CURRENT TOPIC Diagnosis and treatment of bacterial meningitis

DIAGNOSIS Symptoms and signs Bacterial meningitis can be difficult to diagnose as the symptoms and signs are often non-specific, especially in young children. The symptoms may include high temperature, poor feeding, vomiting, lethargy, and irritability. The clinical signs include bulging fontanelle, fever, drowsiness, apnoeas, convulsions, and purpuric rash. In older children the more classic signs of neck stiffness, headache, and photophobia are more common. The specific signs of Kernig, Brudzinski, and nuchal stiffness are often absent in children. These signs are poorly sensitive in adults, let alone children. In one study in adults, both Kernig and Brudzinski signs had a sensitivity of only 5%, while sensitivity of nuchal rigidity was 30%. The non-specific nature of the symptoms and clinical signs means that we often overtreat and look to other investigations to confirm the diagnosis.