Signs and Symptoms

• 95% of patients with bacterial meningitis have two of the following: headache, fever, neck stiffness, and altered mental status

• Altered mental status (i.e., confusion, lethargy, and obtundation) (69%)

• Focal neurologic defects (including positive Brudzinski's sign and Kernig's sign)

• Malaise, restlessness

• Photophobia

• Skin lesions (diffuse petechial rash observed in 50% of patients with meningococcal meningitis)

• Signs and symptoms in neonates, infants, and young children: nonspecific findings, such as altered feeding and sleep patterns, vomiting, irritability, lethargy, bulging fontanel, seizures, respiratory distress, and petechial/purpuric rash16

• Predictors of an unfavorable outcome: seizures, focal neurologic findings, altered mental status, papilledema, hypotension, septic shock, and pneumococcal meningit-

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