Ahmed, aged 3 months, presents with a 24 hour history of lethargy, general disinterest, anorexia, fever and cold skin.

On examination the child looks sick,
inactive, with facial flushing and a fine macular rash on his trunk.

His vital signs are:
Respiratory rate 44/minute
Pulse 120/minute
BP 90/60
Temperature 39 C

There is no neck stiffness but the extremities feel cold.