Although diagnosis of meningococcal disease is traditionally by Gram stain and culture of blood and cerebrospinal fluid, it's not widely appreciated that Gram stain and culture of smears from petechial
lesions are in most cases positive even after empiric antimicrobial therapy has begun and other sites are sterile, Dr.
At least two persons required hospitalization; four patients developed a petechial
rash; five had low white blood cell counts (1100-2500/[mm.sup.3] [normal: 3200-9800/[mm.sup.3]]); five had low platelet counts (42,00077,000/[mm.sup.3] [normal: 150,000-450,000/[mm.sup.3]]); four developed elevated liver function test results, and one patient showed hemoconcentration (hematocrit: 51%).
Symptoms developed 2 weeks after the wife's death, starting with a 5-day febrile syndrome, which progressed to a dry cough and then respiratory distress, with a petechial
rash, hemoconcentration, and thrombocytopenia (53,000 platelets/[micro]L) over the next 2 days.
The initial blanching macules, 1-4 mm in size, later become petechial
. A skin biopsy of the fresh blanching macules will reveal the bacterium Rickettsia rickettsii by immunofluorescence.
on March 9, she was hypotensive with numerous petechial
and purpuric lesions on her face, neck, trunk, and extremities she died 6 hours later.
Approximately 95%-100% of the lungs were affected, and all serous membranes showed petechial
and confluent hemorrhages.
Of 503 cases of meningitis in that study, 115 were associated with a seizure, and all of those had at least one other symptom suggestive of meningitis, such as nuchal rigidity prolonged focal seizure, multiple seizures, or petechial
The cause of petechial
rashes can be distressing to diagnose, but distribution of the rash and, more importantly, the history and clinical appearance of the child are the keys in deciding whether to perform a lumbar puncture.
Variable gross changes in other organs included multifocal hemorrhagic renal cortical infarcts and petechial
hemorrhages on lymph node surfaces.
The rash is petechial
but is limited to an area above the clavicular line only How would you approach this case?
Esophagogastroduodenoscopy revealed severe, erosive gastropathy with multiple petechial
hemorrhages and small erosions of the body and antrum.
Evidence of bleeding, including petechial
rash, positive tourniquet test result, and gum bleeding, were more common in patients with dengue, although they were also found in some patients with leptospirosis.