Most adults and children with meningitis present with one of the three common symptoms but rarely all three, according to a Danish study.
Research to be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases in Copenhagen next month also found about one in seven patients have none of the three symptoms.
Dr Nichlas Hovmand, of the Centre for Research & Disruption of Infectious Diseases (CREDID) at Copenhagen University Hospital, and colleagues, carried out a retrospective observational study of pre-hospital and hospital data in patients with community acquired bacterial meningitis (CABM).
All patients were admitted to the Capital Region of Denmark between January 2016 and December 2021.
The cohort comprised 209 patients, of whom 171 (82%) were adults and 38 (18%) were children.
The most frequent symptoms were altered mental state (58% of total patients, of whom 61% were adults and 42% children) and fever (57% of all patients, of whom 50% were adults and 92% children). Neck stiffness was less common, being reported in nine per cent of all patients.
Children were more likely than adults to have fever, fatigue, rashes and neck stiffness, while adults more often presented with altered mental state, headache and leg pain.
While 85% of all patients had at least one of the three symptoms in the classical triad of meningitis, only 3% had all three and 16% adults and 8% children had none.
Dr Hovmand said: “Patients with bacterial meningitis presented to emergency medical services with a variety of symptoms that differed significantly in children and adults. The classical triad of symptoms was rare for both children and adults.
“Very few patients received antibiotics pre-admission. We suggest that questioning of additional relevant symptoms should be done in all cases of patients with fever or an altered mental state.
“Which symptoms are relevant will vary from case to case as sometimes a few symptoms could be enough to confirm the suspicion of meningitis and thus, further questioning would not change the strategy from there on. If for instance all three symptoms of the triad is present, it is unlikely any other symptoms would eliminate the suspicion of meningitis. In cases of doubt, further questioning could help to differentiate between meningitis and other suspected diagnoses, which would most often be other infections or stroke.
“Thus, knowledge about which symptoms that patients with meningitis present with is an important tool to help find the patients as early as possible, but it is difficult because the symptoms often are unspecific in the early stages of the disease.”
He said patients with fever and/or an altered mentally state should be asked for specifically related symptoms such as neck stiffness, leg pain, headache and rashes.
“However, it is very important to keep in mind that most patients with bacterial meningitis will not present with all the specific symptoms – especially in the early stages of the disease,” he continued.
“The potential symptoms are many, and as well as those already mentioned can include tremors and/or seizures, back pain, diarrhoea, cold-like symptoms, shortness of breath and vomiting.”
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