In elderly patients with meningitis, fever is often?

• A. Absent
• B. Always present
• C. Very common but often missed
• D. Not a feature

Answer: (C)

In older adults, meningitis often presents with atypical signs, and fever is not as predictable as in younger patients. The febrile response can be blunted or low-grade in the elderly because of aging immunity and other chronic conditions, and fever can be masked by antipyretics or baseline illnesses. Despite that, fever still occurs fairly often in elderly meningitis, but it is easy to miss because it may be mild, intermittent, or mistaken for another condition. So the best way to think about it is: fever tends to be a common feature, but it’s frequently overlooked in this population due to a subdued fever response, making vigilance for meningitis crucial even when fever isn’t prominent.