Petechiae in children: Incidence, seasonal variations, and etiology

Abstract

NFORMATION in the literature is scant regarding incidence and pathoI ~enesis of petechiae in children, and nothing appears regarding their seasonal variations. These and related topics are discussed. A five-year survey was undertaken in various pediatric clinics at the New York Post-Graduate Medical School and Hospital of Columbia University. Counts were made of petechiae seen in children with frequent colds (chest clinic), allergy (allergy clinic), rheumatic symptoms (cardiac research clinic) and in children with a variety of complaints (general clinic). Altogether, counts were made on 503 clinic patients, 170 of whom were rheumatic. Area Covered in Count.--In 333 nonrheumatic children, petechiae were recorded for five areas: left and right upper extremity; chest, back, and head including neck; counts were totaled for each child. In 170 rheumatic children counts were made in only three areas : left and right upper extremity, and head, including neck. Repeat Counts.--In twenty-eight children with frequent colds and eightyone rheumatic children, counts were repeated at different seasons. A petechia may be defined as a pinpoint to pinhead red spot formed by the effusion of blood in the skin or mucous membrane2 Histo]ogic examination shows dilated small vessels, usually capillaries, just under the epidermis and in the upper and middle layers of the cutis, with only a relatively small amount of free hemorrhage in the surrounding tissues. The dilated vessels are filled with blood imparting the red color. 1 Petechiae appear in acute and chronic infections. Among the acute conditions are meningitis, Rocky Mountain spotted fever, typhus fever, severe scarlet fever, pneumonia, gonorrheal septicemia, scurvy, allergy, and virus diseases such as smallpox, measles, and German measles. Among the chronic conditions petechiae are encountered in bacterial endocarditis, purpura and leueemia. Petechiae have been observed to appear during menses, 2 with a sudden drop in barometric pressure, and in connection with twitching and athetoid movements of patients with scarlet fever, ~ rheumatic fever, and frequent colds. Petechiae contain the causative bacteria in meningitis and gonorrheal septicemia ;~ in other diseases, ~OXil~S are believed to rupture a vessel wall, as in endocarditis. ~ CHILDREN %VITH I~REQUENT COLDS