Childhood bacterial meningitis: initial symptoms and signs related to age, and reasons for consulting a physician

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Abstract
The relationship of symptoms and signs to age and the reasons for consulting a physician were analyzed in 110 cases of culture-proven childhood bacterial meningitis. H. influenzae caused 74, meningococci 28, pneumococci 6 and streptococci 2 of the cases. Apart from fever (present in 94%), the most common symptoms according to age were as follows: 1–5 months: irritability (85%), 6–11 months: impaired consciousness (79%), 12 months or more: vomiting (82%) and neck rigidity (78%). Absence of neck rigidity at diagnosis was associated with young age (PPH. influenzae differed from those of meningococcal meningitis. Meningitis should be suspected in irritable or lethargic febrile children despite absence of neck rigidity. Fever and vomiting were the most frequent reasons for consulting a physician (60% and 31%, respectively). Despite the frequency and alarming character of irritability, impaired consciousness and neck rigidity, their presence led infrequently to a consultation (6%, 22% and 3%, respectively). Parental ignorance of such symptoms or of their importance may cause treatment delay, despite readily available medical services.