Bacterial meningitis history and symptoms

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Pathophysiology

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Differentiating Meningitis from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

History

  • Help differentiate bactrial from other causes of meningitis
  • Acute presentation vs chronic or subacute presentation
  • Acute within 24 hours
  • Subacute or chronic-1-7 days-viral or fungal
  • Age of patient help determine the causative agent
  • Detailed history of risk factors
  • History of exposure
  • History of immunosuppression
  • History of concomittant sinusitis and otitis media- Strept pneumoniae
  • Intake of unpasterurized milk and cheese-Listria monocytogenes
  • Recent trauma or intracranial surgery

Symptoms

Common symptoms

The common symptoms of acute bacterial meningitis may include fever, neck stiffness and headache. However, this classic triad may not be present in all patients with bacterial meningitis and patients may present with variable symptomatology[1][2][3][4][5]

  • Fever
  • Headache-87%
  • Stiffness of neck-83%
  • Altered mental status

Other symptoms

Other symptoms besides fever, neck stiffness and headache which may present in patients suffering from meningitis may include the following symptoms in adults and infants:[5][6][7][8][9][10]
Adults

Infants

  • Swelling of the fontanelle (soft spot) may be present in infants (0-6 months).
  • High pitch crying
  • Hypothermia
  • Vomiting
  • Lethargy
  • Difficulty breathing

References

  1. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004). "Clinical features and prognostic factors in adults with bacterial meningitis". N. Engl. J. Med. 351 (18): 1849–59. doi:10.1056/NEJMoa040845. PMID 15509818.
  2. Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
  3. Domingo P, Mancebo J, Blanch L, Net A, Nolla J (1988). "Fever in adult patients with acute bacterial meningitis". J Infect Dis. 158 (2): 496. PMID 3403999.
  4. Thomas KE, Hasbun R, Jekel J, Quagliarello VJ (2002). "The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis". Clin Infect Dis. 35 (1): 46–52. doi:10.1086/340979. PMID 12060874.
  5. 5.0 5.1 Chotpitayasunondh T (1994). "Bacterial meningitis in children: etiology and clinical features, an 11-year review of 618 cases". Southeast Asian J Trop Med Public Health. 25 (1): 107–15. PMID 7824999.
  6. Rothrock SG, Green SM, Wren J, Letai D, Daniel-Underwood L, Pillar E (1992). "Pediatric bacterial meningitis: is prior antibiotic therapy associated with an altered clinical presentation?". Ann Emerg Med. 21 (2): 146–52. PMID 1739200.
  7. Chang CJ, Chang WN, Huang LT, Huang SC, Chang YC, Hung PL; et al. (2004). "Bacterial meningitis in infants: the epidemiology, clinical features, and prognostic factors". Brain Dev. 26 (3): 168–75. doi:10.1016/S0387-7604(03)00122-0. PMID 15030905.
  8. Oliver LG, Harwood-Nuss AL (1993). "Bacterial meningitis in infants and children: a review". J Emerg Med. 11 (5): 555–64. PMID 8308235 : 8308235 Check |pmid= value (help).
  9. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J (2006). "Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series". Lancet Neurol. 5 (2): 123–9. doi:10.1016/S1474-4422(05)70288-X. PMID 16426988.
  10. McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T (2017). "Acute bacterial meningitis in adults". Lancet. 388 (10063): 3036–3047. doi:10.1016/S0140-6736(16)30654-7. PMID 27265346.


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