Central nervous system disorders

III./4.2.: Clinical symptoms

The clinical symptoms of purulent meningitises are similar regardless of the causative agent. The illness usually starts with flue-like symptoms (prodrome); weariness, depressed mood, subfebrility, fever, pain in the extremities. Then bacteriaemia develops in the whole body (generalized state), which is indicated by

• - high fever (often accompanied by chills),

• - headache,

• - signs of meningeal irritation, which prove the meningitis, liquor circulatory disturbance and elevated intracranial pressure.

A meningoencephalitis develops when the meningeal inflammation spreads further onto the brain. It is characterized by somnolence, psychological symptoms, confusion, disorientation or agitation, not rarely even by delirium, disturbed perception and sensorium. Brain involvement can lead to focal and generalized epileptic seizures. Without treatment delirium can progress to a severe alteration of consciousness. Around ¼th of all cases are misdiagnosed in the beginning of the disease. An unconscious state developing in a short period of time or within unknown circumstances can lead to the impression of a cerebral circulatory disorder, a metabolic delirium or a delirium caused by alcohol withdrawal. Labyrinth and inner ear impairments occur in 10-20% of all cases.

Neisseria meningitidis (Meningococcus) is one of the most frequent pathogens, which is causative of meningitis and life-threatening bacterial sepsis. Meningococcus is a Gram-negative diplococcus; from its serological subgroups the Meningococcus B and C bacteria cause meningitis. The infection spreads by droplet contact, so the pathogen can be transmitted within the family or in a group of people by a direct physical contact with the patient. Asymptomatic carrying of the pathogen is common (5-50%); especially in younger people. Older carriers are less frequent. The disease cumulates seasonally; there are more patients during the winter, while summer is a less typical period.