A fever, severe headache, sensitivity to light and neck stiffness which prevents forward bending of the head are the first symptoms. There may also be purple patches on the skin. Death can occur within a few hours, so urgent medical treatment is required. Trekkers to rural areas of Nepal should be particularly careful, as the disease is spread by close contact with people who carry it in their throats and noses, spread it through coughs and sneezes and may not be aware that they are carriers. Lodges in the hills where travelers spend the night are prime spots for the spread of infection.
Treatment is large doses of penicillin given intravenously, or chloramphenicol injections.
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