In this section
Petechiae are pinpoint non-blanching spots. Purpura are larger non-blanching spots (>2mm).
There are many causes of fever and petechiae. These include:
All children with fever and petechiae should be reviewed by a registrar or consultant.
Indicators of meningococcal disease (or other serious bacterial infection) include:
Children should be considered unwell when they have the following features:
Important principles in the management of meningococcal disease include immediate fluid resuscitation, early administration of antibiotics (3rd generation cephalosporin) and involvement of intensive care staff.See Acute Meningococcal Disease Guidelines for details on the management of a child with suspected meningococcal disease.
Purpura > 2mm may be an indicator of meningococcal disease. If the clinical picture is suggestive of Henoch Schonlein purpura (purpura on the lower limbs and buttocks in a well child, with or without arthritis or abdominal pain), treat as per HSP guideline
Children who are well and have a clear history of a mechanical cause for their petechiae do not require investigation and may be discharged with review planned within 12 - 24 hours.Mechanical causes of petechiae are:
If there is any doubt about the aetiology of the petechiae, children should be managed as below.
Children with fever and petechiae who do not have a mechanical reason for their petechiae warrant blood tests as part of their management. Blood tests are useful to help in excluding other diagnoses such as ITP and leukaemia. They are also a way of stratifying risk.
Children with ALL of the following features have a very low risk of meningococcal disease and may be discharged from the emergency department after 4 hours observation:
NB. If there is any clinical deterioration or progression of the petechial rash during the 4 hours of observation, treat as per Acute Meningococcal Disease Guidelines
Management of these children is the same as above, although partially treated meningitis must be considered.
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