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Most patients with petechial rash had viral pathogen
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Rapid testing may help identify viruses associated with petechial rashes, according to study results published online.
Henriette Schneider, MD, of the division of pediatric infectious diseases at the University Children’s Hospital Mannheim, Heidelberg University, and researchers from the Children’s Hospital of St. Annastiftskrankenhaus in Ludwigshafen, Germany, conducted a prospective study of 58 children who presented with both signs of respiratory infection and petechiae between November 2009 and March 2012.
Schneider and colleagues said most patients (67%) with rash also had a viral pathogen, and 41% were viral coinfections; the coinfections were found in significantly younger patients who had a higher leukocyte count and were hospitalized for a longer time.
“Due to efficient vaccination programs within Europe and the United States, herd immunity and herd protection against Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae improved,” the researchers wrote. “Consequently, the use of the clinical and diagnostic criteria set the era before the availability of elaborate viral diagnostics as [quantitative real-time polymerase chain reaction]and before the implementation of directed vaccination programs might lead nowadays in Europe and the USA to an overestimation of bacterial infections in such children with a petechial rash.”
Therefore, this makes rapid testing more important to help distinguish bacterial from viral causes, which may help reduce inappropriate antibiotic use, according to the researchers.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Patricia A. Treadwell, MD
I think the study impacts the daily practice of pediatricians because the results provide some direction for diagnoses to consider when a patient presents with a petechial eruption. The study documents the role of viral pathogens as etiologic agents for petechial eruptions. Appropriate work-up can be performed, possibly allowing for less invasive procedures. One issue to consider is the availability of the testing in various settings and the timeliness of receiving the results.
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