Only half of babies under three months old who have bacterial meningitis show signs of a fever, a study has suggested.
Other symptoms associated with meningitis in infants, including a bulging fontanelle (the gap on the top of skull where the bones have not yet come together), coma, seizures and neck stiffness were also found to be uncommon in babies so young, who are at the highest risk of the disease.
The Meningitis Research Foundation (MRF), the charity which funded the study, is now urging people to be aware of other, less well-known, signs and symptoms of meningitis, as they do not want parents to assume infants without a fever do not have the illness, or doctors to miss correctly diagnosing the condition due to a lack of supposedly tell-tale signs.
Professor Paul Heath, one of the study investigators at St George’s, University of London, said: “The classic features of meningitis were uncommon in many cases. The symptoms displayed by young infants when they are seen by doctors at first in hospital are often non-specific and only half of cases showed signs of a fever.”
Professor Heath continued: “Clinicians must still consider bacterial meningitis in the diagnosis of an unwell infant that doesn’t present with fever.”
The study involved 263 infants across the UK and Ireland and found that fever (temperature above 38C) was reported in only 54% of cases, seizures in 28%, bulging fontanelle in 22%, coma in 6% and neck stiffness in only 3%.
Researchers found that infants who did present with fever tended to be older than infants without fever. The median age for this symptom was around 21 days old.
Common signs of meningitis were found to be poor feeding, lethargy and irritability, all of which can be difficult to distinguish from mild illness.
The researchers also noted that 52% of the infants without fever did have other features suggestive of bacterial meningitis, such as temporary cessation of breathing (33%), seizures (32%), bulging fontanelle (16%), coma (7%) and neck stiffness (3%).
Vinny Smith, chief executive at MRF, said: “Young babies are particularly vulnerable to bacterial meningitis. Meningitis and septicaemia are deadly diseases that strike without warning. Rapid diagnosis and treatment provides the best chance of survival.”
Based on the research, Smith said the MRF has collaborated with the study investigators to create a teaching package aimed at doctors and health professionals to aid rapid diagnosis and treatment. They have also created an information sheet for parents, which can be found here.
What are the most common meningitis symptoms in babies and children?
The NHS states the most common symptom of meningitis is the rash that looks like small, red pinpricks at first. It then spreads over the body quickly and turns into red or purple blotches.
According to Meningitis Now, early symptoms in babies and children aside from a fever, include vomiting, muscle pain, and cold hands and feet.
“As babies and toddlers can’t tell you how they feel, it can be easy to miss vital signs and symptoms of meningitis,” said Sarah McMullen, head of knowledge at the National Childbirth Trust (NCT).
“In addition to physical symptoms, parents should look for behavioural signs that include a dislike to being handled or bright lights, being drowsy or unresponsive, unusual crying or moaning, and rapid breathing.
“Obviously the rash is a symptom of meningitis, but this doesn’t appear in all cases. And parents should not wait until the rash appears if they are concerned about their child’s health.”
Susette Worgan-Brown, from Meningitis Now previously told HuffPost UK: “Meningitis and septicaemia [blood poisoning] often happen together. Be aware of all the signs and symptoms. Symptoms can appear in any order, some may not appear at all.”
See below for Meningitis Now’s handy infographic on spotting symptoms.
For more information:
To find out symptoms and treatment in babies and children, visit NHS Choices.
You can also call Meningitis Research Foundation’s free helpline on 080 8800 3344.