Diagnostic assessment of haemorrhagic rash and fever

Aims-To establish criteria for early distinction between meningococcal dise ase and other conditions with similar clinical features, and to identify ot her causes for haemorrhagic rashes accompanied by fever. Methods-In a prospective study, 264 infants and children hospitalised with fever and skin haemorrhages were studied. Results-We identified an aetiological agent in 28%:15% had meningococcal di sease, 2% another invasive bacterial infection, 7% enterovirus infection, a nd 4% adenovirus infection. Five clinical variables distinguished between m eningococcal disease and other conditions on admission: (1) skin haemorrhag es of characteristic appearance; (2) universal distribution of skin haemorr hages; (3) maximum diameter of one or more skin haemorrhages greater than 2 mm; (4) poor general condition (using a standardised observation scheme); and (5) nuchal rigidity. If any two or more of these clinical variables wer e present, the probability of identifying a patient with meningococcal dise ase was 97% and the false positive rate was only 12%. This diagnostic algor ithm did not identify children in whom septicaemia was caused by other bact erial species.