Most patients present with multiple symptoms. The most common symptoms of meningitis are fever, headache, neck stiffness and altered mental status. Other symptoms include nausea, vomiting, photophobia, confusion and irritability (exhibited by uncontrolled cry in children).

Signs elicited include bulging anterior fontanelle in children less than 18 months. Signs of meningeal irritation, focal neurological signs and some systemic findings are also present.

• Fever

  fever, neck stiffness, and altered mental status. [ncbi.nlm.nih.gov]

  Cases without fever, with increased CSF gamma globulin and transient neurological signs and symptoms, have been reported. [emedicine.medscape.com]

  Clinical manifestations include fever; nuchal rigidity; photophobia; seizures; hearing loss, sensorineural; coma; and cerebrovascular thrombosis. [icd9data.com]

• High Fever

  An infant presented to our hospital with high fever and irritability, as well as refusal to walk. Cerebrospinal fluid collected through lumbar puncture showed increased eosinophil count and third-stage Angiostrongylus cantonensis larvae. [ncbi.nlm.nih.gov]

  He had a chesty cough and runny nose for a week and developed a high fever two days before he was rushed to the hospital. He became cranky and less active, cried a lot and refused to drink milk. [thestar.com.my]

  […] are symptoms to look for in children: Irritability Vomiting from a high fever Frequent crying Swelling of the head Lack of appetite Seizures (sometimes also seen in adults if the meningitis is advanced) Symptoms typically come on quickly, in as little [columbianeurology.org]

  You should get medical care right away if you have A sudden high fever A severe headache A stiff neck Nausea or vomiting Early treatment can help prevent serious problems, including death. [medlineplus.gov]

• Fatigue

  […] left with one of more permanent problems and suffer physical, neurological and physiological after-effects Viral meningitis is usually less serious than bacterial meningitis but can still leave people with long-lasting after-effects, such as headaches, fatigue [meningitisnow.org]

  Symptoms may include: Headache Sensitivity to light ( photophobia ) Slight fever Upset stomach and diarrhea Fatigue Bacterial meningitis is an emergency. You will need immediate treatment in a hospital. [nlm.nih.gov]

  Symptoms may include: Headache Sensitivity to light (photophobia) Slight fever Upset stomach and diarrhea Fatigue Bacterial meningitis is an emergency. You will need immediate treatment in a hospital. [medlineplus.gov]

  The symptoms may include fever, headache, stiff neck and fatigue. Rash, sore throat and intestinal symptoms may also occur. How soon do symptoms appear? Symptoms generally appear within one week of exposure. [health.ny.gov]

• Malaise

  Coxsackieviruses) or a more severe usually life-threatening illness caused by a bacterium (especially the meningococcus, Neisseria meningitides, or the serotype designated B of Haemophilus influenzae) Note: Meningitis is often marked by fever, headache, vomiting, malaise [merriam-webster.com]

  Common side-effects are minor and include fever; pain or redness around the injection site; fatigue and malaise; irritability. Very rarely, an allergic response to the vaccine may occur, leading to anaphylaxis or a rash. [victoria.ac.nz]

  In the acute form, brucellosis takes the form of a flulike illness, with fever, sweats, malaise, anorexia, headache, myalgia, and back pain. [emedicine.medscape.com]

  The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias [ncbi.nlm.nih.gov]

• Unconsciousness

  Older children may also: have a stiff neck have a headache have joint pain and aching muscles not like bright lights be drowsy, confused, delirious or unconscious. All children may have fits or convulsions. [plunket.org.nz]

  The man in his 20s was found positive for the coronavirus on March 7 and is unconscious with a fever, pneumonia and meningitis, Yamanashi Prefecture and public broadcaster NHK said. [japantoday.com]

  The man in his 20s was found positive for the coronavirus on March 7 and is unconscious with a fever, pneumonia and meningitis, Yamanashi prefecture and public broadcaster NHK said. [straitstimes.com]

  Image copyright Matthew Griffin Image caption Matthew said he was supported by girlfriend Xiola Johnson, who sat for hours with him in intensive care while he was unconscious He advised students look into the MenACWY vaccine, which can protect against [bbc.com]

  Severe life threatening situations should be managed first by rehydrating patients who are in shock and are hypovolemic, managing seizures and securing the airway if unconscious. [symptoma.com]

• Vomiting

  After 2 months of the illness, he was admitted to our hospital with a persistent headache, vomiting and altered sensorium. CSF for cytospin confirmed myeloid blasts. He was still in haematological remission. [ncbi.nlm.nih.gov]

  Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]

  Typical signs and symptoms include severe headache, nuchal rigidity, fever, altered mental status, photophobia, phonophobia or vomiting. Most patients present with multiple symptoms. [symptoma.com]

  Common signs & symptoms of meningitis and septicaemia Fever, cold hands and feet Vomiting Drowsy, difficult to wake Confusion and irritability Severe muscle pain Pale, blotchy skin. [meningitisnow.org]

• Nausea

  Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]

  Fourteen days later, the patient presented to the emergency department with fever and nausea. HIV test was negative. Ruxolitinib was suspended. Symptoms progressed with neck stiffness, cognitive impairment, and motor aphasia. [ncbi.nlm.nih.gov]

  Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. [symptoma.com]

  Data Synthesis Individual items of the clinical history have low accuracy for the diagnosis of meningitis in adults (pooled sensitivity for headache, 50% [95% confidence interval {CI}, 32%-68%]; for nausea/vomiting, 30% [95% CI, 22%-38%]). [oadoi.org]

• Loss of Appetite

  Symptoms Arching of the back (infants) Behavioural changes Blank, staring expression Bulging fontanelle (infants) Cold hands and feet Diarrhoea Dislike of being handled (infants) Drowsy or difficult to wake Fever Irritability Listless, less responsive Loss [meningitis.com.au]

  The most common symptoms of meningitis are fever, headache, vomiting, loss of appetite, tiredness, drowsiness or altered consciousness, irritability, stiff neck and sensitivity to light. Some people with meningitis can have seizures. [healthdirect.gov.au]

  Symptoms can include fatigue, nausea, loss of appetite, and yellowing of the skin. [carthage.edu]

  Common symptoms are: High fever Irritability Lethargy and drowsiness Vomiting and loss of appetite Headache. [schn.health.nsw.gov.au]

• Tachycardia

  Some factors have however been identified that could worsen the prognosis and they include: Advanced age Low Glasgow Coma Scale Tachycardia Reduced CSF leucocyte count Presence of gram-positive cocci on gram staining Late intervention in bacterial meningitis [symptoma.com]

  Immediate resuscitation if required Clinical signs of shock or hypovolaemia are hypotension, poor peripheral perfusion, cool pale extremities, tachycardia with low volume pulses, high blood lactate or large base deficit. [rch.org.au]

  However, in children with MD and severe tachycardia (possibly requiring further fluid resuscitation) the chronotropic effect of dobutamine can lead to unacceptable tachycardia and further hemodynamic instability. [scielo.br]

  Shock: signs of shock include tachycardia and/or hypotension, respiratory distress, altered mental state and poor urine output. Kernig's sign (pain and resistance on passive knee extension with hips fully flexed). [patient.info]

• Petechiae

  Fever Irritability Listless, less responsive Loss of appetite, refusing food (infants) Muscle, leg or joint pain Neck retraction with arching of the back (infants) Pale or blotchy skin Rash or spots that don’t fade with pressure (also called purpure or petechiae [meningitis.com.au]

  When a patient presents with fever and petechiae, WFS must be considered, even when the patient has a non-toxic appearance. [ncbi.nlm.nih.gov]

  Twenty six patients had cerebrospinal fluid pleocytosis plus positive meningococcal blood cultures or petechiae, and 14 children who did not undergo lumbar puncture had meningism and evidence of meningococcal disease. [doi.org]

• Eruptions

  /or headaches anorexia nuchal rigidity (often not present, especially in young children and infants) positive Kernig’s or Brudzinski’s sign altered mental status shock seizures focal neurological deficit petechial rash (an erythematous maculopapular eruption [childrens.health.qld.gov.au]

  Migration in subcutaneous tissues induces a linear dermatitis with light to moderate pruritus, usually localized to the abdomen and later in multiple skin areas, known as creeping eruption or CLM. [doi.org]

• Hearing Impairment

  Our findings suggest that S. suis infection should be considered when hearing impairment is present in a patient with bacterial infection and that MRI can help detect ventriculitis, which can necessitate a prolonged treatment duration. [ncbi.nlm.nih.gov]

  Whenever possible, brainstem responses were also measured earlier to confirm hearing impairments detected by OAEs. [doi.org]

• Hearing Problem

  There are some possible after-effects of meningitis, which may include: general tiredness frequent headaches difficulty in concentration and short-term memory lapses clumsiness or problems with balance hearing problems mood swings. [rch.org.au]

  However, long-term complications can include: headaches learning problems memory loss hearing problems speech problems vision problems weakness or paralysis seizures scarring or skin damage kidney damage Some types of meningitis can pass from person to [medicalnewstoday.com]

  Steroid medication has been shown in some studies to reduce the risk of developing hearing problems and other complications. Viral meningitis Antibiotics may be given at first when the cause of the meningitis is not known. [patient.info]

• Myalgia

  In the acute form, brucellosis takes the form of a flulike illness, with fever, sweats, malaise, anorexia, headache, myalgia, and back pain. [emedicine.medscape.com]

  The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias [ncbi.nlm.nih.gov]

  […] neck is flexed) Difficulty touching the chin to the chest with the mouth closed Difficulty touching the forehead or chin to the knee Nuchal rigidity can be distinguished from neck stiffness due to cervical spine osteoarthritis or influenza with severe myalgia [merckmanuals.com]

  Symptoms and Signs Viral meningitis, like acute bacterial meningitis, usually begins with symptoms that suggest viral infection (eg, fever, myalgias, gastrointestinal or respiratory symptoms), followed by symptoms and signs of meningitis (headache, fever [msdmanuals.com]

  Other findings less frequently reported included rash, arthralgias, myalgias, facial edema, and lymph node or liver test abnormalities, which can also occur in infectious meningitis, mainly of viral origin, with variable frequency. [doi.org]

• Neck Pain

  The key to meningitis is the neck pain and stiffness. So if your child has severe neck pain and stiffness, and one or more of the other four symptoms, call your doctor to be seen right away, or page the doctor after hours. [askdrsears.com]

  See How Neck Pain and Headache Can Occur Together Stiff neck. This symptom most commonly involves a reduced ability to flex the neck forward, also called nuchal rigidity. [spine-health.com]

  METHODS :A 43-year-old male patient presented with 'neck pain for 15 days, exacerbated accompanying motor and sensory dysfunction of lower limbs with bowel and bladder dysfunction for 4 days' was admitted to our department. [paper.medlive.cn]

  Neck pain and stiffness are common symptoms of meningitis. It can sometimes cause the head, neck, and spine to become rigid and arch backwards (opisthotonos). This is more likely to happen to infants and young children. [healthline.com]

  See also[edit] Neck pain Acquired torticollis References[edit] "Neck pain". MedlinePlus. National Institutes of Health. 5 March 2015. Retrieved 27 October 2015. "Neck pain and stiff neck". NHS Choices. National Health Service. 10 December 2014. [en.wikipedia.org]

• Low Back Pain

  In 2012, fungal meningitis was linked to a contamination in a specific steroid product, methylprednisolone, manufactured in a single pharmacy and injected in the spine of people suffering from low back pain. [emedicinehealth.com]

  Herein, we report a 62-year-old man with a 4-wk history of progressive low back pain with radiation to bilateral lower legs, dysphagia and body weight loss. [science.gov]

• Photophobia

  Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]

  Clinical manifestations include fever; nuchal rigidity; photophobia; seizures; hearing loss, sensorineural; coma; and cerebrovascular thrombosis. [icd9data.com]

  Neck stiffness and photophobia are often absent in infants and young children who may manifest nonspecific signs such as irritability, inconsolable crying, poor feeding, and a bulging fontanel. [orpha.net]

  Typical signs and symptoms include severe headache, nuchal rigidity, fever, altered mental status, photophobia, phonophobia or vomiting. Most patients present with multiple symptoms. [symptoma.com]

  Patient 2 A 32 year old woman presented with a three day history of headache, fever, and photophobia. She had perianal tenderness, and her boyfriend had noticed a rash. On examination, unilateral herpetic lesions were seen (fig 2 ). [ncbi.nlm.nih.gov]

• Diplopia

  […] et al, 2018 A 56-year-old woman with acute vertigo and diplopia Neurol 90:748-752, Sharma, R.,et al, 2018 A 30-year-old man with headache and sleep disturbance Neurol 90:e1535-e1540, English, S.W. [neudle.com]

  These episodes resolve spontaneously and are followed by symptom-free periods of weeks to months Transient neurological abnormalities, including seizures, diplopia, pathologic reflexes, cranial nerve pareses, hallucinations, and coma, occur in as many [emedicine.medscape.com]

  Approximately one-half of patients have transient neurological manifestations, including seizures, hallucinations, diplopia, cranial nerve palsies, or altered levels of consciousness. [web.archive.org]

  Four months later, he complained of headache, diplopia and severe hearing impairment in the left ear. There was no evidence for bacterial, fungal, tuberculous infection or neoplastic infiltration. [science.gov]

  Diplopia With Dural Fibrotic Thickening. Seminars in Pediatric Neurology, Vol. 26, Issue., p. 83. [cambridge.org]

• Eye Pain

  Symptoms of meningitis Meningitis is commonly manifested by: severe headache vomiting high fever stiffness of the neck sensitivity and eye pain on exposure to light skin rash Symptoms can differ in young children and babies. [news-medical.net]

  Symptoms may include: a very bad headache that won't go away neck stiffness back stiffness eye pain when exposed to light nausea, or being sick to the stomach vomiting, or throwing up body aches fever feeling very sleepy or unable to fully wake up feeling [brennerchildrens.org]

  Eye sensitivity and eye pain from bright lights. Dark purple and blotchy skin rash. Dizzy spells. Babies, young children, older adults, and people with other medical conditions may not have the usual symptoms of meningitis. [healthy.kaiserpermanente.org]

  pain, blurry vision, associated with nausea and vomiting. [en.wikipedia.org]

• Meningism

  Viral Meningitis Meningitis caused by viruses is serious but often is less severe than bacterial meningitis. People with normal immune systems who get viral meningitis usually get better on their own. [cdc.gov]

  Meningitis Angels Non-profit organisation supporting families affected by bacterial meningitis. [curlie.org]

  Diagnostic accuracy of meningeal signs in patients with more-severe meningiti. [dx.doi.org]

• Headache

  […] the first description of post-LP headache. 6 Headache and backache are the most frequently reported adverse events associated with LP. [doi.org]

  Reinsertion of the stylet before needle removal decreased the risk of headache (ARR, 11.3%; 95% CI, 6.50%-16.2%). [ncbi.nlm.nih.gov]

• Seizure

  We report a rare case of large frontal sinus osteoma with intracranial extension, associated with meningitis and the development of seizures. [ncbi.nlm.nih.gov]

  Clinical manifestations include fever; nuchal rigidity; photophobia; seizures; hearing loss, sensorineural; coma; and cerebrovascular thrombosis. [icd9data.com]

  Less frequent presentations of CNS tuberculosis include atypical febrile seizures in children, isolated cranial nerve palsies, bilateral papilledema, and acute confusional states. [emedicine.medscape.com]

  Seizures: occur more commonly during the acute stage of the disease. [patient.info]

• Confusion

  Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. [symptoma.com]

  Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]

  CASE SUMMARY: We discuss the case of a 56-year-old white man with a history of rheumatoid arthritis and hypertension who became confused, nauseated, and began to vomit within 2 hours of the ingestion of ibuprofen. [ncbi.nlm.nih.gov]

  Symptoms: Severe headache Stiff neck Dislike of bright lights Fever Throwing up repeatedly Severe sleepiness or confusion Rash Remember: Not everyone gets all these symptoms. They can occur in any order. [services.su.nuigalway.ie]

• Irritability

  An infant presented to our hospital with high fever and irritability, as well as refusal to walk. Cerebrospinal fluid collected through lumbar puncture showed increased eosinophil count and third-stage Angiostrongylus cantonensis larvae. [ncbi.nlm.nih.gov]

  Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. [symptoma.com]

  Meningitis may also be caused by: Chemical irritation Drug allergies Fungi Parasites Tumors Many types of viruses can cause meningitis: Enteroviruses: These are viruses that also can cause intestinal illness. [nlm.nih.gov]

Laboratory tests

• Blood studies like serum electrolytes, serum glucose and blood urea nitrogen.
• Cultures like blood and urine culture.
• Lumbar puncture for CSF analysis [5] – Intracranial pressure should be checked before this procedure to avoid cerebral herniation. Focal neurological signs might suggest herniation.
• Syphilis testing
• HIV screening

Imaging

CT scan is not routinely done but may be required when then are signs of focal neurological deficit.

This involves treating the active infection and managing complications. The medication used is dependent on the type of meningitis. Severe life threatening situations should be managed first by rehydrating patients who are in shock and are hypovolemic, managing seizures and securing the airway if unconscious. Medications that are used are dependent on a wide range of variable like causative organism, age of patient and complications. Such medication may include:

• Antibiotics: Sulfonamides, tetracyclines, carbapenems, fluoroquinolones, penicilins, cephalosporins.
• Antivirals
• Antifungals
• Antituberculosis agents
• Corticosteroids [6]
• Diuretics like osmotic and loop diuretics
• Anticonvulsants like hydantoins and barbiturates

Meningitis is a medical emergency and if treated early, some patients can attain full remission. Some factors have however been identified that could worsen the prognosis and they include:

• Advanced age
• Low Glasgow Coma Scale
• Tachycardia
• Reduced CSF leucocyte count
• Presence of gram-positive cocci on gram staining

Late intervention in bacterial meningitis could lead to permanent brain damage or death. 50% of survivors develop complications like deafness [3], blindness, cranial nerve palsy and hydrocephalus amongst others.

Meningitis is caused by a number of agents including:

• Bacteria: This is the commonest cause and agents include H. influenza, S. pneumonia and N. meningitidis.
• Viruses: Some viruses that can cause meningitis are enterovirus and West Nile virus.
• Parasites: This is a very rare cause of meningitis and is fatal in most cases [4].
• Fungi: This is usually as a result of background immunosuppression and some of the organisms implicated are C. neoformans
• Drugs: NSAIDs, IV immunoglobulin and metronidazole.

There are some risk factors that make an individual more susceptible to some particular pathogens, like age and immune status.

The incidence of meningitis is higher in developing countries because of the poor health sectors which is highlighted by the limited availability of preventive measures like vaccination. The incidence is also dependent on the type of meningitis.

Most meningitis forms affects the extremes of age. Children are particular susceptible to many forms of meningitis [2]. Neonates have the highest risk. Individuals older than 60 years are also at increased risk for meningitis infection.

Sex distribution is equal for most forms of meningitis, although overall, it is slightly more common in males. Meningitis is more common in blacks than in Caucasians and Asians. A particular form, meningococcal meningitis, is endemic in tropical regions alike sub-Saharan Africa and India, and there have been recorded periodic outbreak of epidemics.

Pathogens that cause meningitis can get to the meninges in three major ways:

• Through the blood stream which is the most common route of spread for most pathogens.
• Through a retrograde neuronal pathway.
• Through local contiguous spread.

The first event is invasion of the meninges by the pathogens. The exact method of how they cross the blood-brain barrier is poorly documented but it is usually preceded by an overwhelming sepsis. This triggers an inflammatory response and inflammatory cells cross the now porous blood-brain barrier to enter the brain. There is then predominance of lymphocytes or neutrophils based on the pathogen responsible. This process further worsens the condition as it leads to brain swelling and then ischemia of parts of the brain [1]. The inflammatory cells increased the membrane permeability and alter normal chemical contents of the cerebrospinal fluid like glucose and protein.

The mainstay of prevention of meningitis is vaccination [7]. Vaccination should be given to individuals who are susceptible to H. influenza and S. pneumonia. Also, individuals who live in and those who travel to endemic areas should be vaccinated against N. meningitidis. Researchers who work with the bacteria should also be vaccinated against it.

Chemoprophylaxis is a second form of prevention and is usually reserved for individuals who have had prior exposure to H. influenza, S. pneumonia and N. meningitidis. Rifampin is the drug of choice. Ceftriaxone can also be used.

Meningitis is defined as inflammation of the meninges. The meninges are the three layers of membrane that enclose the brain and spinal cord. Meningitis is a disease of the membranes covering the brain. It is often an infectious disease with bacteria being the commonest cause. It manifests via a myriad of CNS symptoms and could result in permanent disability or death. Meningitis is a medical emergency.

Definition

Meningitis is an infection of the layers covering the brain.

Cause

The cause of meningitis are mainly microorganisms although some people at higher risk of meningitis, like very young children and people who are old. People who have an infection is areas close to the brain, like the ear and throat are also at increased risk of getting this disease.

Signs and symptoms

The common symptoms are fever, headache and neck stiffness. Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. Meningitis is an emergency and if any of this symptoms are noted, the individual should be taken to the hospital immediately.

Diagnosis

Diagnosis involves a series of blood tests to check the level of sugar and protein and also to check for infection of the blood. Part of the fluid surrounding the brain, the cerebrospinal fluid is also checked to know the cause of the meningitis. CT scan may also be required.

Treatment

Treatment of meningitis involves mainly, to treating the underlying cause of the disease. Other supportive therapies are instituted as well as treatment of complications that may arise.

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3. Worsøe L, Cayé-Thomasen P, Brandt CT, Thomsen J, Østergaard C. Factors associated with the occurrence of hearing loss after pneumococcal meningitis. Clin Infect Dis. Oct 15 2010;51(8):917-24.
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7. Advisory Committee on Immunization Practices (ACIP). Updated recommendations for use of meningococcal conjugate vaccines. MMWR Morb Mortal Wkly Rep. Jan 28 2011;60(3):72-6.