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Last Updated: Wednesday, 11 January 2006, 00:40 GMT
Early signs of meningitis found
Meningitis rash
The characteristic rash is the most well-known meningitis symptom
Cold hands, severe leg pain and very pale skin can all be early warning signs of bacterial meningitis, parents are being advised.

A team of experts in Oxford set out to see if the potentially fatal condition could be detected before the characteristic rash appears.

This is often seen just a couple of hours before the child becomes critically ill.

In the Lancet, the experts said GPs should be aware of the early signs.

In developed countries such as the UK, bacterial meningitis is the leading infectious cause of death in children.

At least four in 100,000 British children will become ill with meningococcal disease - which also includes septicaemia, or blood poisoning, and 10% of those infected die.

In many cases, children are only admitted to hospital after their condition is initially misdiagnosed.

Faster diagnosis possible

The Oxford University researchers looked at the cases of 448 children with meningococcal disease, using questionnaires given to parents, and medical records.

Greater awareness of these early signs of the disease among primary care clinicians can save lives and prevent long-term disability in children
Dr George Kassianos, Royal College of GPs

Of the total number of children, all aged 16 and younger, 103 died and 345 survived.

Only half the children were sent to hospital after the first time they were seen by a doctor.

Often children were seen by a local GP who had never encountered a case of meningitis before outside hospital.

Most of the children showed only non-specific symptoms in the first four to six hours, but were close to death 24 hours after infection.

The 'classic' symptoms - headache, stiff neck, sensitivity to light and impaired consciousness as well as rash - developed late, between 13 to 22 hours on average.

Severe leg pain - which prevents the child walking or standing
Cold hands or feet - when the child has a high temperature
Looking very pale, blue or dusky around the lips

But 72% of the children developed identifiable early symptoms in around eight hours.

Dr Matthew Thompson, a lecturer in the department of primary care and a GP in the city, told the BBC News website: "These are all symptoms the parents themselves identified, often many months after their child's death or infection.

"They are signs to give parents and doctors more warning signs."

Dr Thompson said children could exhibit these symptoms and not have meningococcal disease.

But he added: "However, they should be checked out."

'False reassurance'

Dr Thompson said GPs in particular needed to move away from the "traditional" signs.

"We believe that primary-care clinicians are over-reliant on using these three symptoms to diagnose meningococcal disease in children.

"Moreover, clinicians and parents may be falsely reassured by the absence of these features."

Denise Vaughan, chief executive of the Meningitis Research Foundation, which funded the study, said: "This important research has not only identified the early symptoms of septicaemia but the need for doctors to systematically look for those symptoms in sick children.

"We hope this will change the model of how meningitis and septicaemia are looked for in primary care and save lives."

Dr George Kassianos, spokesman for the Royal College of GPs, said: "Parental education about the early signs of meningococcal meningitis is very important.

"And greater awareness of these early signs of the disease among primary care clinicians can save lives and prevent long-term disability in children."

See what the early signs of meningitis are

Q&A: Meningitis warning signs
11 Jan 06 |  Health

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