The first symptoms of bacterial meningitis are similar regardless of the causative agent. Usually they begin with a mild cold, followed by the sudden onset of a severe throbbing headache, fever, pain and stiffness ofthe neck and back, nausea, and vomiting. Deafness and alterations in consciousness progressing to coma may develop. Especially likely in meningococcal meningitis, purplish spots called petechiae, resulting from small hemorrhages, may appear on the skin (figure 26.6). The infected person may develop shock and die within 24 hours. Usually, though, progression of the illness is slower, allowing time for effective treatment.

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