In early sepsis, the skin may be warm but as the condition worsens peripheral perfusion is reduced. In children, cool hands and feet are early findings in meningococcal sepsis and the reversal of the proximal progression of cool skin gives some indication of the adequacy of resuscitation [18].

The skin may provide clues as to the causative organism, such as purpura in meningococcal infection and generalised erythaema in toxic shock syndrome.

A thorough examination is needed to identify possible occult sources.

In the image, the meningococcal bacterium is the diplococcus to the left of the nucleus of the large cell.