Meningitis Hx

HPC
Fever
- When did this start? Did it start suddenly or slowly?
- Does it come and go? Any particular pattern? Is it worse on any particular time of the day?
- Have you tried anything to bring the fever down? Any medicines? Sponging? Does it get better?
- Does anything make the fever worse?
- How did you check the fever? How hot was the body? Do you have thermometer?
- How it has affected? Sleeping? Eating habits? Activity?

Neck stiffness
- When did this start?
- How it affects daily activity
- Have you tried anything to make you feel better? Is there anything that makes it worse?
- Any history of injury to neck or head?
- Do you think something brought it on? Wrong sleeping position? Lifted something heavy? Poor posture?
- Pins and needle sensations on the hands or arm?
- Weakness of upper limbs?
- Any fever? Changes in skin color or appearance?
- Any redness, warmth or swelling around the neck?
- Has this happened before or first time?

Fits
- Did anyone witness it? What did they observed was happening to him/her at that moment?
o Features to suggest: eye rolls up, involuntary, jerking movements, saliva drooping, incontinence
- How were you feeling after the fit? (usually sleepy)
- For how long did it last?
- Any injuries due to fits – esp. if adults – tongue bite/bleed; fell down and hit head or something?
- Any loss of consciousness after the fit?
- Any loss of control of passing of pee or poop during the fit?
- Has it happened before? Do you remember how many times has it happened?

Associated symptoms
- Any muscle pains or body weakness? – myalgia & joint pain in meningococcal disease
- Would you say that you’ve been less active compared to before?
- Any drowsiness or confusion?
- Any change in sleeping pattern?
- Any change in your eating habits? Anorexia in meningitis
- Any changes in your skin color or appearance – duration, size, color, distribution & progression of rash, does it fade with pressure? (N.meningitidis
rash: initially small, macular or popular which later on develops into petechiae, purpura or ecchymosis; can appear anywhere on the body & can spread
quickly)
- Do you experience eye pain when being exposed onto bright light?
- Any nausea or vomiting, loose watery poop? Diarrhea may occur in meningococcal disease
- Any runny nose, cough or ear pain/discharge?

PMH
- Any long running illness – diabetes/ HNT/ epilepsy/ liver disease /HIV and AIDS
- Any surgeries/ admissions – cranial, ear surgeries
- Fits before? Unless covered in HPC
- Any recent conditions of the nose or ear associated with coughing or ear pain

Paeds hx
- Antenatal (Mum’s pregnancy)- any drugs? Any medical illness e.g. diabetes, high blood pressure, fits
- Birth-Birth weight, Term baby? Type of delivery? Any complications? APGAR
- Postnatal
o Growth – give ideas about recurrent illness, malnutrition, any abnormalities – height and weight
o Nutrition – breastfeeding initially, currently food pattern (lot of junk?)
o Immunizations – 0, 6, 10, 14 weeks; 12, 18 months
o Development milestones – (detail in Yr4/5) can child roll over, sit, stand, crawl, walk, reach for things, any speech?
- Make use of MCH card

DHx
- Current meds: name, dose, frequency – diabetic steroids, NSAIDS + antibiotics
- Allergies

FHx
- Anyone else with same issues?
- Any illnesses of siblings or parents and blood relatives – epilepsy/ berry aneurysm/ HNT/ diabetes?
- Anyone sick? (esp. communicable disease)

SHx
- Occupation (laboratory worker increased risk for contact with LCM)
- Hobbies
- Exposure to chemical/ animals contact (BITES)/ plants
- Alcohol consumption
- Smoke hx; for child any passive smoking?
- Children (milk)
- Travel history
- Where do you get your water supply at home?
- Could you describe the type of house you live in? Who all do you live with?
- Contact with someone who is/was sick?
- Are you sexually active?
o Do you have one partner or more than one?
o Do you use condoms?

Bacterial meningitis:
- Sinusitis or otitis
- Seizures

Subacute bacterial meningitis: Neurologic symptoms (developing over 1-7)

Viral meningitis:
- Neurologic symptoms (developing over 1-7)
- Mylagias
- Fatigue
- Anorexia
- Fever, vomiting, headache (Mumps virus)
- lymphocytic choriomeningitis virus (occupation)

Chronic symptoms: certain viruses or by tuberculosis, syphilis, fungi (especially cryptococci), or carcinomatosis