[Fever and skin hemorrhages in children--is it meningococcal disease?]

Area of Science:

• Pediatric Infectious Diseases
• Clinical Diagnostics
• Microbiology

Context:

• Distinguishing meningococcal disease from other febrile illnesses with haemorrhagic rashes is clinically challenging.
• Meningococcal disease can rapidly progress to severe outcomes if not promptly identified.
• Identifying causative agents of febrile haemorrhagic rashes is crucial for appropriate treatment.

Purpose:

• To establish criteria for the early distinction between meningococcal disease and similar conditions.
• To identify the specific causes of fever accompanied by skin haemorrhages in pediatric patients.

Summary:

• A prospective study of 264 hospitalized infants and children with fever and skin haemorrhages identified causative agents in 28% of cases.
• Meningococcal disease accounted for 15% of infections; enterovirus and adenovirus infections were also identified.
• Five clinical variables (characteristic haemorrhage appearance, universal distribution, >2 mm diameter, poor general condition, nuchal rigidity) effectively discriminated meningococcal disease.

Impact:

• An algorithm using two or more of these variables achieved 97% probability of identifying meningococcal disease with a 12% false-positive rate.
• This diagnostic approach aids in the early and accurate identification of meningococcal disease in children.
• The algorithm does not identify other bacterial causes of sepsis, highlighting the need for further diagnostic investigation in specific cases.