Symptoms of septicaemia

• Fever
• Many children become suddenly ill with a fever: the classic picture is of a disease of rapid onset. However, some children develop septicaemia after a simple viral illness. In these cases the symptoms may be initially trivial and last for some time and then suddenly become more serious with a high fever and other symptoms of sepsis.
• A history of a fever in a child presenting afebrile is important.
• Not all children with meningococcal disease (or other serious bacterial infection) have fever¹⁷. A fever that subsides after antipyretics cannot be dismissed as viral in origin.
• Hypothermia, especially in infants, may also indicate serious infection ¹⁸
• Rigors Children with septicaemia often have rigors¹⁹. Occasionally the shaking, if very severe may be mistaken for fitting, but children having rigors will remain conscious.
• Aches They usually experience very bad muscle aches and joint aches making them restless and miserable.
• Limb pain Isolated severe limb pain in the absence of any other physical signs in that limb is a well-established phenomenon in MD^{20 7}. The pain can be very severe and children have been mistakenly put into plaster to treat presumed fractures.
• Gastrointestinal symptoms vomiting, nausea and poor appetite (poor feeding in babies) are common in septicaemia. Abdominal pain and diarrhoea (leading to faecal incontinence in some cases) are less common but well documented²¹. This can create confusion with gastro intestinal infections.
• Weakness This can become profound.
• Rash Ask about any new rashes or marks on the child’s skin that the parents may have noticed. Note that parents may not realise that the petechiae or purpura or 'bruises' on the child’s skin are a rash as they associate the word ‘rash’ more with a pink ‘measles-like’ rash. They may use other words to describe the rash, for example bruise, spot, freckle, blister, stain or mark on the skin – like chocolate, etc.
• Urine output Ask whether the child has passed urine or had a wet nappy recently. Oliguria is one of the early signs of shock
• Cold hands and feet, mottled skin As septicaemia advances, cold hands and feet and mottled skin are signs of circulatory compromise that parents notice.
• Signs of circulatory compromise - complications of septicaemia