What do meningitis and septicaemia look like?
Two of the most serious infections are meningitis and blood infection (septicaemia). These are uncommon; the vast majority of children with a fever do not have these infections. Some forms of meningitis and septicaemia are covered by the childhood immunisation programme. This programme has made these (and other conditions like pneumococcal disease, rotavirus, mumps and measles) much less common than they once were. Meningitis and septicaemia are medical emergencies. The following gives a guide as to symptoms to look out for.
Early signs of meningitis/septicaemia
Many children who develop meningitis or septicaemia may, for example, just feel unwell or look generally unwell. There are three symptoms that commonly develop early on - often before the more classic symptoms listed later:
- Leg pains - which can become severe and make it hurt to stand or walk.
- Cold hands or feet - even if there is a fever.
- Pale or mottled skin. In particular, pale, dusky or blue skin colour around the lips.
Rash in meningitis/septicaemia
The best known sign of meningitis or septicaemia is a rash which does not turn pale when pressed. However, there is not always a rash. Some variations of the rash include:
- The rash may be red or purple.
- Small spots develop at first and may occur in groups anywhere on the body. They often grow to become blotchy and look like little bruises.
- One or two isolated spots may develop at first - but many may then appear in different parts of the body.
- Spots can be tiny but are typically more than 2 mm in diameter.
- The spots/blotches typically (but not always) stay coloured and do not fade when pressed. To check for this, do the tumbler test. Place a clear glass (tumbler) firmly on one of the spots or blotches. If the spot/blotch does not fade and you can still see it through the glass, get medical help immediately.
- Note: a rash does not occur in all cases of meningitis and septicaemia but can be quite characteristic when it does occur.
Other signs of meningitis/septicaemia
- Your child looks ill.
- Fever with shivering - hands and feet often feel cold.
- Stiff neck - your child cannot bend their neck forwards.
- Headache - which can become severe.
- Fast breathing.
- Aches and pains in muscles or joints - the pains can become quite severe.
- Dislike of bright lights - the child shuts their eyes and prefers the dark.
- Drowsiness, confusion or odd behaviour - the child may appear 'vacant'.
- Repeatedly being sick (vomiting). Sometimes, tummy (abdominal) pain and diarrhoea.
In babies - other signs of these conditions
- Your child may be hot, yet hands and feet may feel cold. They may shiver.
- Skin may look pale, blotchy, or blue.
- Excessive crying - often different to their usual cry.
- Fast or unusual patterns of breathing.
- Refusing feeds - sometimes with vomiting.
- Being irritable - especially when picked up and handled. Normally a baby is happier when picked up and held.
- Drowsiness or sleepiness - not waking easily.
- The 'soft spot' on the baby's head may bulge out, instead of being indented. This is called a 'bulging fontanelle'.
- Jerky movements may occur and the body may appear stiff. Sometimes the opposite occurs and the body appears floppy. Fits (convulsions) can develop.
What happens in meningitis or septicaemia?
The symptoms often develop quickly, over a few hours or so, or more slowly, over a few days. The symptoms may suggest a less serious illness at first, such as flu. But, even if you think it was flu to start with, if symptoms become worse and your child seems really sick you should seek urgent medical advice.
Further reading and references
Feverish illness in children - Assessment and initial management in children younger than 5 years; NICE Guideline (Updated August 2017)
Feverish child - risk assessment; NICE CKS, September 2013 (UK access only)
Thompson M, Van den Bruel A, Verbakel J, et al; Systematic review and validation of prediction rules for identifying children Health Technol Assess. 2012 Mar16(15):1-100.
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