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TBE Meningococcal Disease Influenza Smallpox


The incubation period is 2-10 days and in most cases usually less than 4 days. Adults may become very ill within 24 hours, and children even more rapidly. Since the onset of the disease varies from insidious with mild prodromal symptoms to fulminating, medical attention should be sought immediately whenever meningitis is suspected or the patient exhibits symptoms like:

  • high fever (30-41C)

  • malaise

  • nausea and vomiting

  • sudden onset of intense headache accompanied by mental changes in mental status (confusion, drowsiness, delirium, agitation or coma)

  • lethargy

  • photophobia

  • stiffness of neck

  • pale and clammy skin, even though the person might have temperature

  • limb and joint pains due to focal infection

  • hemorrhagic rash: reddish or purple bruise-like skin spots which fail to disappear (the rash persists when gently pressed with a glass - see below)

In Infants:

  • bulging fontanelle (not always observed)

  • high-pitched, moaning cry

  • refusing feeds

  • difficult to wake

If you observe further deterioration, seek medical advice again even it the patient was already examined. If your doctor is not available, go straight to the nearest hospital emergency department. (3, 5)

Hemorrhagic rash

The rashes appear in about 75% of the patients and may be quite variable. They can be as small as 1-2 mm and appear as tiny red, purple-black spots or they may be much larger resembling bruises. Their most common location is armpits, groin and ankles, and areas where pressure may be applied (e.g. underwear and socks).

How to perform the glass test?

This test is very simple and can easily be done at home. Whenever you suspect that a person has septicemia, press a clear glass firmly against the bruise-like rash. Septicemic rashes will not fade away.

The correct interpretation of this test may be more difficult if your skin is dark.


In older children and adults, changes in consciousness may progress through irritability, confusion, drowsiness, stupor and coma. Seizures and cranial neuropathies may occur. Dehydration is common, and vascular collapse may lead to shock and complications (such as the Waterhouse-Friderichsen Syndrome).

The list of sequelae includes e.g. deafness, headaches, blindness, epilepsy, blood circulation problems and sometimes, even amputation.

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