Article
Diagnostic assessment of haemorrhagic rash and fever
H E Nielsena, E A Andersene, J Anderseng, B Böttigerf, K M Christiansenc, P Daugbjergb, S O Larsenh, I Lindg, M Nirb, K Olofssond
a This
paper is also published in the journal Ugeskrift
for Læger Paediatric Department, Gentofte
Hospital, N. Andersensvej, 2900 Hellerup, Denmark, b Paediatric Department, Glostrup Hospital, c Paediatric
Department, Holbæk Hospital, d Paediatric
Department, Næstved Hospital, e Paediatric Department, Nykøbing Falster
Hospital, f Department of
Virology, Statens Seruminstitut, Denmark, g Neisseria Department, Statens Seruminstitut,
Denmark, h Biostatistical Departments, Statens
Seruminstitut, Denmark
Correspondence to: Dr Nielsen Hanie{at}gentoftehosp.kbhamt.dk
Accepted 8 January
2001
AIMS
To establish criteria for
early distinction between meningococcal disease and other conditions
with similar clinical features, and to identify other causes for
haemorrhagic rashes accompanied by fever.
METHODSIn a prospective
study, 264 infants and children hospitalised with fever and skin
haemorrhages were studied.
RESULTSWe identified an
aetiological agent in 28%: 15% had meningococcal disease, 2% another
invasive bacterial infection, 7% enterovirus infection, and 4%
adenovirus infection. Five clinical variables distinguished between
meningococcal disease and other conditions on admission: (1) skin
haemorrhages of characteristic appearance; (2) universal distribution
of skin haemorrhages; (3) maximum diameter of one or more skin
haemorrhages greater than 2 mm; (4) poor general condition (using a
standardised observation scheme); and (5) nuchal rigidity. If any two
or more of these clinical variables were present, the probability of
identifying a patient with meningococcal disease was 97% and the false
positive rate was only 12%. This diagnostic algorithm did not identify
children in whom septicaemia was caused by other bacterial species.
Keywords: meningococcal disease; petechiae; enterovirus; adenovirus
© 2001 by Archives of Disease in Childhood
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