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Diagnostic assessment of haemorrhagic rash and fever
H E Nielsen1, E A Andersen, J Andersen
1This paper is also published in the journal Ugeskrift for Laeger Paediatric Department, Gentofte Hospital, N. Andersensvej, 2900 Hellerup, Denmark. Hanie@gentoftehosp.kbhamt.dk
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.
Methods:
In a prospective study, 264 infants and children hospitalised with fever and skin haemorrhages were studied.
Results:
We 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.
Insights
Early diagnosis of meningococcal disease in children with fever and haemorrhagic rash is possible. Five clinical signs, including characteristic rash and nuchal rigidity, accurately identify meningococcal disease with 97% probability.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Distinguishing meningococcal disease from other febrile illnesses with haemorrhagic rashes is critical for timely treatment.
- Meningococcal disease can rapidly progress to severe outcomes if not identified promptly.
Purpose of the Study:
- To develop criteria for the early differentiation of meningococcal disease from similar conditions.
- To identify the causes of fever accompanied by haemorrhagic rashes in children.
Main Methods:
- A prospective study involving 264 infants and children hospitalized with fever and skin haemorrhages.
- Analysis of clinical variables present at admission to identify distinguishing features.
Main Results:
- An aetiological agent was identified in 28% of cases: 15% meningococcal disease, 7% enterovirus, 4% adenovirus, and 2% other invasive bacterial infections.
- Five clinical variables (characteristic rash appearance, universal distribution, rash diameter >2mm, poor general condition, nuchal rigidity) predicted meningococcal disease with 97% probability if two or more were present.
- The diagnostic algorithm showed a 12% false positive rate and did not identify other bacterial causes of sepsis.
Conclusions:
- A combination of specific clinical signs can reliably distinguish meningococcal disease in children presenting with fever and haemorrhagic rash.
- This diagnostic approach aids in early identification, though other bacterial causes require separate consideration.