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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