title: Suspected Brazilian purpuric fever in a toddler with overwhelming Epstein-Barr virus infection.
abstract: We describe a toddler from Connecticut who developed purulent conjunctivitis, fever, and a morbilliform rash. Blood cultures were positive for Haemophilus influenzae biogroup aegyptius; further investigation was performed to assess the possibility that the illness was consistent with Brazilian purpuric fever, which, to our knowledge, has not been reported in the United States. This isolate shared morphological and some biochemical characteristics with previously studied H. influenzae biogroup aegyptius strains but differed according to slide agglutination testing, plasmid characterization, and ribotyping. Blood and tissue samples obtained during his hospitalization were also positive for Epstein-Barr virus. The child died 8 days after hospitalization. Fifty other cases of invasive H. influenzae infection were identified by active surveillance studies. Of the 49 viable surveillance isolates, 10 were biotype III (two of which had the same ribotype as the strain from our case.
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: M
authors.initials: M
authors.lastname: Virata
authors.forename: N E
authors.initials: NE
authors.lastname: Rosenstein
authors.forename: J L
authors.initials: JL
authors.lastname: Hadler
authors.forename: N L
authors.initials: NL
authors.lastname: Barrett
authors.forename: M L
authors.initials: ML
authors.lastname: Tondella
authors.forename: L W
authors.initials: LW
authors.lastname: Mayer
authors.forename: R S
authors.initials: RS
authors.lastname: Weyant
authors.forename: B
authors.initials: B
authors.lastname: Hill
authors.forename: B A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D016470:Bacteremia / Q000382:microbiology; D015373:Bacterial Typing Techniques; D017809:Fatal Outcome; D006192:Haemophilus Infections / Q000150:complications* / Q000382:microbiology; D006193:Haemophilus influenzae / Q000145:classification* / Q000302:isolation & purification; D006566:Herpesviridae Infections / Q000150:complications* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D011693:Purpura / Q000150:complications*