Early recognition of meningitis and septicaemia.

Meningitis is a disease feared by parents and health professionals alike. The rapid onset and progression of the disease and potentially lethal outcome makes it vital to diagnose the disease early, but this can be difficult. This is particularly the case during the current swine flu pandemic, where concerns have been raised that cases of meningitis may be missed due to a misdiagnosis of swine flu. Early symptoms of meningitis and septicaemia often resemble viral illnesses such as influenza, making the condition difficult to diagnose. Classic symptoms (the ones that many health professionals and lay people most commonly associate with meningitis), such as a nonblanching rash and a stiff neck, are often late symptoms of the disease and neck stiffness is rarer in infants and young children. The presence of ear or upper respiratory tract infections does not necessarily exclude a diagnosis of meningitis. The emphasis should therefore be on regular, close monitoring of an ill child and assessment of the vital signs. Awareness of the recognised "red flag" symptoms of septicaemia--cold hands and feet, limb pain and pale or mottled skin--could also aid earlier diagnosis and hence potentially improve prognosis.