8/6/2023 0 Comments Pinpoint bleeding5,6 In a retrospective review of 129 hospitalized children with fever and petechiae, 20% had culture-proven bacterial infection, one-half of which was due to N. 4 More recently, it has been recognized that bacterial causes of fever and petechiae are relatively uncommon. Early studies focused on hospitalized children reported an incidence of meningococcal disease in 7% to 11% of children with fever and petechiae and a case-fatality rate of 10%. Historically, the presence of fever and petechiae in a child required evaluation for meningococcal infection. 3 When petechiae occur on the nail bed, they appear as red-brown, longitudinal discolorations under the nail plate and are called “splinter hemorrhages”. Petechiae can occur in “crops”, are seen commonly in BSIs, and usually occur with fever and as an early clinical sign in BSI. The appearance of petechiae or purpura in a febrile patient raises the concern for an infectious etiology ( Box 73-1). Because these latter lesions are not the result of extravasated blood, applying pressure with a glass slide to blanch the vessels (diascopy) can help differentiate petechiae from other vascular lesions. In certain cases, petechiae can be difficult to differentiate from telangiectases and angiomas. Petechiae resolve in 2 to 3 days also but can evolve into macular purpura, ecchymoses, palpable purpura, vesicles, pustules, or necrotic ulcers, depending on the underlying etiology and clinical course. For the remainder of the chapter, “petechiae” will be used to include all macular purpuric lesions <1 cm in size. Both are the result of extravasation of blood from capillaries. Lesions of macular purpura are larger than petechiae but smaller than ecchymoses. Petechiae are small, ≤4 mm in diameter, non-blanching purpuric macules that can appear on the skin, conjunctiva, retina, and mucous membranes. Eichenfield, in Principles and Practice of Pediatric Infectious Diseases (Fourth Edition), 2012 Petechiae and Macular Purpura
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