What are the early signs of meningitis?
Headache: Headache is one of the earliest symptoms of acute meningitis. Patients describe it as severe, persistent, and different than usual. Headache in meningitis patients is a key sign of compression, meaning that the nerves, arteries, veins, and other structures inside the skull are under high pressure from the inflammation. It’s usually associated with blurred vision and changes in consciousness and not relieved by usual analgesics.
Fever: High-grade fever (>103°F – 39.4°C) is characteristic. In infants and young children, it may result in febrile seizures and transient loss of consciousness.
Vomiting: Projectile vomiting in meningitis is also a sign of compression. The patient propels the stomach contents far away in severe violent bursts without the usual sense of nausea usually experienced prior to the other types of vomiting.
Confusion: Unexplained confusion associated with loss of concentration and disorientation to time, place, or persons. In neonates and infants, its seen as inactivity or sluggishness.
Stiff neck: This specific sign usually appears early. The patient cannot flex the neck forward all the way, possibly due to neck muscle spasm to avoid painful stretching of the spinal cord meninges within the spine.
Sleepiness: Unexplained sleepiness or inability to wake up is usually reported, especially in neonates and young infants.
Photophobia or photosensitivity (Dislike of bright lights): This is manifested by favoring dim light and covering the eyes in bright sunlight. Infected babies may sleep prone (lying on the abdomen) to avoid bright lights. However, this sign is not as common in young children.
Skin rash: It starts as small, red spots before spreading quickly and turning into red or purple blotches. It is a sign of meningococcal septicemia (bacterial spread in the bloodstream). The rash is easier to see in the palms of hands, the soles of feet, the roof of the mouth, and inside the eyelids.
The tumbler test is a simple method to confirm the meningococcal septicemic rash if you suspect the condition. Applying a glass tumbler firmly against the rash and observing the rash through it. If it is a meningococcal septicemic rash, it will appear clearly.
Seizures: Seizures occur as an early sign in 20% of infected children either from the brain swelling or the bacterial toxins. They may be persistent and need urgent management. Several studies reported the association of poor outcomes of meningitis in adults and seizures.
Anticonvulsant therapy may be needed to prevent their recurrence.