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Pediatric myth: fever and petechiae

Published online by Cambridge University Press:  21 May 2015

Martin D. Klinkhammer  and
James E. Colletti
Martin D. Klinkhammer
Affiliation:
Department of Emergency Medicine, Regions Hospital, Saint Paul, Minn.
James E. Colletti*
Affiliation:
Department of Emergency Medicine, Regions Hospital, Saint Paul, Minn. Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
*
200 First St. S.W., Rochester MN 55905; jamesecolletti@gmail.com

Abstract

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A child presenting with petechiae and fever is assumed to have meningococcemia or another form of bacterial sepsis and therefore to require antibiotics, blood cultures, cerebrospinal fluid analysis and hospital admission. A review of the literature challenges this statement and suggests that a child presenting with purpura (or petechiae), an ill appearance and delayed capillary refill time or hypotension should be admitted and treated for meningococcal disease without delay. Conversely, a child with a petechial rash, which is confined to the distribution of the superior vena cava, is unlikely to have meningococcal disease. Outpatient therapy in this context is appropriate. In other children, a reasonable approach would be to draw blood for culture and C-reactive protein (CRP) while administering antibiotics. If the CRP is normal, these children could be discharged to follow-up in 1 day, whereas children with CRP values greater than 6 mg/L would be admitted.

Keywords

meningitispetechiaepurpuralumbar puncturepediatrics
Type
Knowledge Applied to Practice Application des connaissances à la pratique
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 479 - 482
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Van Nguyen, Q, Nguyen, EA, Weiner, LB.Incidence of invasive bacterial disease in children with fever and petechiae. Pediatrics 1984;74:77–80.CrossRefGoogle ScholarPubMed
2.Wong, VK, Hitchcock, W, Mason, WH.Meningococcal infections in children: a review of 100 cases. Pediatr Infect Dis J 1989;8:224–7.Google ScholarPubMed
3.Baker, RC, Seguin, JH, Leslie, N, et al.Fever and petechiae in children. Pediatrics 1989;84:1051–5.CrossRefGoogle ScholarPubMed
4.Mandl, KD, Stack, AM, Fleisher, GR.Incidence of bacteremia in infants and children with fever and petechiae. J Pediatr 1997;131:398–404.Google Scholar
5.Toews, WH, Bass, JA.Skin manifestations of meningococcal infection: an immediate indicator of prognosis. Am J Dis Child 1974;127:173–6.CrossRefGoogle ScholarPubMed
6.Dashefsky, B, Teele, DW, Klein, JO.Unsuspected meningococcemia. J Pediatr 1983;102:69–72.CrossRefGoogle ScholarPubMed
7.Yung, AP, McDonald, MI.Early clinical clues to meningococcaemia. Med J Aust 2003;178:134–7.CrossRefGoogle ScholarPubMed
8.Kuppermann, N, Malley, R, Inkelis, SH, et al.Clinical and hema-tologic features do not reliably identify children with unsuspected meningococcal disease. Pediatrics 1999;103:E20.Google Scholar
9.Brogan, PA, Raffles, A.The management of fever and petechiae: making sense of rash decisions. Arch Dis Child 2000;83:506–7.CrossRefGoogle ScholarPubMed
10.Wells, LC, Smith, JC, Weston, VC, et al.The child with a non-blanching rash: How likely is meningococcal disease? Arch Dis Child 2001;85:218–22.Google Scholar
11.Nielsen, HE, Andersen, EA, Andersen, J, et al.Diagnostic assessment of haemorrhagic rash and fever. Arch Dis Child 2001;85:160–5.Google Scholar