Article
The child with a non-blanching rash: how likely is meningococcal
disease?
L C Wellsa, J C Smitha, V C Westonb, J Colliera, N Ruttera
a Academic Division of
Child Health, Queens Medical Centre, Nottingham NG7 2UH, UK, b Department of Microbiology, Queens Medical
Centre, Nottingham
Correspondence to: Prof. Rutter Nick.Rutter{at}nottingham.ac.uk
Accepted 14 May 2001
AIMS
To examine a number of simple
clinical features and investigations in children with a non-blanching
rash to see which predict meningococcal infection.
METHODSA total of 233 infants and
children up to 15 years of age presenting with a non-blanching rash
were studied over a period of 12 months. Clinical features and
laboratory investigations were recorded at presentation. The ability of
each to predict meningococcal infection was examined.
RESULTSEleven per cent had proven
meningococcal infection. Children with meningococcal infection were
more likely to be ill, pyrexial (>38.5°C), have purpura, and a
capillary refill time of more than two seconds than non-meningococcal
children. Five children with meningococcal disease had an axillary
temperature below 37.5°C. No child with a rash confined to the
distribution of the superior vena cava had meningococcal infection.
Investigations were less helpful, although children with meningococcal
infection were more likely to have an abnormal neutrophil count and a
prolonged international normalised ratio. No child with a C reactive
protein of less than 6 mg/l had meningococcal infection.
CONCLUSIONSMost children with
meningococcal infection are ill, have a purpuric rash, a fever, and
delayed capillary refill. They should be admitted to hospital and
treated without delay. Children with a non-blanching rash confined to
the distribution of the superior vena cava are very unlikely to have
meningococcal infection. Measurement of C reactive protein may be
helpfulno child with a normal value had meningococcal infection. Lack
of fever at the time of assessment does not exclude meningococcal disease.
Keywords: purpura; meningococcal infection
© 2001 by Archives of Disease in Childhood
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eLetters:
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- Petechiae or purpura in meningococcal disease
- Rod Phillips
- ADC Online, 28 Aug 2001 [Full text]
- reply to Dr Rod Phillips
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- ADC Online, 11 Sep 2001 [Full text]
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- ADC Online, 15 Oct 2001 [Full text]
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