What are the key clinical signs and symptoms to recognize meningitis in adults and children?

Key clinical signs and symptoms to recognize meningitis in adults and children include:

• Red flag combination: Fever, headache, neck stiffness, and altered level of consciousness or cognition (including confusion or delirium) are the hallmark signs for bacterial meningitis in both adults and children, though fever and neck stiffness may be less common or harder to identify in babies and older adults.
• Adults: Fever (less common in older adults), headache, neck stiffness (may be difficult to detect in those with dementia or arthritis), altered consciousness or cognition, ill appearance, and non-blanching petechial or purpuric rash (especially in meningococcal disease).
• Babies and children: Fever (less common in babies), irritability, lethargy, reduced feeding (in babies), unusual behavior (agitation, aggression, or subdued), weak high-pitched or continuous cry (in babies), bulging fontanelle (in infants with open fontanelle), pale or mottled skin, and non-blanching petechial or purpuric rash.
• Other signs: Photophobia, seizures, unexplained body pain (limb, back, or abdominal), vomiting, and early signs of sepsis or shock.
• Note on rash: Non-blanching petechial or purpuric rash is a critical sign mainly in meningococcal disease and should be checked all over the body including conjunctivae; it may be difficult to see on darker skin.

Recognition should be heightened in people with risk factors such as missed immunisations, reduced spleen function, or recent contact with meningococcal disease.

Because some signs may be subtle or absent, especially in babies, young children, and older adults, clinical suspicion should be based on the overall assessment of symptoms and signs.

Immediate hospital transfer is essential if bacterial meningitis is suspected.

NICE NG240