Diagnostic assessment of haemorrhagic rash and fever.
OBJECTIVE
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.
Nielsen
H E
HE
This paper is also published in the journal Ugeskrift for Laeger Paediatric Department, Gentofte Hospital, N. Andersensvej, 2900 Hellerup, Denmark. Hanie@gentoftehosp.kbhamt.dk
Andersen
E A
EA
Andersen
J
J
Böttiger
B
B
Christiansen
K M
KM
Daugbjerg
P
P
Larsen
S O
SO
Lind
I
I
Nir
M
M
Olofsson
K
K
D000258:Adenovirus Infections, Human / Q000150:complications / Q000175:diagnosis; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004769:Enterovirus Infections / Q000150:complications / Q000175:diagnosis; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008589:Meningococcal Infections / Q000150:complications* / Q000175:diagnosis; D009127:Muscle Rigidity / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D011693:Purpura / Q000209:etiology*; D018709:Statistics, Nonparametric