ABSTRACT
History Michael is a 7-year-old boy brought to the emergency department (ED) by his father at 10 pm. He has had an intermittent fever and backache for the last 48 hours, has vomited three times, had two loose stools and an episode of violent shivering this evening. He was previously healthy, except for frequent abdominal pain during the last school term, not associated with any change in bowel habit. His parents are originally from Nigeria, although he was born in the United Kingdom. He has frequently travelled to Nigeria in the summer holidays and returned from his most recent trip 1 week ago. He has received all his routine immunizations according to the United Kingdom schedule.
