The child with a non-blanching rash: how likely is meningococcal disease?

Aims-To examine a number of simple clinical features and investigations in children with a non-blanching rash to see which predict meningococcal infec tion. Methods-A total of 233 infants and children up to 15 years of age presentin g with a non-blanching rash were studied over a period of 12 months. Clinic al features and laboratory investigations were recorded at presentation. Th e ability of each to predict meningococcal infection was examined. Results-Eleven per cent had proven meningococcal infection. Children with m eningococcal infection were more likely to be ill, pyrexial (> 38.5 degrees C), have purpura, and a capillary refill time of more than two seconds than non-meningococcal children. Five children with meningococcal disease had a n axillary temperature below 37.5 degreesC. No child with a rash confined t o the distribution of the superior vena cava had meningococcal infection. I nvestigations were less helpful, although children with meningococcal infec tion were more likely to have an abnormal neutrophil count and a prolonged international normalised ratio. No child with a C reactive protein of less than 6 mg/l had meningococcal. infection. Conclusions-Most children with meningococcal infection are ill, have a purp uric rash, a fever, and delayed capillary refill. They should be admitted t o hospital and treated without delay. Children with a non-blanching rash co nfined to the distribution of the superior vena cava are very unlikely to h ave meningococcal infection. Measurement of C reactive protein may be helpf ul-no child with a normal value had meningococcal infection. Lack of fever at the time of assessment does not exclude meningococcal. disease.