Clinical features of meningococcal septicaemia

The clinical features of septicaemia include:

• non specific symptoms and signs:
  • fever - not seen always especially in neonates
  • nausea and vomiting
  • lethargy
  • irritable or unsettled mood
  • ill appearance
  • refusing food/drink
  • headache
  • muscle ache or joint pain
  • respiratory symptoms and signs or difficulty inbreathing (1)
    
    
• more specific signs and symptoms
  • non-blanching rash - keep in mind that the rash may be less visible in people with darker skin tones, in these patients check the soles of the feet palms of the hand and conjunctivae
  • altered mental state - which includes confusion, delirium, drowsiness, and impaired consciousness
  • shock
  • capillary refill time more than 2 seconds
  • unusual skin colour
  • hypotension
  • leg pain - isolated limb pain or joint pain is a well established signs of meningococcal septicaemia which might be misdiagnosed as fractures due to the intensity of the pain (2)
  • cold hands/feet
  • unconsciousness
  • toxic or moribund state (1)

Note:

• Kernig's sign, Brudzinski's sign, paresis, focal neurological deficit and seizures are absent in patients presenting only with meningococcal septicaemia (1)
• a generalised petechial rash (beyond the distribution of the superior vena cava) or a purpuric rash in any location, in an ill child, are strongly suggestive of meningococcal septicaemia and should lead to urgent treatment and referral to secondary care (3)

Reference:

• 1. National Institute for Health and Clinical Excellence (NICE) 2010. Bacterial meningitis and meningococcal septicaemia: Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care.
• 2. Meningitis Research Foundation 2008. Meningococcal meningitis and septicaemia. Guidance notes. Diagnosis and treatment in general practice
• 3. Scottish Intercollegiate Guidelines Network (SIGN) 2008. Management of invasive meningococcal disease in children and young people. A national clinical guideline