Diagnostic assessment of haemorrhagic rash and fever. Issue 2 (1st August 2001)

• Record Type: Journal Article
• Authors: Nielsen, H E; Andersen, E A; Andersen, J; Böttiger, B; Christiansen, K M; Daugbjerg, P; Larsen, S O; Lind, I; Nir, M; Olofsson, K
• Is Part Of: Archives of disease in childhood. Volume 85:Issue 2(2001)
• Page Start: 160
• Page End: 165
• Publication Date: 2001-08-01
• Subjects: meningococcal disease -- petechiae -- enterovirus -- adenovirus; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/adc.85.2.160
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : AIMS: 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.