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Pediatric myth: fever and petechiae

Published online by Cambridge University Press:  21 May 2015

Martin D. Klinkhammer  and
James E. Colletti
Martin D. Klinkhammer
Affiliation:
Department of Emergency Medicine, Regions Hospital, Saint Paul, Minn.
James E. Colletti*
Affiliation:
Department of Emergency Medicine, Regions Hospital, Saint Paul, Minn. Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
*
200 First St. S.W., Rochester MN 55905; jamesecolletti@gmail.com

Abstract

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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.

Keywords

meningitispetechiaepurpuralumbar puncturepediatrics
Type
Knowledge Applied to Practice Application des connaissances à la pratique
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 479 - 482
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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