classic triad of fever, neck stiffness, and altered mental status is present in less than 50% of cases 1. In adults, the most common signs and symptoms at admission are headache, fever, neck stiffness, and altered mental status 1. A petechial rash is identified in 20-52% of patients and is indicative of meningococcal infection in over 90% of patients 1.
Key Signs and Symptoms
- Fever
- Headache
- Neck stiffness (nuchal rigidity)
- Photophobia (sensitivity to light)
- Phonophobia (sensitivity to sound)
- Altered mental status
- Nausea
- Vomiting
- Rash (particularly in meningococcal meningitis)
Special Considerations
- In infants, signs may be more subtle and include irritability, poor feeding, lethargy, and a bulging fontanelle
- Kernig's sign and Brudzinski's sign may be positive in older children and adults, but have low diagnostic accuracy for prediction of cerebrospinal fluid (CSF) pleocytosis 1
- Age can be an indicator of the likely causative agent, with Listeria or pneumococcal disease more common in older people, and meningococcal infection more common in adolescents and young adults 1
From the Research
Meningitis Signs and Symptoms
- The signs and symptoms of meningitis can vary in severity from benign and self-limited to life-threatening with potentially severe morbidity 2
- Bacterial meningitis is a medical emergency that requires prompt recognition and treatment, with mortality remaining high despite the introduction of vaccinations for common pathogens 2
- Aseptic meningitis is the most common form of meningitis, with an annual incidence of 7.6 per 100,000 adults, and most cases are viral and require supportive care 2
Diagnosis of Meningitis
- Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis due to variable sensitivity and specificity 2
- The diagnosis of meningitis relies on the examination of cerebrospinal fluid obtained from lumbar puncture, as clinical findings are also unreliable 2, 3
- Delayed initiation of antibiotics can worsen mortality, and treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis 2, 3
Treatment of Meningitis
- Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors 2, 3
- Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics 2, 3
- Vaccination against the most common pathogens that cause bacterial meningitis is recommended, and chemoprophylaxis of close contacts is helpful in preventing additional infections 2
- Ceftriaxone and cefotaxime are both effective in the treatment of bacterial meningitis, with ceftriaxone offering an advantage in case of administration since it is administered as a single daily dose 4, 5