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Fever and petechiae in children
R C Baker1, J H Seguin, N Leslie
1Division of Ambulatory and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH 45229.
Abstract:
A prospective study of patients with fever and petechiae was performed. Of 190 patients enrolled in the 1-year study, 13 (7%) had meningococcal disease. The most common bacterial association was Streptococcus pyogenes (19 patients). Viral infections were documented in 28 patients. Patients with invasive bacterial disease (group I) appeared more sick, were more likely to have signs of meningeal irritation, and were more likely to have petechiae on the lower extremities than those with less serious, nonbacteremic disease (group II). No patient in group I had petechiae only above the nipple line. Patients in group I had a significantly higher peripheral white blood cell count and absolute band form count. Although no laboratory test or physical finding was sufficiently sensitive to detect all patients with serious disease, the patient with abnormal cerebrospinal fluid, elevated white blood cell count, or elevated absolute band form count was at increased risk for invasive, bacterial disease. Conversely, the risk of serious disease was small if all of these values were in the normal range in the nonill-appearing child or if sore throat and clinical pharyngitis were present in the patient older than 3 years of age.
Insights
Meningococcal disease presents with fever and petechiae. Invasive bacterial infections, including meningococcal disease, show distinct clinical and laboratory signs compared to less severe illnesses.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Fever and petechiae in children can indicate serious infections.
- Differentiating invasive bacterial disease from less severe conditions is crucial for timely treatment.
Purpose of the Study:
- To identify clinical and laboratory predictors of invasive bacterial disease in patients presenting with fever and petechiae.
- To distinguish meningococcal disease and other serious bacterial infections from viral or non-bacteremic conditions.
Main Methods:
- Prospective study of 190 patients with fever and petechiae over one year.
- Clinical assessment, including physical examination and signs of meningeal irritation.
- Laboratory investigations: peripheral white blood cell count, absolute band form count, and cerebrospinal fluid analysis.
Main Results:
- Meningococcal disease was diagnosed in 7% of patients; Streptococcus pyogenes was the most common bacterial association.
- Patients with invasive bacterial disease (Group I) exhibited more severe illness, meningeal signs, and petechiae predominantly on lower extremities.
- Elevated white blood cell count, abnormal cerebrospinal fluid, and increased absolute band forms were associated with increased risk of invasive bacterial disease.
Conclusions:
- No single test reliably identifies all serious invasive bacterial infections.
- Certain clinical findings (e.g., petechiae distribution) and laboratory values (WBC, band forms, CSF) increase the suspicion for invasive bacterial disease.
- Normal laboratory values in a non-ill appearing child or specific symptoms like sore throat in older children may indicate a lower risk of serious illness.
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