Meningitis Symptoms and the Glass Test: When to Call 911

As winter and the school term get going in Amman, fevers and colds are everywhere, and most are simple viruses that pass on their own. But among all those fevers there is one illness worth knowing well, because it can get worse within hours: meningitis. This guide explains the symptoms in adults and babies, how to do the glass test, why you shouldn't wait for a rash, and when to call 911.

What is meningitis?

Meningitis is inflammation of the membranes that cover the brain and spinal cord. It can be caused by viruses or bacteria, and rarely fungi. Viral meningitis is more common and usually milder. Bacterial meningitis, most often caused by meningococcus, pneumococcus or Haemophilus influenzae, can be life-threatening and needs urgent treatment in hospital. According to the WHO, around 1 in 6 people who get bacterial meningitis die, and about 1 in 5 are left with long-term effects such as hearing loss. The same bacteria can also cause blood poisoning (septicaemia), which is what causes the rash that doesn't fade under pressure. You can't tell the types apart at home, so every suspected case is treated as an emergency.

What are the symptoms of meningitis in adults and babies?

Symptoms often come on suddenly, and they look different in babies and adults. Babies and toddlers can't tell you about a headache or a stiff neck, so their signs are different. These are the main signs according to the NHS and the US CDC:

Two important points from Meningitis Now and the NHS: symptoms can appear in any order, and some may not appear at all. Don't wait for the whole list. If your child or relative seems ill in a way that's different from a normal cold, and is getting worse, trust your instincts and get help.

Most fevers in children are not meningitis. Our guide to a child's fever and when to worry explains the limits by age, and fever and when to go to urgent care helps with milder cases. If headache is the main symptom in an adult, see headaches and when to worry.

How do you do the glass test?

The rash of meningococcal septicaemia often starts as tiny red, brown or purple pinprick spots and can spread into larger patches that look like bruises. To do the test:

1. Press the side of a clear glass firmly against the spots.
2. Look at the spots through the glass.
3. If they are still visible and don't fade, this is an emergency: call 911 or go to the ER now.

The NHS says the rash can be harder to see on brown or black skin, so check paler areas: the palms, soles of the feet, roof of the mouth, whites of the eyes and inside the eyelids. Most importantly, the rash is often a late sign and may never appear. If someone is very unwell, don't wait for a rash, and don't be reassured just because a rash fades under the glass.

When should you call 911 or go to the ER?

Call 911 for

• A rash that doesn't fade under a glass in someone who is unwell or has a fever.
• Being hard to wake, unresponsive, confused, or not making sense.
• A first-time seizure.
• A baby who is floppy or unresponsive, or has a weak, high-pitched or continuous cry.
• Someone getting rapidly worse, with very cold hands and feet and pale or blotchy skin.

Go to the ER now

• Fever with a very painful headache, a stiff neck, or not being able to look at bright light.
• A baby under 3 months with a temperature of 38°C or more, or 3–6 months with 39°C or more.
• A child who is refusing feeds, sleepier than usual, or has a bulging soft spot.
• Any symptoms you're worried might be meningitis, even if not all of them are there.

Urgent care or a doctor the same day

• You've been in close contact with someone diagnosed with bacterial meningitis, even if you feel well.
• Fever with a mild to moderate headache and no warning signs, lasting more than two or three days.
• A child with a fever who is alert and drinking, but you're not reassured.

Home care is usually fine

• A cold or flu with fever, where the person is alert, eating and drinking, and perks up after fever medicine.
• A rash that fades under the glass in a child who is active and well, while you keep watching.

If a young child has a seizure with a fever, our guide to febrile seizures and what to do explains the steps. And know the emergency numbers in Jordan before you need them.

How can you protect your family from meningitis?

According to the WHO, vaccines give the most effective long-lasting protection. The main ones are Hib, pneumococcal vaccines, the MenACWY meningococcal vaccine and MenB. No single vaccine protects against every type, so vaccinated people can still get meningitis and knowing the symptoms still matters. Check your child's vaccination record with your doctor or health centre. If you're planning Hajj or Umrah, Saudi Arabia requires the MenACWY vaccine for pilgrims.

If someone close to you is diagnosed with meningococcal disease, public health or a doctor may offer you preventive antibiotics, especially if you live in the same household. A doctor decides whether you need them. Wash your hands often and avoid sharing cups or toothbrushes.

What happens when you come in?

Suspected meningitis is seen straight away. The emergency doctor checks temperature, pulse, breathing and level of alertness, and looks at the skin for a rash and the neck for stiffness. The doctor may request tests such as blood tests from the on-site laboratory. Meningitis needs urgent treatment in hospital, and the team won't wait for results to act: they arrange the next step without delay. The emergency department at Emergency Plus is open 24/7 with emergency physicians in the building.

Sources

• NHS — Meningitis: symptoms
• NHS — Meningitis
• Meningitis Now — Signs and symptoms
• CDC — About meningitis
• WHO — Meningitis fact sheet