Fever and Petechiae/Purpura, and Rash

Question 1

Petechiae vs purpura

Answer 1

• Petechiae = pinpoint, non-blanching spots

- Purpura = larger, > 2mm non-blanching spots

Question 2

List some causes of fever with petechiae/purpura

Answer 2

• Infection
○ Viral(most common)
○ Bacteria(meningococcus, pneumococcus, hib)

• Non-infectious
○ HSP, HUS, ITP/plt function disorder
○ Leukaemia/bone marrow infiltration
○ Traumatic/mechanical
- local physical pressure e.g. tourniquet/BP cuff
- Coughing or vomiting leading to petechiae around the head and neck

Question 3

What is the most important cause to rule out? With what petechial/purpural feature should you consider it?

Answer 3

Ruling out meningococcal disease is top priority:

- Consider if unwell/purpura > 2mm (and not likely to be HSP)

Question 4

When can a child with a non-mechanical cause be discharged?

Answer 4

• 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 of 1/2 hour obs:
  • Well and
  • WCC 5 - 15x10^9/L and
  • CRP < 8 mg/L and
  • No deterioration in clinical state or progression of the rash over 4 hours

Question 5

What kinds of questions should you ask about a rash?

Answer 5

- Site
	• Inc. where it started -> spread
	• Widespread
	• Specific locations e.g. hand, mouth, legs, cheeks
- Quality 
	• Size? pinpoint/large?
	• Blanching/non-blanching
	• Erythematous/violet? Papular? Pin-prick? Vesicles? 

• Severity: feeding, sleep, school
• Time course esp. in relation to fever
• Rel/Agg: trauma? emollient/steroid?

Question 6

What is more predictive of sepsis in children: WCC or purpura?

Answer 6

Purpura

Question 7

DDx of rash +/- fever?

Answer 7

1. Viral exanthems (Roseola, Coxsackie, Parvovirus, Varicella, HSV, molluscum)
2. Streptococcal and staphylococcal disease
3. Urticaria
4. Eczema
5. Kawasaki disease
6. Congenital skin lesions (haemangioma)
7. Meningococcal
8. Cellulitis/erysipelas/necrotising fasciitis/TSS