There are many types of infections, and almost every organ in the body can undergo an infectious process. They are more common in the airways, the gastrointestinal tract and the urinary tract because they are in close contact with the outside world, but infections can travel through the bloodstream as well. As they do, bacteria, viruses, and even parasites can relocate to another organ and create serious problems, as it happens in meningitis.
Out of the organs that may become infected throughout the body, an infection in the nervous system is by far one of the most dangerous. It may cause severe health problems and carry long-lasting consequences. Meningitis is more common in susceptible populations, as in the case of infants, the elderly, and immunocompromised patients, which is why it is important to stay alert at the warning signs and symptoms this disease triggers. These are the most important:
Fever
Rising temperatures is the most important sign when it comes to infections, and meningitis is not the exception to the rule. More than 76% of patients with meningitis would have fever, and it is often a low-grade fever as the disease starts (a period called prodromal stage) and more elevated temperature later on, when patients start having other symptoms associated to the nervous system.
In many cases, patients who were previously treated with antibiotics may not have high fever, and their diagnosis might become a bit more difficult. In other cases, patients with immune problems may not have a higher temperature than normal. However, fever stands as one of the element in the classic triad of meningitis, along with vomiting and headache.
Nausea and vomiting
The second most important symptom in meningitis is nausea and vomiting. It is common in more than 35% of patients with meningitis, and it doesn’t matter whether it is viral, microbial or even fungal meningitis, it will be usually associated with a very specific type of vomiting.
Vomiting in meningitis is sometimes called projectile vomiting because it can be very violent and forceful. In susceptible populations, it may also lead to dehydration and malnutrition, aggravating the condition of the patient. It is usually enclosed in the triad of meningitis along with fever and headache, but we don’t need to have all three symptoms to start suspecting this disease.
Headache
Meningitis is the inflammation of the meninges, which is the outer layer of the brain. Thus, headaches should be one of the most common symptoms. Headache in meningitis is often intense, but it may be intermittent in tuberculous meningitis or very mild during the prodromal state and in younger children.
Headache is reported in almost every case of meningitis, but the onset is not abrupt and violent. Instead it is progressive and sustained. An abrupt and severe headache should be assessed by a doctor in the emergency room, as it may be caused by a vascular reason that might be life-threatening in the short term.
Tachycardia and rapid breathing
Patients with meningitis often have tachycardia (an irregularly fast heart rate) and rapid breathing as a result of the inflammatory process in their nervous system. Tachycardia is a symptom related to the heart, but it counts as a meningeal symptom along with headache, fever, and mental changes because it is directly triggered by the brain in the event of acute inflammation.
In the brain there are also centers to control the rate of breathing, which is why it is also common to have rapid breathing or abnormal breathing patterns. We should be very careful to see them, especially in younger children. Sometimes, patients would have a primary respiratory infection and a secondary meningitis, and this aggravates their respiratory symptoms.
Fatigue and changes in mental status
After the initial stage of the disease and when neurological signs start to appear, one of the first things patients report is a change in their energy level. Infants and children become drowsy and lethargic, and adults experience fatigue and muscle weakness. In some cases, these changes may even reach to the point of coma, an alteration in the mental status consisting of a complete loss of consciousness sustained for a long time.
Since the alteration is located in the brain, a change in the mental status is common in meningitis. It is frequent in the elderly, especially after a prolongued fever. Mild cases of drowsiness and lethargy are common in younger patients and 40% of children with meningitis would also have seizures shortly after the onset of the systemic symptoms.
Neck stiffness
One of the most important signs of meningitis is called neck stiffness. It is a contracture of the muscles in the neck area along with muscular pain and often accompanied with headaches. Neck stiffness counts as another meningeal symptom, and it is also known as nuchal rigidity. Even though this symptom is very common, not every patient needs to have neck stiffness to consider meningitis as a possible diagnosis.
For example, neck stiffness is not as common in children as it is in adults, and it is less frequent in meningitis associated with Lyme disease. It is often absent in younger children, even if they have seizures, fever, and other severe symptoms of the disease. In most adults, neck stiffness marks the start of the meningeal symptoms and it is often preceded by 2 days of mild fever as the prodromal state of the disease.
Skin rash
There are various skin manifestations of meningitis, and it often appears as a hemorrhagic skin rash dispersed all over the legs and trunk, palms and soles. Patients with severe rash may also have red spots on their mucous membranes, and even the white portion of the eyes. It is often difficult to recognize when patients have a darker skin tone.
Some cases of meningitis are associated with viral diseases with their own skin manifestations, as it happens with herpes zoster virus, measles, coxsackievirus, and some enteroviruses. All of them may give rise to different patterns of skin rash that should be recognized in each case. In infants, skin rash can be very important to identify many different infections. However, there are extra signs and symptoms that may help parents identify meningitis symptoms, even in infants and very small children.
Light sensibility
This is a common symptom in infants and adults, and it counts as a sign of meningeal involvement. Light sensitivity results from an irritation to the nervous system, and it is a common sign to look for in infants. It is also known as photophobia because children would immediately close their eyes or turn away their gaze when there’s bright light. Adult patients report discomfort maintaining their eyes open and they prefer keeping the curtains shut to reduce sunlight in their room.
Light sensitivity is common in various diseases, and most of them are not serious, For example, it is common in conjunctivitis, contact lent irritation, and sunburn. It is also common in cases of rabies, botulism, and severe cases of detached retina. Therefore, you might need the opinion of a health professional and a complete physical exam to figure out what is happening and what is triggering this problem.
Besides photophobia, some patients may also report something called phonophobia, which is a similar sensitivity to sounds. These patients feel annoyed in the streets and loud places and need to stay away from them to relieve their headache.
Loss of appetite
Poor appetite is a very important symptom to take into consideration in very small children and infants. This is sometimes the only give-out sign that something is wrong, and health professionals take it seriously to investigate where does it come from. It is not only reducing the food intake, but rather a constant lethargy, slow motion and inactivity affecting feeding as well. In time, these symptoms become worrying for parents and may even lead to nutrient deficiency, complicating the disease further.
Adults may also experience loss of appetite, especially those having nausea and severe vomiting. In these patients, it is important to maintain proper nutrition and they may need urgent parenteral feeding and therapy to recover from this ailment. Thus, it is common to have meningitis patients hospitalized for a couple of days until their infection is resolved.
If you have seen severe changes in the pattern of feeding in your infant, report this warning sign to your pediatrician regardless of having additional symptoms or not. This is sometimes caused by a severe infection and your physician will need to perform a series of lab tests and a thorough physical exam to figure out the root cause.
Irritability
Another important symptom in small children and infants is irritability, which is a feeling of continuous agitation or becoming upset easily. Patients with irritability feel frustrated because of their symptoms, and infants often cry a lot and become difficult to control. Irritability is more common in children, and they may not have major symptoms like headache or fever. Instead, they become irritable, with difficulty to concentrate and coordinate their movements.
Irritability and other unspecific neurological symptoms may last for a few days and even weeks in certain cases. In other cases, there’s a classic description of headache with fever and vomiting. Thus, if you find any abnormal behavior in your child, especially severe drowsiness, loss of appetite and irritability, don’t wait one more day to talk to your doctor about these symptoms.
Bulging fontanelle in neonates
Different from grown children, neonates do not have a completely mature skeletal system. There are several areas of the skeleton they will progressively grow harder and stronger, and one of them is the skull. After touching the skull of a neonate, you would find a few gaps with no bone. Instead, they have a soft membrane in between that will slowly become bone as he becomes older. These spaces are called fontanelles, and there are two main fontanelles in your baby: one in the front called anterior fontanelle and it is shaped like a diamond, and one in the back called posterior fontanelle and it is shaped like a triangle. These two spots are extremely important to detect meningitis in a newborn.
These spaces should be kept in line with the skull, but when they start bulging or protruding this is a bulging fontanelle and often appears in meningitis. This is a sign of intracranial pressure, and it is often accompanied with lethargy, irritability, and other worrying symptoms. In these cases, do not delay the diagnosis of your newborn. If you have a doubt about the fontanelles in your newborn, talk to your doctor so he can clearly instruct you and answer to your concerns.
As you can see, meningitis can be a highly variable disease. Even the basic signs and symptoms associated to the nervous system sometimes are not the ones to look for in a given patient. There’s a variation in children, adults, and even immunocompromised patients. Therefore, while it is important be attentive to the symptoms, sometimes you don’t need to have the triad of headaches, vomiting and fever to suspect this disease.
In any case, if you find yourself in doubt about your current medical condition, or if you detect an abnormal behavior in your child or infant, ask your doctor right away. Meningitis has severe complications, including cerebral edema, septic arthritis, and pericardial effusion, and may also result in long-lasting consequences such as deafness, paralysis, intellectual problems, and much more. Thus, an early treatment is your way to go to prevent all of these consequences in yourself and your siblings.
References
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