The cardinal sign of meningococcal septicaemia is a purpuric rash in an ill child. At the onset, however, the rash is not florid and a careful search should be made for purpura in any unwell child. In about 13% of patients with meningococcal septicaemia, a blanching erythematous rash replaces a purpuric one, and in 7% of cases no rash occurs. In the much rarer toxic shock syndrome, the initial clinical picture includes a high fever, headache, confusion, conjunctival and mucosal hyperaemia, scarlatiniform rash with secondary desquamation, subcutaneous oedema, vomiting and watery diarrhoea. Early administration of antibiotics, concurrent with initial resuscitation is vital.
In countries where the vaccine against Meningococcus C has been introduced a fall in the number of cases of infection is occurring.
Having completed the primary assessment and resuscitation and identified by means of the key features that septicaemia is the most likely dignosis, the child is reassessed.
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