The most important method for detecting serious bacterial infections remains a thorough history and physical examination of the patient. In addition to the generally recognized and well-known manifestations of bacterial infections, there are many unfamiliar and almost imperceptible signs that allow an astute clinician to suspect the presence or serious threat of a serious bacterial disease.
Symptoms of meningitis include stiff neck, Kernig and Brudzinsky symptoms. The symptom of Kernig means resistance to extension of the knee in the position of the patient lying on his back with his legs bent at the hips at an angle of 90 °. Symptom Brudzinsky cause by bending the head when the patient is on his back.
A positive result can be considered reciprocal flexion of the legs at the knees. With a pronounced stiff neck, the child lies with his head thrown back; with simultaneous spasm of the back muscles, the child takes the posture of opisthotonus. This, however, relatively late signs and their absence does not give grounds for excluding meningitis, especially in young children.
The most common symptoms include vomiting, headache, and photophobia. Less frequent, but a valuable symptom is a high cry. A tense or protruding large spring should suggest the presence of a meningeal infection. The noise that is heard over the fontanelles or the temporal region, although it occurs in many healthy children, is more characteristic of patients with bacterial meningitis.
Physical signs of bacterial meningitis are red dermographism, although, according to the author, it is an unreliable and non-specific symptom. Red dermographism is a red stripe with thin pale borders appearing in response to skin irritation with a spatula edge or other hard blunt object.
In patients with meningitis, signs of disturbance of the nervous system and mental changes (irritability, drowsiness, lethargy, coma), hyperreflexia, ataxia, optic nerve papilla swelling (rarely) and local symptoms such as hemiparesis or cranial nerve damage are observed. Severe excitability, especially uncontrollable, should always make the doctor think about meningitis.
Seizures often develop. In one study on the study of meningitis caused by N. influenzae, convulsions at the time of admission were observed in 22% of children. In the work on pneumococcal meningitis, this figure was in 31%.
Carefully collected history has a great help in diagnosis. Information about a recent head injury in the area of the sinuses or the base of the skull may suggest an infection route. Recurrent or chronic otitis media may indicate mastoiditis with the transition to the meninges.
It is necessary to take into account the data on contact with patients with meningococcal infection, as well as patients with infections such as H. influenzae, especially in children from closed groups such as kindergartens and nurseries.