Pediatric myth: fever and petechiae.
A child presenting with petechiae and fever is assumed to have meningococcemia or another form of bacterial sepsis and therefore to require antibiotics, blood cultures, cerebrospinal fluid analysis and hospital admission. A review of the literature challenges this statement and suggests that a child presenting with purpura (or petechiae), an ill appearance and delayed capillary refill time or hypotension should be admitted and treated for meningococcal disease without delay. Conversely, a child with a petechial rash, which is confined to the distribution of the superior vena cava, is unlikely to have meningococcal disease. Outpatient therapy in this context is appropriate. In other children, a reasonable approach would be to draw blood for culture and C-reactive protein (CRP) while administering antibiotics. If the CRP is normal, these children could be discharged to follow-up in 1 day, whereas children with CRP values greater than 6 mg/L would be admitted.
Klinkhammer
Martin D
MD
Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota, USA.
Colletti
James E
JE
D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005334:Fever / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008589:Meningococcal Infections / Q000175:diagnosis*; D011693:Purpura / Q000382:microbiology*; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology*
D002097:C-Reactive Protein