Bacterial Meningitis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate bacterial meningitis (bacterial meningitis):

Leading symptoms

  • Severe headache (> 5 on the visual analog scale (VAS); approximately 90% of cases).
  • Septic fever (> 38.5 °C; 50-90% of cases)
  • Meningismus (painful neck stiffness) (about 80% of cases; need not occur in children, unlike adults) [late symptom].
  • Impaired consciousness ranging from lethargy (lack of drive), somnolence (drowsiness with abnormal sleepiness while maintaining responsiveness and arousability) to coma (about 75% of cases) [late symptom]

Notice:

  • Triad of fever, meningismus and impaired consciousness occurs in less than half of all patients with bacterial meningitis!
  • In immunosuppressed patients, fever and/or headache may be absent – often acute disturbance of consciousness is the only leading symptom.

Associated symptoms

  • General feeling of illness
  • Vertigo (dizziness)
  • Irritability
  • Confusion
  • Nausea/vomiting (as a sign of increased intracranial pressure/brain pressure).
  • Photophobia (photophobia)
  • Skin lesions
    • Diffuse erythematous maculopapular exanthema – rash with small papules.
    • Petechiae (flea-like bleeding; due to disseminated intravascular coagulopathy/blood clotting disorder (DIC)) (about 25% of cases)
  • Focal neurological symptoms, such as.

    • Cranial nerve and limb paresis (paralysis) or
    • Aphasia (Greek ἀφασία aphasía “speechlessness”).
  • Epileptic seizures

Other indications

  • Boys are more likely to complain of headaches, girls are more likely to have seizures
  • Older children were more likely to be sensitive to light and pain
  • Tuberculous meningitis: early stage of the disease rather nonspecific; very slow progression with subacute disease course:
    • Fever, loss of appetite, headache, vomiting, photophobia (photophobia; sensitivity to light).
    • Clinical signs: Meningismus (painful neck stiffness), coma, cranial nerve palsy, confusion, hemiparesis (hemiplegia/paraparesis (incomplete paralysis of both legs), epileptic seizures/convulsions (50% in children; 5% in adults).