Fever and Petechiae

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Basics

Description

  • Petechiae
    • Small hemorrhages (<3 mm in size) into the superficial layers of the skin
    • Manifest as a reddish purple, macular, nonblanching skin rash
  • Purpura
    • Larger skin hemorrhages (>3 mm in size)
    • Often macular like petechiae but may be raised or tender

Epidemiology

  • Most patients (70–80%) presenting with fever and petechiae have defined or presumed viral infections, which are often caused by enteroviruses or adenovirus.
    • Parvovirus B19 may also be responsible for many cases of fever and generalized petechiae in children.
  • Approximately 0.5–11% of children presenting with fever and petechiae will have an invasive bacterial disease, most commonly Neisseria meningitidis.
    • Infants and toddlers are at greatest risk of having an invasive bacterial infection with fever and petechiae.
    • Teenagers and young adults are most commonly affected by outbreaks of meningococcemia, presenting with fever and petechiae.
  • Streptococcal pharyngitis may cause fever and petechiae in the well-appearing child.
  • Other etiologies, such as acute leukemia, idiopathic thrombocytopenic purpura (ITP), and Henoch-Schönlein purpura (HSP), are responsible for a minority of cases of fever and petechiae.

General Prevention

  • Vaccine recommendations
    • All children should complete the Streptococcus pneumoniae and Haemophilus influenzae type B immunization series that begins at 2 months of age.
    • Routine childhood immunization with meningococcal vaccine is recommended for all children at 11–12 years of age and a booster dose at 16–18 years of age.
    • Infants and children at high risk for meningococcal disease such as those with asplenia or terminal complement deficiencies should receive meningococcal vaccine as early as 2 months of age.
    • Annual immunization against influenza viruses is recommended for all children >6 months of age.
  • Chemoprophylaxis is recommended for close contacts of patients with meningococcal disease. Ideally, treatment should begin within 24 hours; rifampin is the drug of choice in most children (dosing <1 month of age: 5 mg/kg PO every 12 hours × 2 days, ≥1 month of age: 10 mg/kg PO every 12 hours × 2 days). Alternatives include ceftriaxone, ciprofloxacin, and azithromycin.

Pathophysiology

Petechiae may result from several different mechanisms:

  • Disruption of vascular integrity—due to infections, vasculitis, or trauma
  • Platelet deficiency or dysfunction—typically thrombocytopenia due to sepsis, disseminated intravascular coagulation (DIC), ITP, or leukemia
  • Factor deficiencies, although these are more likely to manifest as ecchymoses or deep bleeding

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Basics

Description

  • Petechiae
    • Small hemorrhages (<3 mm in size) into the superficial layers of the skin
    • Manifest as a reddish purple, macular, nonblanching skin rash
  • Purpura
    • Larger skin hemorrhages (>3 mm in size)
    • Often macular like petechiae but may be raised or tender

Epidemiology

  • Most patients (70–80%) presenting with fever and petechiae have defined or presumed viral infections, which are often caused by enteroviruses or adenovirus.
    • Parvovirus B19 may also be responsible for many cases of fever and generalized petechiae in children.
  • Approximately 0.5–11% of children presenting with fever and petechiae will have an invasive bacterial disease, most commonly Neisseria meningitidis.
    • Infants and toddlers are at greatest risk of having an invasive bacterial infection with fever and petechiae.
    • Teenagers and young adults are most commonly affected by outbreaks of meningococcemia, presenting with fever and petechiae.
  • Streptococcal pharyngitis may cause fever and petechiae in the well-appearing child.
  • Other etiologies, such as acute leukemia, idiopathic thrombocytopenic purpura (ITP), and Henoch-Schönlein purpura (HSP), are responsible for a minority of cases of fever and petechiae.

General Prevention

  • Vaccine recommendations
    • All children should complete the Streptococcus pneumoniae and Haemophilus influenzae type B immunization series that begins at 2 months of age.
    • Routine childhood immunization with meningococcal vaccine is recommended for all children at 11–12 years of age and a booster dose at 16–18 years of age.
    • Infants and children at high risk for meningococcal disease such as those with asplenia or terminal complement deficiencies should receive meningococcal vaccine as early as 2 months of age.
    • Annual immunization against influenza viruses is recommended for all children >6 months of age.
  • Chemoprophylaxis is recommended for close contacts of patients with meningococcal disease. Ideally, treatment should begin within 24 hours; rifampin is the drug of choice in most children (dosing <1 month of age: 5 mg/kg PO every 12 hours × 2 days, ≥1 month of age: 10 mg/kg PO every 12 hours × 2 days). Alternatives include ceftriaxone, ciprofloxacin, and azithromycin.

Pathophysiology

Petechiae may result from several different mechanisms:

  • Disruption of vascular integrity—due to infections, vasculitis, or trauma
  • Platelet deficiency or dysfunction—typically thrombocytopenia due to sepsis, disseminated intravascular coagulation (DIC), ITP, or leukemia
  • Factor deficiencies, although these are more likely to manifest as ecchymoses or deep bleeding

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