Signs & Symptoms

Not all patients will develop all, or even many of the signs and symptoms listed below.

Meningitis and septicaemia can be hard to recognise, especially in small children who get lots of minor illnesses with similar symptoms and can’t explain how they are feeling. Paramedics need to be aware of these possible presentations.

/// Meningitis Research Foundation, 2015a

Certain signs and symptoms may be subtle or absent in children and young babies.

Listed opposite are some signs that may be evident in young babies.

Opposite you will find a list of common signs and symptoms in toddlers and young children presenting with meningitis and/or septicaemia.

(Click to enlarge)

Red ticks indicate those signs/symptoms more commonly seen in meningitis and septicaemia, and not in more minor illnesses.

/// Meningitis Research Foundation, 2015b

A review by Curtis et al (2010) outlines the diagnostic accuracy of clinical features in bacterial meningitis. These are displayed below in table 1 (click to enlarge). What this table shows us is that some features are highly specific, but not overly sensitive.

In order of decreasing magnitude on history-taking, reports of bulging fontanel, neck stiffness, seizures (outside the febrile-convulsion range), or reduced feeds raise concern about the presence of meningitis.

On physical examination, in order of decreasing magnitude, the presence of jaundice, being toxic or moribund, or having meningeal signs, neck stiffness, bulging fontanelle, Kernig sign, tone up, fever of 40°C, or Brudzinski sign all raise the probability of meningitis.

Whilst petechial rash had a strong likelihood ratio of 37, the sample size studied was small (only four patients displayed the sign), contained in one prospective trial. Therefore the diagnostic utility of rash is currently unclear.

Table 1. Accuracy of clinical features. (Curtis et al, 2010)

Don’t wait for a rash as it doesn’t always appear
Not everyone gets all of these symptoms
Symptoms can appear in any order
Septicaemia can occur with or without meningitis

/// Meningitis Research Foundation, 2015b