Clinical presentation and diagnosis

A high index of suspicion should be maintained for patients at risk for CNS infections. Prompt recognition and diagnosis are essential so that antimicrobial therapy can be initiated as quickly as possible. A medical history (including risk factors for infection and history of possible recent exposures) and physical examination yield important information to help guide the diagnosis and treatment of meningitis. Common signs and symptoms include fever, headache, nuchal rigidity (stiff neck), and photophobia. As common meningeal signs are not typically present in infants, nonspecific signs and symptoms including excessive irritability or crying, vomiting or diarrhea, tachypnea, altered sleep pattern, and poor eating should be noted. Depending on involved pathogens and disease severity, patients may also present with altered mental status, stupor, and seizures.

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