Meningococcal Septicaemia Pearls

30% of those who have meningococcal septicaemia have BLANCHING rash,

Limb pain is classic sign of meningococcal septicaemia

The danger of them going home late in the evening is they’re put to bed at night and then they go downhill once they’re in bed then not found til the morning by which time they may be very unwell/too late.

If they are tachycardic – DON’T just put it down to fever, think this could be shock.

A short history is worrying.

Clinical Features of Severe Disease

  • presence of shock
  • absence of meningism
  • rapidly progressive purpuric rash
  • low peripheral white blood cell cound
  • thrombocytopenia
  • markedly deranged coagulation
  • depressed conscious level

Symptoms of Septicaemia

  • fever
  • rigors
  • aches
  • limb pain
  • gastrointestinal symptoms
  • weakness
  • rash

Symptoms of Meningitis

  • fever
  • headache
  • vomiting
  • drowsiness / confusion
  • fits
  • photophobia
  • confusion / aggression

Signs of meningitis

  • neck stiffness
  • photophobia
  • babies:
    • full / bulging fontanele (raised ICP)
    • feel stif / jerky movements / or floppy
    • fits
  • drowsiness / decreased conscious level
  • aggression – teenagers
  • +/- rash

Signs of Septicaemic Shock

  • Early Signs
    • tachycardia
    • cool peripheries (CRT > 4seconds), temp gap >3degrees
    • pallor
    • Decreased urine output (<1ml/kg/hr)
    • tachypnoea – secondary to acidosis & hypoxia
  • Progression
    • metabolic acidosis with BE > -5
    • hypoxia: PaO2 < 10kPa in air or sats of <95% in air
    • Increasing tachypnoea, tachycardia and gallop rhythm
  • Late Signs
    • drowsiness or agitation
    • hypotension: BP can be normal until child very shocked

Clinical signs of raised ICP

  • falling / depressed conscious level
  • abnormal posturing: decorticate or decerebrate
  • dilated pupils or unequal pupils
  • focal neurology
  • bradycardia and hypertension
  • abnormal breathing pattern
  • Cushing’s triad:
    • slow pulse
    • raised BP
    • Abdnormal breathing pattern – late sign of Raised Intracranial pressure
  • papilloedema – late sign (absence not reassuring)

Contraindications to lumbar puncture

  • prolonged or focal seizure
  • focal neurological signs
  • widespread purpuric rash in ill cild
  • GCS < 13
  • pupillary dilatation
  • abnormal posture
  • Raised intracranial pressure (bradycardia / raised BP / irregular resps)
  • coagulopathy
  • papilloedema
  • hypertension