Meningitis: a disease measured in hours, and why you should not wait for all three signs

The most important thing first: bacterial meningitis worsens by the HOUR, not by the day. Per CDC, the early symptoms are not specific — very much like a bout of flu — and then it worsens very fast and can kill within hours. Flu behaves differently: it is at its worst while the fever is up and then eases off. Still walking about in the morning and already dull and sluggish by midday is an answer in itself.

Recognising it: the classic trio, and why not to wait for all three

In adults the three signs usually quoted are FEVER, SEVERE HEADACHE and a STIFF NECK. Per CDC there is also vomiting, sensitivity to light and altered consciousness. But waiting for the full trio is waiting too long, because many people never get all three. Check these four things over and over:

• LEVEL OF ALERTNESS: call them, shake them gently, ask their name. Being harder to rouse each time than the time before is the gravest sign here.
• HEADACHE: worse than they have ever known, building by the hour, with forceful vomiting.
• NECK: the person cannot bring their own chin towards their chest, or doing it sends pain shooting. Do not press their head down yourself.
• COLD WHILE THE FEVER IS STILL ON: cold hands and feet, pale or mottled skin, fast breathing, severe pain in the muscles, joints or abdomen. Per CDC these are signs of the bloodstream form, and they appear BEFORE any purple rash.

Newborns and small children: a completely different picture

This is the part most often missed. Per CDC, small children may not have the signs above, or they may be very hard to spot:

• Feeding poorly, refusing feeds, vomiting.
• Deeply drowsy and hard to rouse; or the opposite — intensely fretful, a shrill cry, no better even when picked up.
• A bulging fontanelle — the soft spot on top of the head feeling tight or domed.
• Floppy when held, or held rigid, with reflexes that are not as usual.
• A baby under three months with a fever: go in, do not watch at home. A soft neck rules NOTHING out in a small child.

The purple rash: a late sign, not a screening test

• If there is a rash, press or stretch the skin where it is, or press a clear glass against it and look while you are pressing.
• The rash pales and then returns when you let go: an ordinary rash — keep watching.
• The rash does NOT fade — dark red or purple spots or patches, like blood under the skin: go for emergency care at once. Per CDC, a dark purple rash is the meningococcal bloodstream form, at a LATE STAGE. Waiting for it to appear is waiting too long.
• NO rash rules NOTHING out: the meningitis form may never produce a rash at all, so do not wait for a rash before going.

What to do now

• Write down the TIME, not just the date: when the fever started, when the headache started, when the vomiting started, when they first turned sluggish — the doctor needs to know how many hours this has been running.
• Wake the person to check on them; do not leave them to sleep undisturbed «so they can rest» — how well they respond is exactly what needs watching.
• Lay them on their side while they are vomiting or confused, so they do not choke.
• Go straight away if any sign in the box below is present; do not let somebody with a severe headache or confusion drive themselves.
• Take the sheet with the times on it and the vaccination record; if you suspect the meningococcal form, phone the facility ahead.

What you must NOT do

• Do NOT use antibiotics left over in the house: not enough to treat this disease, but quite enough to turn the spinal fluid test falsely negative — and the doctor loses the route to the right bacterium.
• Do NOT bring the fever down and then go to sleep until morning: that makes the person more comfortable, it does not slow the disease. A temperature coming down does not mean the illness is retreating.
• Do NOT wait for office hours to end or for a clinic to open — this disease does not keep business hours.
• Do NOT use coin-rubbing, pricking, cupping, and do not put or rub anything on an area with a rash — it wipes out the sign the doctor needs to see.
• Avoid aspirin in children and teenagers with a viral fever because of the link with Reye's syndrome; paracetamol (acetaminophen) is generally used, but the dose is the doctor's decision.

When you must go to hospital

Close contacts: go and ask, do not buy medicine yourself

Per CDC, close contacts of a meningococcal case need antibiotics to keep them from catching the disease — a close contact means living in the same household, or contact with saliva: sharing food and drink, sharing a cup, kissing. The bacteria spread through saliva and respiratory secretions, and are not as easily caught as a cold. Your job is to ask a doctor that same day; this article does not name a medicine or a number of days, because that is the doctor's prescription.

This is an illness that belongs in hospital — it cannot be diagnosed or treated at home. Y Te Xanh's role is in two other places: advice by video call so you can decide whether to go in right now, and recovery care at home once the hospital has discharged you. If any sign in the box above is present, go in first and call afterwards.

The signs and the prevention advice in this article follow the publicly available materials of the US CDC; this article passes them on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

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