Presenting Features

Meningococcal Disease and Meningococcal Meningitis Clinical Assessment Presenting Features

Table 2: Presenting features
Features suggestive of meningococcal septicaemia	Features suggestive of meningococcal meningitis
Early features [8]: Fever Cold hands and feet Pallor Skin mottling Extremity pain	Early features: Fever Irritability Lethargy Respiratory symptoms Vomiting
Late features: Clinical shock Confusion Petechial rash Reduced consciousness Neck stiffness Rapid change in condition	Late features: Bulging fontanelle Altered mental state Headache Neck stiffness Photophobia Petechial rash

Symptoms of meningitis in the paediatric population are often non-specific in the early stages and clinical symptoms vary with age. The young child under 2 years of age may present with fever, irritability or drowsiness. Teenagers may exert aggressive or combative behaviour which may be mistaken for substance abuse [9]. The classical signs of meningeal irritation, i.e. headache, photophobia or neck stiffness are more likely to be seen in the older child in the later stages of the illness.

In general, meningococcal disease is less likely if the disease has lasted more than 24 hours.

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