Introduction

Presentations of meningococcal infection can be as meningitis alone (15%), septicaemia alone (25%), or both meningitis and septicaemia (60%). Less commonly, individuals may present with pneumonia, myocarditis, endocarditis, pericarditis, arthritis, conjunctivitis or pharyngitis.

In most children with early (4-8 hours) meningococcal disease, fever may be the only symptom. Other non-specific symptoms include irritability, lethargy, vomiting, coryzal symptoms and myalgia. Particularly in those children under 2 years of age, the typical meningococcal symptoms and signs may not be present. Because of this, it is important to have a high index of suspicion when assessing unwell children.

Any sick child presenting to the emergency department should have baseline observations performed on arrival. These include heart rate, respiratory rate, oxygen saturations, temperature, blood pressure/capillary refill time, and conscious level (AVPU)[4].

Normal physiological values in children (adapted from APLS 6^th edition – note this is a simplified guide to approximate normal values, please see the full table for further information)

The child should have a rapid ABCDE assessment, followed by a more detailed review.

Rapid ABCDE assessment (adapted from [7])

Any deviation from the normal range in combination with any of the features on the next page should prompt consideration of a diagnosis of invasive meningococcal disease.