In this second part of our meningitis paper, we emphasize the importance of clinical findings in the differential diagnosis and of early treatment for a better prognosis. The classical triad of meningitis is fever, headache and meningeal irrritation findings. Preceding viral upper respiratory tract infection is present in 75% of cases. Anorexia, nausea and vomiting are the commonest nonspecific signs. Headache, and neck and back pain are frequently encountered in children after infancy. Focal or generalized convulsion is observed in 20-30% of the patients before establishment of clinical diagnosis, which is more common in S. pneumoniae and H. influenzae infections than in meningococcal meningitis. In general, less than 10% of the patients have conscious lability (lethargy, stupor and coma) in the initial physical examination due to increased intracranial pressure, cerebritis and hypotension. Neck stiffnes is evident in 60-80% of the children, and meningeal irritation findings like Kernig and Brudzinski signs may also accompany. Especially patients less than 18 months may not demonstrate these neurological abnormalities. Petechial and purpuric skin lesions are encountered in 25% of the patients with bacterial pathogens. Focal neurological findings are not infrequent. Sixth cranial nerve palsy should remind the physician of increased intracranial pressure. Hemiparesis may point out the development of cerebral vascular occlusion. Deafness and ataxia may follow inflammation of the inner ear, and blindness after diminished blood flow in the occipital lobe. Papilledema is not observed in the early uncomplicated session of meningitis, but it may be seen in dural venous sinus thrombosis, brain abscess, subdural empyema and obstruction of CSF flow. Nonspecific findings like feeding difficulty, bulging in the fontanalle, widening in the sutures, hypo/hyperthermia, respiratory irregularity, abdominal distention and lethargy are common findings in the neonatal and infancy periods. Therefore, suspicion for meningitis and prompt management of its workup will yield early treatment which will undoubtedly positively affect prognosis.

Keywords: menenjit, çocuk, invazif enfeksiyonlar