Triad of meningitis

Q: Which patient population usually presents with the classic triad of acute bacterial meningitis? (select one)

A) Older 

B) Younger

Answer: A

The classic triad of acute bacterial meningitis consists of the following:

• fever
• nuchal rigidity and 
• change in mental status

Patients in the sixth and above decades are more prone to present with a triad. In contrast, only one-third of younger patients present with a full triad, making it difficult to recognize the disease. 

Usually, patients present with sudden onset. Headaches are universal in all patients besides the above triad. Other associated symptoms are nausea, altered mental status, possibly seizures, aphasia, hemiparesis, cranial nerve palsy, rash, arthritis, papilledema, and coma.

Meningitis may occur secondary to sinusitis, otitis,, pneumonia, endocarditis or any other systemic disease.

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References:

1. van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351:1849.

2. Weisfelt M, van de Beek D, Spanjaard L, et al. Community-acquired bacterial meningitis in older people. J Am Geriatr Soc 2006; 54:1500.

3. Attia J, Hatala R, Cook DJ, Wong JG. The rational clinical examination. Does this adult patient have acute meningitis? JAMA 1999; 282:175.