Meningococcal disease is extremely unpredictable. The presentation can be very varied and patients may be difficult to differentiate from those with viral illnesses during the early stages. Most children with MD present as an acutely febrile child and may not have a rash at first.
It is important to take a detailed history and ask parents about the specific symptoms of septicaemia and meningitis. Beware of simply 'eyeballing' a child and assuming they have a trivial illness. This is how many mistakes are made. Make sure you have understood what exactly is worrying the parent and why they are seeking help at this point. Be careful if the child has had contact with a case of meningococcal disease even if they have had prophylactic antibiotics as they can still become ill. Ask about travel to sub-Saharan Africa or contact with Hajj pilgrims.15 16
At the initial assessment look for signs and symptoms of septicaemia or meningitis. Some symptoms can be subtle and must be specifically asked about when taking a history.