Incidence of bacteremia in infants and children with fever and petechiae

J Pediatr. 1997 Sep;131(3):398-404. doi: 10.1016/s0022-3476(97)80065-0.


Objective: We determined the incidence of serious invasive bacteremia caused by Neisseria meningitidis and other organisms in febrile infants and children with a petechial rash. Further, we studied the diagnostic value of laboratory and clinical finding in these patients.

Study design: We conducted this prospective cohort study in the emergency department of an urban pediatric teaching hospital, during an 18-month period, and enrolled consecutive patients with temperature of 38 degrees C or higher and petechiae. Our measures included (1) laboratory tests (leukocyte count, coagulation profile, blood culture, and cerebrospinal fluid bacterial culture); (2) a questionnaire requesting clinical data including general appearance, number and location of petechiae, and presence or absence of purpura; and (3) a follow-up telephone survey documenting health status.

Results: A total of 411 patients were enrolled, with 57.7% between 3 and 36 months of age. Eight patients (1.9%) had bacteremia or clinical sepsis. Six had serious invasive bacteremia: N. meningitidis (two patients), group A streptococcus (one), or sepsis with negative culture results (three). Two had occult bacteremia caused by Streptococcus pneumoniae and no evidence of sepsis. No patient had a positive cerebrospinal fluid culture result. None of the 357 well-appearing patients (95% confidence interval: 0.0%, 1.0%) had serious invasive bacteremia. Fifty-three patients appeared ill, including all six with serious invasive bacteremia. Ill appearance of the child had a sensitivity of 1.00 (95% confidence interval: 0.60, 1.00), and a leukocyte count of 15,000 or greater, or of less than 5000, had a sensitivity of 1.0 (95% confidence interval: 0.53, 1.00) for detecting serious invasive bacteremia. All children with meningococcemia had purpura.

Conclusions: Invasive bacteremia occurred less frequently in our study than in previous series and was identified by clinical criteria. Our data support the treatment of selected well-appearing children with fever and petechiae as outpatients.

MeSH terms

  • Adolescent
  • Age Distribution
  • Bacteremia / complications*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Fever / microbiology*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Meningococcal Infections / complications*
  • Neisseria meningitidis*
  • Pneumococcal Infections / complications*
  • Prospective Studies
  • Purpura / microbiology*
  • Streptococcal Infections / complications*
  • Streptococcus pyogenes*
  • Surveys and Questionnaires