Meningitis

Recognition

Rapid onset of high fever, chills, and extreme headache
Nuchal rigidity: Stiff, rigid neck — the hallmark sign. Caused by painful stretching of inflamed meninges
Photophobia: Pain from bright light (meningeal irritation)
Petechial rash: Deep red/purple spots that do not blanch when pressed — indicates bacterial blood infection (meningococcemia). Critical red flag
Confusion, drowsiness, slurred speech, delirium (elevated intracranial pressure)
Kernig sign: Resistance to knee extension with hip flexed at 90 degrees
Brudzinski sign: Neck flexion induces involuntary hip and knee flexion
Bacterial vs. viral: Bacterial is severe, potentially fatal, requires immediate antibiotics. Viral is generally less severe and self-limiting (resolves in 1-2 weeks)

Systemic contraindication during acute meningitis — communicable disease with active CNS infection
Post-recovery: Clients who have completely recovered with no lingering neurological damage can receive standard massage with no special modifications
Hearing loss: CN VIII (vestibulocochlear) damage from intracranial pressure can cause permanent hearing loss — adjust communication accordingly in recovered clients

"Worst headache ever" + stiff neck + fever = medical emergency — call 911 immediately. Do not delay for further assessment
Non-blanching petechial rash with fever — meningococcemia. Emergency referral
Do not treat during active infection. The condition is communicable
HiB vaccine prevents the most common bacterial forms. Be aware that unvaccinated individuals are at higher risk

Meningitis systemically contraindicates massage while acute. It is a communicable disease.
"Worst headache ever" combined with stiff neck and fever requires emergency medical referral.
Kernig sign and Brudzinski sign are the key clinical tests for meningeal irritation.
Non-blanching petechial rash indicates bacterial blood infection and is a critical red flag.
Once fully recovered with no lingering damage, standard massage requires no special modifications.