Symptoms

After an incubation period of 3-5 days (63,64), disease onset may be either insidious with mild prodromal symptoms or florid. Early symptoms and signs include malaise, fever, and vomiting. Sever headache, neck stiffness, photophobia, drowsiness, and a rash may develop. The rash may be petechial or purpuric and characteristically does not blanche under pressure. Meningitis in infants is more likely to be insidious in onset and lack the classical signs. In approx 15-20% of cases, septicemia is the predominant feature. Even with prompt antibiotic treatment, the case fatality rate is 3-5% in meningitis and 15-20% in those with septicemia. (65).

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