New research calls into question the classic ‘triad’ of meningitis red flags, with one in seven patients experiencing none of these symptoms.
Neck stiffness is the least common sign of meningitis among children and adults, a Danish study has found.
Following analysis of 200 hospital admissions for meningitis, researchers found just over half had altered mental state (58%) and/or fever (57%) on presentation, while only 9% had the third “classic” meningitis sign of neck stiffness.
Although 85% of patients presented with at least one of these classic meningitis signs, only 3% presented with all three. And, somewhat frighteningly, one in seven patients had none of these, according to the research set to be presented at the European Congress of Clinical Microbiology & Infectious Diseases in April.
The finding that the classic “triad” of meningitis signs rarely occurs means that questioning patients about other relevant symptoms becomes very important in improving meningitis identification, the study authors suggest.
“We suggest that all 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,” they wrote.
“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.”
The study involved 171 adults and 38 children admitted with meningitis to the Copenhagen University Hospital over a five-year period.
Fever, fatigue and rashes were the most frequent symptoms for children, with 92% presenting to hospital with fever and 71% with fatigue.
For adults, altered mental state was the most common symptom, experienced by 61% of patients, while 36% presented with headache and 15% with leg pain.
In addition, only one child and seven adults received antibiotics before their admission to hospital.
Rates of antibiotic prescription before hospital admission must increase in order to improve meningitis outcomes for both children and adults, the study’s authors concluded.
