CC: The patient is a three-year-old boy who was brought to A&E with a high fever and suspected meningitis. The patient’s mother is the source of the history.

HPI: The patient appeared to be normal and healthy until yesterday when he developed congestion and a fever. The fever was controlled when the patient was given paracetamol. However, last night the patient’s temperature remained at 39.5ºC despite a dose of paracetamol. The patient’s mother then contacted and visited their primary care provider, Dr Wilson, this morning. In the morning the child was weak and lethargic. The doctor said that the child appeared to be dehydrated. Dr Wilson advised the mother to bring the child to the hospital. The mother says that the child’s condition has not changed since they left Dr Wilson’s office. The mother reports that the child has had very little to eat or drink since the day before. She says that he does not have any diarrhoea, vomiting or any other symptoms. The child attends day care three times a week and the mother thinks that her son might have had contact with a sick child there. The child is up-to-date with all immunisations. In the past the child has had two ear infections but no other known infections or illnesses.

PMH: Two episodes of otitis media, both resolved with antibiotics, last course was six months ago.