Purpuric rash and fever among hospitalized children aged 0–18 years: Comparison between clinical, laboratory, therapeutic and outcome features of patients with bacterial versus viral etiology

Moran Gawie-Rotman, Guy Hazan, Yariv Fruchtman, Yuval Cavari, Eduard Ling, Isaac Lazar, Eugene Leibovitz

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The evaluation of children with purpuric rash and fever (PRF) is controversial. Although many of them have viral infections, on occasion such patients may be infected with Neisseria meningitidis. We described all children aged 0–18 years with PRF in southern Israel during the period 2005 ̶ 2016 and compared their microbiologic, laboratory, clinical and outcome characteristics in relation to various etiologies of this syndrome. Methods: Data were summarized from electronic patient and microbiology files. Viral diagnoses were made by serology and/or PCR. Results: Sixty-nine children with PRF were admitted; 30 (43.48%), 9 (13.04%) and 30 (43.48%) had a syndrome of bacterial, viral or non-established etiology, respectively. N. meningitidis infection was diagnosed in 16/69 (23.19%) patients and in 16/30 (53.33%) patients with bacterial etiology; 14/30 (46.67%) patients suffered from a non-invasive bacterial disease (9 with Rickettsial disease). Adenovirus and Influenza B (3 and 2 cases, respectively) represented the most frequent etiologic agents among patients with viral etiology. More patients with PRF of bacterial etiology were older, of Bedouin ethnicity, looked ill on admission, had higher rates of meningitis and were treated more frequently with antibiotics compared with patients with non-bacterial PRF. Fatality rates among patients with bacterial, viral and non-established etiology were 5/30 (16.7%), 0% and 2/39 (5.1%). Conclusions: Although PFR was uncommon, high rates of meningococcal infections were recorded in children with PRF, which was associated with high fatality rates. Rickettsial infections were frequent, emphasizing the need for a high index of suspicion for this disease in endemic geographic areas.

Original languageEnglish
Pages (from-to)556-563
Number of pages8
JournalPediatrics and Neonatology
Volume60
Issue number5
DOIs
StatePublished - 1 Oct 2019

Keywords

  • N. meningitidis
  • bacterial infection
  • fever
  • purpura
  • viral infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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