• 2 different types of illness

  • meningitis

  • sepsis

• 13 serotypes

  • most infections B or C strains

• meningitis also strep pneumo of H.influenzae

• highers \<1yo

• 1-4yo

• another peak 15-19yo

Infection

• prodromal

  • non-specific symptoms

    • acute fever

    • vomiting

    • nausea

    • lethargy

    • irritability

    • refusing food/drink

    • headahce

    • muscle/joint pain

    • resp symptoms

  • dry cough = influenza compared to meningococcal disease

• classical signs

  • maybe absent

  • within first 4-6hrs

• meningitis

  • photophobia

  • severe headahce

  • focal neural difict

  • drowsiness/confusion

  • seizures

  • Kernig’s sign

    • supine with leg raised at hip and bent 90deg

    • pain or resistance with furter extension

  • Brudzinski sign

    • postiive if involuntary bending/flexion when in supine position ha dhead passively raised or lifted

  • low sensitivity/high specificity

• sepsis

  • rash

    • non-banching

  • rapidly deteriorating condition

  • limb/joint pain

  • cold hands/feet

  • capillary refill time > 2sec

  • unusual skin colour

  • tachycardia

  • rigors

• how quickly disease progression

• clinical judgement - does seem more severe

• level of parental/caregiver concern

Management

• refer

• Benzylpenicillin

  • \<1yo 300mg IV/IM

  • 1-9yo 500mg IV or IM

  • >10yo 1.2g IV/IM

• Ceftriaxone 50-100mg/kg up to 2g

if cannot be ruled out:

• plan review 4-6hrs

• advise patient to return to practice in 12-24hrs or any time if concern

• not being sent home alone

• check on patient every hour for next 6-12hours