Staphylococcal Meningitis Clinical Presentation

Updated: Dec 14, 2015
  • Author: Lawrence A Zumo, MD; Chief Editor: Niranjan N Singh, MD, DM  more...
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Presentation

Symptoms

Classic Symptoms of Staphylococcal Meningitis

Classic signs of staphylococcal meningitis include the following:

  • Neck stiffness
  • Altered consciousness (drowsiness, confusion, stupor, coma)
  • Generalized or focal seizures
  • Brudzinski sign (flexion at the hip and knee in response to forced flexion of the neck)
  • Kernig sign (inability to completely extend the legs)
  • Hypotension, very commonly

In immunosuppressed patients, the classic meningeal signs may be absent.

Symptoms of S aureus Septicemia

In S aureus septicemia, look for signs of systemic embolization/seeding, including the following:

  • Roth spots
  • Janeway lesions
  • Petechiae
  • Subconjunctival hemorrhages
  • Cardiac murmurs
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Physical Examination

With a high index of suspicion, making the diagnosis of bacterial meningitis is, in general, not difficult. All febrile patients with lethargy, headache, or confusion of sudden onset, even if fever is only low grade or the patient is a confused alcoholic, should undergo an urgent lumbar puncture, since a definitive diagnosis of meningitis can be made only by examination of CSF.

In patients who have not undergone a neurosurgical procedure, presentation of S aureus meningitis may be similar to that of other types of bacterial meningitis. Patients with septicemia have additional systemic signs and symptoms, including septic shock.

Common presentations of CoNS meningitis include low-grade fever (in 14-92% of cases), malaise, poor feeding, and irritability. Signs of meningeal irritation are not usually present, since no functional communication exists between the infected ventricles and CSF spaces in most cases.

Redness of the skin overlying a shunt, if it occurs, is a highly specific sign. Infections with symptoms referable to the distal portion of the shunt are more specific; shunts that end in a vessel lead to bacteremia, while shunts that end in the pleural or peritoneal space cause peritonitis or pleuritis.

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