Clinical signs of bacterial meningitis at admission

Introduction

To identify clinical signs of high sensitivity in adult community acquired bacterial meningitis on the time of admission to a hospital.

Methods

All adult cases of culture positive cerebrospinal fluids in East Denmark from 2002 to 2004 were included. Medical records were collected retrospectively with 98.4% case completeness.

Results

132 cases were included. Only 40% had the "typical triad of symptoms" (altered consciousness, fever and nuchal rigidity). 89% had clinically altered consciousness, 77% had fever, 73% had nuchal rigidity, 70% reported headache, 16% reported convulsions prior to admission, 14% had petechiae.

75% had 3 or more of the 6 clinical signs mentioned above.

Petechiae were registered only among meningococcal (n = 11; 61% of cases) or pneumococcal (n = 6; 8% of cases) aetiology.

Conclusion

"3 out of 6 clinical cardinal symptoms" was more sensitive in detecting community acquired bacterial meningitis than the "typical triad of symptoms".