Bacterial meningitis history and symptoms

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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]

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

Other symptoms

Adults

Photophobia (inability to tolerate bright light)
Phonophobia (inability to tolerate loud noises)
Irritability
Altered mental status (in small children)
Seizures (in 20-40% of cases)
Vomiting may be present.
Nausea
Increased sleepiness
Anorexia

Infants

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

References

↑ 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.
↑ 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.
↑ 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.
↑ 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.

Template:WikiDoc Sources

[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.

[pmid8416268-2] 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.

[pmid3403999-3] 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.

[pmid12060874-4] 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.

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