Meningitis symptoms can appear in any order, making early diagnosis difficult — a reality underlined by an outbreak in Reading that has claimed the life of a student from Henley College in Oxfordshire.
According to Dr Tom Nutt, chief executive of the charity Meningitis Now, the classic signs of the infection — including a high temperature, severe headache, vomiting, stiff neck, sensitivity to light, confusion, drowsiness, cold hands and feet, severe muscle pain, and a distinctive rash — may emerge in no particular sequence and not all may be present. This variability, he explained, means the illness can easily be mistaken for flu in its early stages.
Symptom variability and the challenge of early recognition
The UK Health Security Agency (UKHSA), which is leading the investigation into the Reading cases, has stressed that meningococcal disease does not spread easily; transmission requires close and prolonged contact with respiratory or throat secretions, such as through kissing, coughing, sharing food or drinks, or vaping. Nonetheless, the speed with which bacterial meningitis can escalate makes prompt identification critical.
Common symptoms, as detailed by Dr Nutt and supported by UKHSA and NHS guidance, include a sudden high fever, a severe headache that does not respond to ordinary painkillers, nausea or vomiting, a stiff neck (making it difficult to touch the chin to the chest), and photophobia — discomfort or pain when looking at light. Patients may also become confused, unusually drowsy, or difficult to wake. Muscle and joint pain, sometimes severe, can occur, along with cold hands and feet even when the rest of the body feels hot.
Additional symptoms noted in public health guidance include diarrhoea, rapid breathing, a lack of appetite, and in some cases seizures or fits. In babies and young children — a group particularly vulnerable alongside teenagers and young adults — the signs can differ: a high fever, constant crying or an unusually high-pitched cry, extreme sleepiness or sluggishness, poor feeding, vomiting, a stiff body or arching back, a bulging soft spot on the head (the fontanelle), and abnormal reflexes. Crying when moved is another indicator.
The UKHSA has confirmed that three cases of meningococcal infection have been reported among young people in the Reading area. Two individuals remain in treatment at the Royal Berkshire Hospital. At least one of the confirmed cases is Meningitis B (MenB), a strain that has been linked to a cluster of fatal cases in Kent earlier this year, although the agency understands the Reading strain is not the same as the one identified in the Canterbury outbreak in March. In that Kent cluster, linked to a nightclub, 21 confirmed cases of MenB led to two deaths and hospitalised more than a dozen people.
Close contacts of those affected in Reading are being offered antibiotics as a precaution, and information about symptoms is being distributed to students and parents at all affected schools. The University of Reading has issued a statement urging its students to check their vaccination status and be alert to symptoms. Henley College has confirmed the deceased student attended the college, a detail verified by Hart Surgery in Henley-on-Thames.
The non-blanching rash: a key diagnostic sign — but not the only one
Of all the symptoms, the rash associated with meningococcal meningitis and septicaemia carries particular diagnostic weight, yet it is also the most misunderstood. Dr Nutt and public health experts emphasise that a rash does not always develop, and patients should never wait for one to appear before seeking help.
When present, the rash is typically blotchy, red or purple, and crucially, it does not fade when pressure is applied — a characteristic tested by rolling a clear glass or tumbler over the spots. If the marks remain visible through the glass, it is a medical emergency. The UKHSA notes that on brown or black skin the rash can be harder to see, and advises checking paler areas such as the palms of the hands, the soles of the feet, or inside the eyelids. The glass test remains the standard first check recommended by the NHS and Meningitis Now.
The importance of this sign lies in what it represents: a rash that does not blanch under pressure is often caused by bleeding under the skin (petechiae or purpura), a hallmark of meningococcal septicaemia — the blood poisoning form of the infection. This can lead to rapid deterioration, limb amputation, and death if not treated immediately. However, the absence of a rash does not rule out meningitis; many patients, particularly in the early stages, have no rash at all.
Because symptoms can appear in any order, the UKHSA and the NHS advise anyone who suspects meningitis to call 999 or go straight to the nearest A&E department. If unsure about severity, NHS 111 can provide guidance. The message from charities and health officials is consistent: trust your instincts and do not wait for all the classic signs to develop.
Bacterial meningitis requires urgent hospital treatment with intravenous antibiotics, fluids, and oxygen. While viral meningitis often resolves on its own within seven to ten days, bacterial meningitis can be life-threatening. The UKHSA has stated that the risk to the wider public in Reading remains low, reflecting the bacteria’s limited transmissibility.
Nevertheless, the outbreak has highlighted concerns about protection. MenB is the most common cause of bacterial meningitis in the UK among those under 25. In the 2024/25 epidemiological year, 313 cases of MenB were recorded in England, up from 301 the previous year. The MenB vaccine is offered to infants on the NHS but is not routinely available to teenagers and young adults, though it can be obtained privately. Meningitis Now has launched a campaign called “No Plan B for MenB”, calling for wider vaccination coverage for this age group.
Around 300 to 400 cases of meningococcal disease are diagnosed in England each year. In 2024/25, there were 378 confirmed cases of invasive meningococcal disease (IMD). Even with prompt treatment, bacterial meningitis can leave lasting harm: approximately 30 to 50 per cent of survivors experience long-term after-effects, including hearing or vision loss, brain damage, epilepsy, problems with memory and concentration, and limb amputation.
The two patients still receiving treatment at the Royal Berkshire Hospital face an uncertain recovery. The UKHSA continues to investigate the links between the three Reading cases, while public health teams from Reading Borough Council, along with welfare and mental health support from institutions including the University of West London, are coordinating responses. Dr Nutt’s warning remains the most direct: symptoms can appear in any order, and any one of them — not just the rash — could be the first sign of a life-threatening infection.