Common symptoms

Usually, at the beginning of a purulent (bacterial) meningitis, a slight increase in temperature can be observed, which is accompanied by other symptoms such as fatigue and tiredness. In most cases, this phase is followed by a rapid increase in fever of up to 40°C as soon as the meningitis is fully developed. The fever remains constant in many cases, although cases with a fluctuating fever curve have also been described.

In rare cases, the body temperature continues to rise and reaches values above 42°C, at which one must assume an acute danger to life (septic fever). With tuberculous meningitis, on the other hand, a slower rise in body temperature is usually observed, which also rises to values above 39°C within a week. Headaches are usually the first symptom of meningitis, along with general fatigue and exhaustion.

Together with fever and stiff neck, they are among the leading symptoms of bacterial meningitis. Although headaches increase only slowly at the beginning, in the course of the disease, severe headaches are often reported, which are caused by irritation of the meninges. In babies, it is often difficult to diagnose meningitis at an early stage, as symptoms such as headaches are only noticeable by loud crying and are far less specific than in adults.

In the early stages of meningitis, patients often report flu-like symptoms accompanied by severe nausea and vomiting. These symptoms are very unspecific, but in combination with severe headaches and neck stiffness, they may already indicate the diagnosis of meningitis. Meningitis often presents itself in the early stages with increasing sensitivity to light (photophobia).

This can make the already existing headaches even worse. The reason for this is that meningitis often spreads to the conjunctiva and causes conjunctivitis. However, this symptom is not specific to meningitis and can also be caused by other conditions such as migraine.

Neck stiffness is one of the first, but also one of the most specific signs of meningitis.It is accompanied by a pain-related inhibition of passive flexion of the head and can be so strong that one speaks of opisthotonus, which is accompanied by a strong backward inclination of the head and an extreme extension of the trunk. The reason for this phenomenon is that the meninges, which also run in the spinal cord, shorten during an inflammation and therefore a normal head position is already painful, as this causes tension in the irritated meninges. Neck stiffness is one of the symptoms that can usually distinguish meningitis from a severe migraine.

Nevertheless, further diagnostics are of course carried out. If the neck stiffness occurs in combination with fever and severe headaches, a visit to a doctor is highly recommended, as early diagnosis and therapy of meningitis are very important. Back pain often occurs as a result of meningitis and the associated severe irritation of the meninges.

They are often described as a consequence of tuberculous meningitis. The back pain can continue for several days even after successful therapy. In about one third of all cases, epilepsy occurs in addition to the symptoms already described.

This can be limited to one area (focal) or spread from there to other areas of the brain (secondary generalized). The symptoms of epilepsy depend on the region of the brain in which it spreads, but usually a cramping of the extremities, twitching and unconsciousness are observed. Meningitis often results in migraine-like dizziness, which further aggravates the pre-existing headaches and nausea.

This is caused by an irritation of the cranial nerves responsible for the sense of balance (vestibular nerve). Rashes can often occur in meningitis. This is particularly the case with bacteria, such as meningococci, which have a systemic effect, i.e. are distributed throughout the body. The full manifestation of this disease is called Waterhouse Friedrichsen syndrome. Furthermore, sometimes small bleedings in the skin, so-called petechiae, can be observed, which can give a first hint to the pathogen of the disease.