Do you have any of these?
Meningitis usually presents with one or more of the following symptoms.
* High fever, sometimes with chills
* Severe headache
* Nausea or vomiting
* Light sensitivity (photophobia)
* Sound sensitivity
* Neurological signs such as drowsiness or confusion
* Twitching
* Sleepiness
* Opisthotonus
* Irritability
* Sore throat
* Delirium (particularly in children[1])
* Seizures (occurs in about 20 to 40 percent of patients).
* Nuchal rigidity (stiff neck, occurs in less than 50 percent of cases, but if seen, it is considered pathognomonic).
* Swelling of fontanelle (soft spot) in infants.
One large prospective study demonstrated that the classic triad of nuchal rigidity, fever, and mental status change was present in only 44 percent of confirmed cases of community acquired bacterial meningitis.[2] Headache was the most common reported symptom (87 percent) followed by neck stiffness (83 percent).
Nuchal rigidity is typically assessed with the patient lying supine, and both hips and knees flexed. If pain is elicited when the knees are passively extended (Kernig's sign), this indicates nuchal rigidity and meningitis. In infants, forward flexion of the neck may cause involuntary knee and hip flexion (Brudzinski's sign). Although commonly tested, the sensitivity and specificity of Kernig's and Brudzinski's tests are uncertain.[3]
Neck stiffness may prevent the head from bending forwards. If the child can touch the chest with the chin by bending the head forwards the physical sign of neck stiffness is probably not present. Neck stiffness in a child with a fever is a medical emergency.
In "meningococcal" meningitis (i.e. meningitis caused by the bacteria Neisseria meningitidis), a rapidly-spreading petechial rash is typical, and may precede other symptoms. The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet.
Symptoms in infants under 12 months include high fever, fretfulness, irritability - particularly when handled, difficulty awakening, drowsiness, difficulty feeding, and/or a stiff neck, or bulging fontanelle (soft spot on top of head).
In a recent validation study published in the Journal of the American Medical Association (JAMA), a Bacterial Meningitis Score in children over the age of 2 months with at least 1 risk factor (positive CSF Gram Stain, CSF absolute neutrophil count ≥ 1000 cell/µL, CSF protein ≥ 80 mg/dL, peripheral blood absolute neutrophil count ≥ 10,000 cell/µL, history of seizure before or at presentation time) has a sensitivity of 100% (95% CI, 96.9%-100%), specificity of 63.5% (95% CI, 61.4%-65.6%), and negative predictive value of 100% (95% CI, 99.8%-100%) in predicting bacterial meningitis based on data collected from 20 academic medical centers as part of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.[4] |
|
