The clinical features of acute bacterial meningitis vary with the age and immune status of the patient. Children may present with fever, convulsions, refusal of feeds, irritability, excessive cry and vomiting. Adults may present with fever, headache, vomiting, lethargy, confusion, and a stiff neck.
The manifestations, however, may be subtle, especially in newborns, immunosuppressed patients, and the aged. In addition, patients who develop meningitis after head trauma or neurosurgical procedure may have features that are difficult to distinguish from the underlying pathology. As such, a high index of suspicion is needed in this category of patients to make a early diagnosis.
Clinical examination may reveal neck stiffness/retraction, positive Kernig’s and Brudzinski signs and features of acute ill-health with deranged neuro-vital signs.

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