Meningitis is an infection of the membranes—the meninges—that surround the spinal cord and brain. As the name implies, bacterial meningitis originates from a bacterial infection. After becoming infected, the meninges swell and place pressure on both the spinal cord and brain, causing a wide range of symptoms.
Without treatment, meningitis can be life-threatening. Even after recovery, some people have permanent disabilities. Symptoms often develop without warning and worsen quickly, so being aware of them is the key to preventing potential complications.
As with many infections, one of the earliest symptoms of bacterial meningitis is a fever—often involving sweating, chills, and flu-like symptoms. In cases of severe infection, the fever may reach extreme temperatures and become difficult to manage.
If a high fever persists for too long, it can cause serious damage to the brain and even become fatal. Adults with fevers over 105 degrees should seek immediate medical attention.
Another signature symptom of bacterial meningitis is neck stiffness. Often, the neck becomes so stiff that a person is no longer able to touch their chin to their chest. As the inflammation worsens around the spinal cord, the pressure continues to prevent the neck from moving properly.
In some cases, the stiffness is so extensive that the knee may even flex when a person move's their neck. Along with the stiffness, many people feel intense pain with the movement.
Studies show that nearly 87% of bacterial meningitis cases involve a headache. Often, the head pain will worsen over time as the infection and inflammation progress. Some people report experiencing the headache in only one area, such as the forehead, while others say it feels like a general pressure inside their heads. The pain may be severe enough to interfere with daily activities.
Many experts view confusion as one of the three signature symptoms of bacterial meningitis—alongside fever and neck stiffness. They will often refer to these symptoms as the “triad,” and over 40% of people with bacterial meningitis experience all three symptoms.
The altered mental state is due to inflammation in the brain affecting cognitive functions and may even involve some level of memory loss.
The triad of bacterial meningitis symptoms—confusion, fever, and neck stiffness—often leads to other symptoms, especially nausea and vomiting. High fevers frequently cause people to feel sick to their stomach, leading to persistent vomiting.
Medical professionals also note that bacterial meningitis can eventually progress to a bloodstream infection called meningococcal septicemia that damages the walls of the blood vessels. If this occurs, nausea and vomiting are two of the most typical symptoms.
Along with the splitting headache, many people develop a sensitivity to bright lights. This condition, called photophobia, can persist for years after receiving treatment for bacterial meningitis.
Though the sensitivity is mild for most individuals, it may be severe enough for even small amounts of light to trigger severe pain. Due to their similarities, it is common for people to confuse meningitis-related photophobia with a migraine or other headache disorder.
In addition to photophobia, people with bacterial meningitis may become much more sensitive to sounds. This is known medically as phonophobia. Like photophobia, phonophobia can cause painful headaches, often following exposure to a loud or “sharp” sound.
These two symptoms can also contribute to nausea and vomiting, as well as feelings of dizziness and confusion.
When someone feels sick, it often affects their appetite. In cases of bacterial meningitis, this can be even more severe, as inflammation in the brain may actively inhibit areas like the hypothalamus, harming the “satiety” and “feeding” functions.
Other common symptoms, such as fever, photo- and phonophobia, and confusion, may also cause loss of appetite.
If a bacterial meningitis infection spreads to the bloodstream, causing meningococcal septicemia, it can result in more than just nausea and vomiting. As the blood vessels begin to bleed into the skin and organs, the extremities no longer receive the blood they need.
Ultimately, this can cause the hands and feet to feel extremely cold. They may also feel numb or develop a slight blue or purple color.
Throughout the progression of meningitis, a person may develop a distinctive skin rash. These rashes do not always appear in the early stages, though if they do, they resemble small pinpricks. This petechial rash looks similar to flea or bug bites.
When a person has meningococcal septicemia, they can develop a large, purple rash that resembles a bruise.
As research into meningitis continues, some experts have identified a potential early warning sign: abdominal pain. Historically, the stomach pain from meningitis is so severe that doctors have misdiagnosed the condition as appendicitis.
Some research indicates that as many as 10% of people with bacterial meningitis experience abdominal pain and experts believe this number could increase as recognition improves.
When the inflammation around the brain and spinal cord worsens, the effects can be extremely variable and far-reaching. Many studies report joint and extremity pain in meningitis patients over the years, but it is only recently that doctors have begun to focus on these symptoms as characteristic of meningitis.
This pain is particularly severe in the legs and may be so strong that a person refuses to walk or is outright incapable of standing. The most common areas for this pain appear to be the calf muscles and the leg joints.
The body experiences a certain level of fatigue and weakness while fighting off any serious infection. With bacterial meningitis, the other symptoms can interfere with daily activities like eating and sleeping. Improper nutrition, a lack of sleep, and a raging immune system leave infected people feeling weak, tired, and severely fatigued.
This fatigue and general malaise may persist long after recovering from the infection.
Bacterial meningitis’ signature high fever typically involves a significant amount of sweating. This, alongside symptoms like a lack of appetite and persistent vomiting, can quickly lead to severe dehydration and a lack of electrolytes.
Often, a person feels extremely thirsty while fighting the infection but is simply unable to keep fluids down. This is particularly prevalent among children and is an indicator that they need immediate medical attention.
Seizures and convulsions are common symptoms of the later stages of bacterial meningitis, with around 17% of people experiencing them. The presence of seizures dramatically increases the mortality rate of the infection.
Experts believe that convulsions occur when inflammation spreads throughout the body or when it directly affects the central nervous system.
Various case reports and anecdotes about the progression of bacterial meningitis involve mention of “difficulty walking.” In some instances, this is due to inflammation interfering with the nerves of the spinal cord, impacting a person’s ability to move their legs and balance.
The inflammation may also be putting pressure on the brain in a manner that directly inhibits balance. Symptoms like leg pain could also be contributing to difficulty walking.
Yet another effect of bacterial meningitis’ effects on the nerves is persistent, uncontrollable shaking or shivering. This symptom could affect the entire body or be localized to a specific area, like the hands. Sometimes, the tremors develop early in the infection’s progression, though this is not common.
The often-accompanying bloodstream infection of meningococcal septicemia can lower the body’s temperature, promoting shivering that is distinct from the tremors resulting from pressure on the brain and nerves.
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