Features and outcome in meningococcal disease presenting with maculopapular rash.

Abstract

Sixty nine patients with meningococcal disease some of whom presented with a maculopapular rash were entered in a prospective multicentre study. The clinical and laboratory features of children presenting with maculopapular rashes were compared with those of children presenting with typical haemorrhagic rashes. Of the 69 children 26 (38%) developed maculopapular rashes; nine (13%) had a maculopapular rash only, and the remaining 17 had a mixed maculopapular-purpuric rash. Twelve of the 17 (7%) had less than 12 petechiae. Children with maculopapular rashes had significantly higher platelet counts (median 294 compared with 243x 10I), and plasma total haemolytic complement activity (80.5 compared with 65-0 U/mi) and significantly lower Glasgow meningococcal septicaemia prognostic scores (2.5 compared with 5.5) than those with purpuric rashes on admission. There were no significant differences between the groups in mortality, white celi count or absolute neutrophil count on admission, or C reactive protein concentration.Meningococcal disease can present with a maculopapular rash alone but this does not necessarily mean that the disease is less severe.

Meningococcal disease and its management in children

“…The classic features may be preceded by viral infection-like non-specific symptoms. Up to 30% of children with meningococcal disease may present with a non-specific maculopapular rash (fig 6), although most will have non-blanching elements 13. Differentiating the nonblanching rash of meningococcal disease from viral rashes is almost impossible.…”

Recognition, Treatment and Complications of Meningococcal Disease

“…3). [21] This rash is seen in up to 38% of cases of meningococcal disease [22] and significantly decreases the chance of a GP diagnosing meningococcal disease. [18] …”

Prise en charge des lésions des parties molles du purpura fulminans chez l’enfant

“…Le PF, observé dans 27,5 % de ces infections, doit être craint dès qu'il existe une seule lésion purpurique (ne s'effaçant pas à la vitropression) ou une éruption maculo-papuleuse [15] associée à un syndrome infectieux. C'est pour cette raison que l'enfant fébrile doit être examiné totalement dévêtu.…”

“…Ces matrices, dont la prise est favorisée par la thérapie par pression négative, permettent aussi une couverture solide de certains moignons d'amputation [8]. Les lambeaux locaux sont de réalisation délicate lors du PF, la qualité de la microcirculation étant difficile à évaluer et les tissus avoisinants de mauvaise qualité [15]. Des lambeaux libres ont été décrits pour la couverture osseuse et articulaire lors de sauvetages de membres [36,37].…”