Diagnostic assessment of haemorrhagic rash and fever

Author:

Nielsen H E,Andersen E A,Andersen J,Böttiger B,Christiansen K M,Daugbjerg P,Larsen S O,Lind I,Nir M,Olofsson K

Abstract

AIMSTo 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.METHODSIn a prospective study, 264 infants and children hospitalised with fever and skin haemorrhages were studied.RESULTSWe 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.

Publisher

BMJ

Subject

Pediatrics, Perinatology and Child Health

Reference20 articles.

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