Clinical presentation of meningitis
Bacterial meningitis is a serious central nervous system (CNS) infection. It is difficult to differentiate from viral encephalitis. Meningitis typically presents with an acute history of fever, neck stiffness and altered conscious state. Headache, photophobia, and nausea or vomiting are often prominent. The hallmark of encephalitis, however, is an acute change in mental status – this can be subtle, or associated with confusion or coma.
Aseptic meningitis often has a milder clinical presentation than bacterial meningitis. However, these conditions cannot be distinguished on clinical grounds alone and diagnosis requires lumbar puncture with cerebrospinal fluid (CSF) analysis. Aseptic meningitis is an indicator condition for HIV testing1. If aseptic meningitis is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection.
Adults and children with meningococcal or pneumococcal meningitis can present with nonspecific symptoms and signs of sepsis (eg leg pain, peripheral mottling, cold hands and feet) before meningism is identifiable. For information about recognition of sepsis, see Identifying sepsis or septic shock.
Neonates and infants with meningitis often present with nonspecific signs of sepsis rather than the classical signs of meningitis. Early consultation with an experienced clinician is required for all cases of suspected meningitis in neonates and infants.
For advice on managing meningitis, see Key principles of managing meningitis.