Meningococcal disease
Herpes simplex encephalitis
Bacterial meningitis
Urinary tract infection
Kawasaki disease
Septic arthritis
Pneumonia
Focal neurological signs Focal seizures Decreased level of consciousness
Neck stiffness Bulging fontanelle Decreased level of consciousness Convulsive status epilepticus
Fever for more than 5 days and at least 4 of the following: • bilateral conjunctival injection • change in mucous membranes • change in the extremities • polymorphous rash • cervical lymphadenopathy
Tachypnoea (respiratory rate >60 breaths/minute) age 0–5 months; >50 breaths/minute, age 6–12 months; >40 breaths/minute, age >12 months Crackles in the chest Nasal flaring Chest indrawing Cyanosis Oxygen saturation ≤95%
Swelling of a limb or joint Not using an extremity Non-weight bearing
Vomiting Poor feeding Lethargy Irritability Abdominal pain or tenderness Urinary frequency or dysuria
Non-blanching rash, particularly with 1 or more of the following: • an ill-looking child • lesions larger than 2 mm in diameter (purpura) • capillary refill time of ≥3 seconds • neck stiffness
