Presence Of Petechiae Research Articles

Post-mortem diagnosis of malaria in decomposed and embalmed body.

The diagnosis of malaria during the autopsy of a decomposed corpse may prove challenging. Macroscopic changes are non-specific and may include, among others, cerebral oedema, pulmonary oedema, hepatosplenomegaly and, on occasion, the presence of petechiae. The most effective diagnostic tools for malaria are the examination of blood smears and the use of rapid immunochromatographic tests. As a result of the progressive putrefaction of the corpse and blood hemolysis, classical tests are no longer viable. Consequently, the sole remaining option is the utilisation of real-time reaction (RT-PCR) to ascertain the presence of plasmodium DNA in specific organs. This study concerns the diagnosis of a fatal form of cerebral malaria in a 23-year-old Caucasian male who had travelled to Africa. The autopsy was conducted at a local hospital, after which the body was embalmed and stored in cold storage for a period of 8.5 months. Subsequently, the corpse was transported to Poland, where a further forensic autopsy was conducted. A significant challenge was to confirm the presence of malaria in a corpse that had been embalmed several months prior to the investigation. Samples were obtained from internal organs for genetic analysis to determine the presence of parasite DNA. An RT-PCR test was conducted on genetic material obtained from the brain, heart, lungs, kidney, liver, and spleen. The presence of Plasmodium falciparum genetic material was identified in samples obtained from the brain, lungs, kidney, liver, and spleen. These findings substantiated the post-mortem diagnosis of a severe form of cerebral malaria, which was the underlying cause of death.

Hyperleukocytosis in Pediatric Patients with Acute Lymphoblastic Leukemia: Demographic and Clinical Characteristics.

Background: Hyperleukocytosis, defined as a total leukocyte count of more than 50,000/mm3 leukocytes, occurs in almost one in five children with acute lymphoblastic leukemia (ALL). It represents an unfavorable prognostic factor in this disease. The aim of the following study was to describe demographic and clinical features in patients with hyperleukocytosis and their relationship with leukocyte count. Methods: We retrospectively analyzed the available medical data of patients with ALL diagnosed and treated at the University Children's Hospital in Lublin between 2017 and 2024. Results: Of the 97 patients, 10 (10.3%) had hyperleukocytosis. They were significantly more likely to be older boys diagnosed with T-ALL. The group with hyperleukocytosis had a higher mortality rate. The presence of hyperleukocytosis also correlated with the presence of petechiae, thrombocyte and neutrophil counts, and LDH activity. Patients with hyperleukocytosis also experienced a higher incidence of infections as a complication of therapy as leukocyte counts increased. Conclusions: Hyperleukocytosis, although rare, is an important factor in the course of ALL, both clinically and prognostically.

Therapeutic Approach in Pigmented Purpuric Dermatoses-A Scoping Review.

Pigmented purpuric dermatoses (PPD) encompass a group of chronic skin conditions characterized by the presence of petechiae, purpura, and pigmentation changes. While generally benign, these dermatoses can be persistent and aesthetically bothersome. Key clinical features include red to brownish patches with a distinctive "cayenne pepper" appearance, predominantly localized on the lower extremities, particularly the shins. Subtypes include Schamberg disease, Majocchi's disease, Gougerot-Blum disease, Ducas and Kapetanakis pigmented purpura, and lichen aureus. Diagnosis relies primarily on clinical evaluation of skin lesions, with biopsy as a confirmatory tool. Although the exact cause of PPD remains unclear, capillary fragility and red blood cell extravasation are implicated. Treatment strategies for PPD aim to alleviate symptoms, considering the generally benign and chronic nature of the condition. As there is no standardized treatment, various methods with varying efficacy are employed. After searching SCOPUS and PubMed databases, we assessed 42 original articles to present current knowledge regarding therapy of PPD. This review will compare treatment approaches specifically in Schamberg disease and other manifestations of pigmented purpuric dermatoses.

Co-infecção de patógenos transmitidos por carrapatos e Leishmania sp. em cães com sinais sugestivos para leishmaniose em uma área endêmica no nordeste do Brasil

ABSTRACT: The present study aimed to investigate the occurrence of Leishmania spp., hemotropic Mycoplasma spp., tick-borne pathogens (TBP), and co-infection in dogs with clinical signs suggestive of visceral leishmaniasis (VL). It also aimed to determine the factors associated with infection and to map the distribution of co-infected dogs in an endemic area in the Northeast region of Brazil. Blood samples from 168 dogs were evaluated for serological analysis to Leishmania spp., Anaplasma spp., Ehrlichia spp., Babesia spp., and molecular assays to Leishmania spp., Anaplasma platys, Ehrlichia canis, Babesia spp., and hemotropic Mycoplasma spp. In serological and molecular analysis, 29.8% and 5.9% of dogs were co-infected. In the regression analysis, seropositivity for Ehrlichia spp., Babesia spp., and Leishmania spp. was significantly associated with the presence of petechiae, young dogs, and weight loss. Serology revealed that co-exposure with Babesia spp. and Ehrlichia spp. was associated with fever and thrombocytopenia, and there was an association between seropositivity for Ehrlichia spp. and Babesia spp. in dogs seropositive for Leishmania spp. The presence of hemotropic Mycoplasma spp. DNA was associated with anorexia. Thus, dogs with clinical VL have co-infection with other pathogens, reinforcing the importance of this study for a better understanding of these co-infections in dogs from endemic areas.

Hypervirulent Strains of Neisseria meningitidis and Clinical Manifestations in Children With Invasive Meningococcal Disease.

Hypervirulent clonal complex (cc) have been associated with higher incidence and case fatality rate of invasive meningococcal disease (IMD). The aim of this study was to describe the clinical manifestations of the hypervirulent cc of meningococcus in children. Retrospective study in patients hospitalized by IMD microbiologically confirmed at three children's tertiary health care centers in Santiago, Chile, between 2010 and 2018. Demographic, clinical information and determination of the cc and factor H binding protein (fHbp) alleles were performed. In total 93 cases were evaluated, sequence typing was available for 91 cases, and 87 (95.6%) had a cc assigned; 63.7% were MenW and 31.8% MenB. The median age was 9 months, 67% were male and 18.7% had any comorbidity. A 26.4% presented neurological deficit, 25.3% petechiae and 20% diarrhea. Sixty-seven percent were admitted to the pediatric intensive care unit (PICU) and the case fatality rate was 9.9%. Regarding cc and fHbp alleles, ST11, ST41/44 and allele 22 were the most frequently identified, with 63.7%, 19.8% and 72.5%, respectively. We found statistically significant differences between the cc and presence of petechiae, diagnosis of meningococcemia plus meningitis, admission and days in PICU and advanced support. Allele 22 for fHbp was associated with the absence of petechiae, low suspicion of IMD, less diagnosis of meningitis+meningococcemia, PICU admission, advanced support and adrenal insufficiency. Epidemiological and microbiological surveillance of IMD should integrate clinical and laboratory components, including molecular and genetic characterization, to enrich the dynamic understanding of the clinical evolution of IMD.

Comparison of Multisystem Inflammatory Syndrome (MIS-C) and Dengue in Hospitalized Children.

ObjectiveMultisystem inflammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profile of children admitted with MIS-C and dengue were compared to understand their presentation at the outset.MethodsThis was a retrospective study of children ≤ 12 y admitted with MIS-C (WHO definition) or laboratory-confirmed dengue between August 2020 and January 2021 at a tertiary center in North India.ResultsA total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had significantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140 × 109/L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable.ConclusionIn hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.

Age clinical and laboratory features of primary Epstein-Barr viral infection in children

Aim: to delineate the clinical presentation and laboratory profile of primary Epstein-Barr viral infection (EBVI) in children.Materials and methods. A retrospective study was conducted on the demographic, clinical and laboratory data of 104 children with infectious mononucleosis due to Epstein–Barr virus (EBV) infection in children. The analysis included serologically confirmed cases – the presence of IgM to the capsid EBV antigen (VCA IgM) with the absence of antibodies to the nuclear EBV antigen (EBNA IgG).Results. The mean age of children was 4.0 (2.6; 9.0) years. The maximum hospital morbidity for infectious mononucleosis was observed in children from 2 to 5 years – 35.6 % whereas in patients from 12 years to 17 years – 19.2 %. The mean peak temperature was higher in young children. The rate of the cervical lymphadenopathy was significantly higher in adolescents compared with infants (P < 0.001). Tonsillitis syndrome was more commonly seen in children aged from 2 to 11 years (P < 0.05). Rash was detected in 22.1 % (n = 23) of children. The presence of petechiae was more common in older children. Hepatosplenomegaly syndrome was reported in 50 % of older children and only in 8.7 % of infants. Cytolytic syndrome was reported in 54.2 % of patients from 6 to 11 years and in 100 % of the adolescents from 12 to 17 years, although in infants it was only in 34.8 % (P < 0.001). Atypical mononuclear cells were detected in 8.7% of early age children and in 24.3–37.5 % of older children.Conclusions. Age differences were noted in clinical findings for cervical lymphadenopathy and splenomegaly, which were less common in children of the first 2 years. A significant difference in the incidence of hepatitis was found: with increasing age of the patient, the mean level of ALT increased significantly and gradually.

CUTANEOUS AND HEMORRHAGIC BLEEDING INJURIES OF THE IDIOPATHIC THROMBOCYTOPENIC PURPURA

The idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease of unknown cause being attributed by some authors as an immune response to some types of vaccine as a trigger of the disease. It is estimated that 10 in every 100,000 middle-aged individuals develop the disease. The first treatment choice is corticosteroids, and the diagnosis is performed with clinical evidence of bleeding, bruises, epistaxis, petechiae, and hematologic tests that confirm intense thrombocytopenia. This case report is about a melanoderma patient, 34 years old, who had a sudden appearance of bruising on various areas of the body and presence of petechiae and hemorrhagic blisters in the oral cavity. Hematologic examinations showed intense thrombocytopenia (30,000 platelets); the patient was treated with a corticosteroid and bevacizumab without adequate response and because it was a refractory disease, the patient underwent chemotherapy with vincristine leading to remission of the disease.

The role of the phylogeographic distribution of Rhipicephalus sanguineuson the spread of Rocky Mountain spotted fever in Arizona and Mexico

Rocky Mountain spotted fever (RMSF) is a rapidly‐progressing, tick‐borne, zoonotic disease caused by the bacterium Rickettsia rickettsii. Most of the symptoms of RMSF are flu‐like in nature; including fever, nausea, fatigue, and muscle weakness. The one non‐specific symptom is the presence of petechiae, but by the time they appear it is often too late. Even with treatment, RMSF can have a fatality rate of up to 35% and if left untreated it can rise to as high as 80%. In 2003, a new vector for RMSF was identified; Rhipicephalus sanguineus, or the brown dog tick. Unlike its Dermacentor counterparts, R. sanguineus is found nationally, yet is only known to act as a vector in the Arizona region. The number of cases in Arizona has been on the rise year over year and, perhaps more troubling, just south of the Arizona border, the number of cases in Mexico has surpassed 4000 in the last three years, with an annual fatality rate as high as 47%. Recently, the brown dog tick was indicated as the vector for this outbreak in Mexico. Therefore, understanding why R. sanguineus can act as a vector for RMSF in the Arizona region, but not elsewhere has become more urgent.We propose three hypotheses for the recent emergence of R. sanguineus as a vector for RMSF: (1) there exists a distinct sub‐population of R. sanguineus which better transmits R. rickettsii, (2) a distinct strain of R. rickettsii maintains more favorably in the R. sanguineus populations in this region, and (3) changing environmental factors and dog‐keeping practices in the Arizona region have contributed to the spread of RMSF.To test these hypotheses, we have partnered with the Midwestern Veterinary Mobile Clinic as well as the Arizona Animal Welfare League to collect brown dog tick and serum samples from 16 locations spanning Arizona, New Mexico, and Mexico. We isolated and sequenced 12S, 16S, and COX‐1 tick mitochondrial genes and used a maximum likelihood phylogenetic method on the concatenated sequences. To determine rickettsial prevalence, we tested for the rickettsial‐specific, rOmpA gene and sequenced it. Furthermore, immunofluorescence assay (IFA) was conducted on canine serum samples to evaluate canine anti‐rickettsial antibody seroprevalence in these locations. Finally, all these data were mapped on a geographic climate model. Results indicate variation in tick phylogeographic distribution, rickettsial prevalence rates ranging from 18% to 64% among sub‐populations of R. sanguineus, and seroprevalence rates as high as 33%, indicating areas with endemic levels of RMSF (&gt;15%). These data indicate that no single factor, but rather a confluence of factors drive the spread of RMSF in the region. With this data we can begin to predict and prevent future outbreaks of RMSF and improve canine and human health.Support or Funding InformationMWU One Health Award to JVB, MWU REAP Award to JVB, MWU CGS Funding to AO, Kenneth A. Suarez Award to SM

A retrospective cohort study to predict severe dengue in Honduran patients

BackgroundAn important challenge in the identification of dengue is how to predict which patients will go on to experience severe illness, which is typically characterized by fever, thrombocytopenia, haemorrhagic manifestations, and plasma leakage. Accurate prediction could result in the appropriate hospital triage of high risk patients. The objective of this study was to identify clinical factors observed within the first 24 h of hospital admission that could predict subsequent severe dengue.MethodsWe conducted a retrospective cohort study of 320 patients with febrile illness who had confirmation of dengue within one week of admission, using data from the 2009–2010 Honduras Epidemiological Survey for Dengue. The outcome measure was plasma leakage defined using hemoconcentration ≥15% as determined by serial hematocrit testing. We conducted univariable analysis and multivariable logistic regression analysis to construct a predictive model for severe dengue.ResultsThirty-four (10.6%) of patients in the 320 patient cohort had hemoconcentration ≥15%. In the final multivariable logistic regression model the presence of ascites, OR 7.29, 95% CI 1.85 to 28.7, and a platelet count <50,000 platelets/mm3 at admission, OR 3.02, 95% CI 1.42 to 6.42, were significantly associated with plasma leakage, while the presence of petechiae, OR 0.24 95% CI 0.080 to 0.73, and headache, OR 0.38, 95% CI 0.15 to 0.95, were negatively associated with leakage. Using an estimated probability of 7% as a threshold for a person being considered a severe case correctly predicted 26 of the 34 severe cases (sensitivity 76.4%) and 201 of the 286 non-severe cases (specificity of 70.3%) for a percentage correctly classified of 70.9%.ConclusionWe identified signs and symptoms that can correctly identify a majority of patients who eventually develop severe dengue in Honduras. It will be important to further refine our models and validate them in other populations.

Current Analysis of Hangings That Deviates From Recently Published Studies.

The constellation of injuries observed in hangings is a subject receiving frequent review in forensic pathology literature. Whereas recent studies have reported high concordance between hangings and internal findings such as strap muscle hemorrhages and hyoid bone and thyroid cartilage fractures, a 2-part study examining autopsied suicidal hangings over a 9-year period at the Wayne County Medical Examiner's Office produced markedly differing results. Retrospectively and prospectively, external and internal autopsy observations were correlated with factors such as age, sex, body height, body mass index, ligature, and height of suspension. In keeping with well-established forensic textbooks, nearly all cases displayed ligature marks and there was strong association between body position and the presence of petechiae. Diverging from contemporary articles, there was a distinctive paucity of internal injuries in both retrospective and prospective portions. Addressing concerns of confirmation bias, assessments confirmed the consistency in identifying and documenting injuries by the pathologists both retrospectively and prospectively.

Comparison of Clinical Findings and Rapid Streptococcal Antigen Detection Test in the Diagnosis of Group A Streptococcal (GAS) Pharyngitis

Background: Group A -hemolytic Streptococcal (GAS) pharyngitis is a common illness in children. Diagnosis and proper treatment of group A streptococcal sore throat is important particularly to prevent non-superlative sequel. Clinical findings continue to be used in differentiating streptococcal infection from viral sore throat. Objectives: The aim of this study was to evaluate the accuracy of clinical findings and rapid test in comparison with culture in the diagnosis of group A Streptococcal (GAS) pharyngitis. Patients and Methods: Ninety-four children between 3 to 16 years, who were referred to the pediatric clinic of Rasoul-e-Akram hospital with clinical findings of fever or sore throat were evaluated from October 2006 to May 2007. Clinical findings were recorded and swabs were taken for group A streptococcal cultures and streptococcal rapid antigen detection test. Analysis of statistical significance was performed using the chi-square method. The accuracy of clinical findings and rapid test was compared with the culture method as the gold standard, and sensitivity, specificity, positive predictive values, negative predictive value, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated. Results: The culture was positive in 38 (40.4%) of the 94 evaluated children. The mean age of children was 8 3.7 years. The presence of petechiae, exudate and Lymphadenopathy (LAP) was more likely in children with positive streptococcus culture and rapid test (P value < 0.05). Lymphadenopathy was known to feature the most sensitivity (100%), specificity (76.8%), and positive predictive value (74.5%), negative predictive value (100%) and positive likelihood ratio (LR) (4.3) among clinical findings. The results of rapid test showed sensitivity of 89.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 93.3% in comparison with culture as the gold standard. In general, the accuracy of rapid test was found higher than subjective clinical findings (P = 0.001). Conclusions: Although LAP had good performance in early diagnosis of GAS, a combination of clinical findings, including tonsillar exudates, petechiae with results of rapid antigen test or culture is necessary for clinician judgment. Throat culture is the gold standard test for detecting group A Streptococcal infection, but rapid test is a good replacement for culture.

Commentary

Commentary

Acute ITP presenting as gingival bleeding

The report is an interesting case of ITP which lead to continuous intermittent bleeding from gingival sulcus of right lower back teeth with multiple petechiae and ecchymosis of chest, upper – lower extremities, lips and buccal mucosa. A complete hemogram revealed Thrombocytopenia with platelet count as low as 22,000/mm3. The patient was immediately hospitalized and administered platelet replacement and medication. Signs such as generalized spontaneous gingival bleeding or the presence of petechiae and hematomas on body leads to suspicion of altered coagulation or bleeding disorder. This emphasizes the significance of clinical examination, early diagnosis and referral of such patients to specialized centers for prompt treatment.

Diagnosis and treatment of von Willebrand disease: new perspectives and nuances

In 1926, Erik von Willebrand, a Finnish internist andacademic, evaluated and described a 5-year-old girlwith extreme bleeding and bruising due to what hadbeen designated the A˚landic haemorrhagic diseaseby inhabitants of this archipelago island in the Gulfof Bothnia. Hjordis, the propositus, was the ninth of12 children born to a pedigree in which four femalesiblings had already died before the age of 4 withuncontrolled haemorrhage and in which 23 of 66family members, predominantly females, had expe-rienced significant bleeding and bruising complica-tions [1]. In fact, Hjordis herself eventually died atthe age of 13 during her fourth menstrual cycle.Professor von Willebrand mistakenly concluded thatthis bleeding diathesis was an unusual form ofhaemophilia and decided to label the new diseaseas pseudo-haemophilia to differentiate it from thesex-linked recessive haemophilia A. Little did vonWillebrand realize that this disease, eventually tobecomeeponymous[vonWillebranddisease(VWD)],would become the most commonly diagnosed con-genital bleeding disorder, with a prevalence rangingbetween 1 per 10 000 individuals to 1.3% [2]. Type1 VWD is the most common subtype, representingup to 75–80% of all cases while the subtype 3 VWDoccurs in approximately 1 per million population inthe United States and Europe [2]. Determination ofthe exact prevalence of VWD is hindered somewhatby the heterogeneity of clinical and diagnosticlaboratory features. Even Professor von Willebrandappreciated the challenges of diagnosing VWD as hecollaborated with Professor Rudolf Ju¨gens at theBerlin University to examine patients blood sampleswith a newly invented kapilla¨rtrombometer appa-ratus [3]. Although they were technically mistakenwhen they attributed the bleeding manifestations ofVWD to a platelet defect, their observations wereremarkably prescient since it was not until early1970s that the existence of a specific von Willebrandfactor (VWF) glycoprotein separate from factor VIIIwas finally appreciated and demonstrated to supportplatelet adhesion to the subendothelial matrix ofdamaged blood vessels.Over the last 81 years since von Willebranddescribed the bleeding disorder, there have beennumerous attempts and approaches to refine thediagnosis of the disease so that appropriate andefficacious treatment can be delivered. The clinicalphenotype of VWD includes, in part, information onwhether bleeding is spontaneous or related to surgi-cal or physical trauma; family history and inheri-tance pattern; menstrual history in women; age ofonset of bleeding (to distinguish between acquired vs.inherited coagulation disorders); and sites of bleed-ing(mucocutaneousvs.visceral,intra-articular,intra-muscular, or soft tissue locations). Subsequentlaboratory testing is necessary to exclude or confirmthe diagnosis and to further classify the subtype ofVWD. This article will focus on selected vagariesassociated with the ability to utilize clinical pheno-typic information gathered through the history andphysical examination to predict the presence ofVWD. The clinical diagnosis of VWD must be based,however, on more than physician suspicion andintuition. Thus, the need for confirmatory testing inthe laboratory. The frailties of conventional labora-tory testing for diagnosing VWD and the use of anin vitro surrogate of the bleeding time will also be

How useful is the presence of petechiae in distinguishing non-accidental from accidental injury?

Child abuse and neglect remains a significant cause of morbidity and mortality in children. Dermatologists may not fully conceptualize their crucial role in the evaluation of child abuse and neglect as both mandated reporters and experts in skin pathology. This CME article summarizes the current information on cutaneous signs and clinical signs of abuse for dermatologists so that they gain more insight into the skin examination for child abuse and neglect, develop confidence in their ability to distinguish dermatologic signs of accidental versus inflicted trauma, and more frequently consider abuse and neglect in their differential diagnosis.

Comparação entre métodos clínicos e laboratoriais no diagnóstico das faringotonsilites estreptocócicas

Diagnosis and correct treatment of group A streptococcal sore throat is important particularly to prevent non-suppurative sequelae. Clinical findings continue to be used to differentiate streptococcal infection from viral sore throat. The American Academy of Pediatrics recommends that streptococcal sore throat diagnosis should always be performed by microbiological identification methods. The aim of this study is to evaluate the accuracy of clinical diagnosis in comparison with culture and rapid test. Children aged 2 to 13 years who had received a clinical diagnosis of sore throat and sought treatment at the pediatric emergency unit of São Paulo Santa Casa were evaluated and those with clinical signs or viral infection were excluded. Clinical findings were recorded and swabs were taken for group A Streptococcus cultures and a Streptococcus rapid test. The culture was positive in 96 (24.4%) of the 376 children evaluated. The presence of petechiae, purulent exudate and painful tonsils were more likely to occur in children with positive streptococcus cultures, however they exhibited low diagnostic accuracy. The doctors' subjective evaluation failed to identify 21% of positive cases and antibiotics were prescribed in 47% of negative cases, compared with 3 and 6%, respectively, for the rapid test. A microbiologic method is necessary for the correct prescription of antibiotics in children with streptococcal sore throat.

Petechiae Are Frequent in Well Babies

Epidemiology| July 01 2002 Petechiae Are Frequent in Well Babies AAP Grand Rounds (2002) 8 (1): 9–10. https://doi.org/10.1542/gr.8-1-9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Petechiae Are Frequent in Well Babies. AAP Grand Rounds July 2002; 8 (1): 9–10. https://doi.org/10.1542/gr.8-1-9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: petechiae Source: Downes AJ, Crossland DS, Mellon AF. Prevalence and distribution of petechiae in well babies. Arch Dis Child. 2002;86:291–292. To determine the prevalence of petechial spots in well babies, these British investigators examined 116 infants under 12 months of age at child health surveillance clinics in the Sunderland area of Great Britain. The number and location of petechiae (defined as non-blanching red/purple lesions less than 2 mm diameter) and clinical details were recorded by 1 of 2 examiners. A total of 27.6% of babies had 1 or more petechiae, 8.6% had 2 or more, and 2.6% had 3 or more. There was no association of petechiae with preceding viral symptoms in these infants and none of them subsequently developed sepsis. Most of the petechiae (97.5%) were below the neck. The authors conclude that many well infants examined in the community are likely to have petechiae. As these authors point out, “it is clear that sick children with petechiae need to be managed on the assumption that they have meningococcemia.” However, it has not been so clear how we should manage well children with petechiae. These investigators provide useful data that argue for nonintervention in well children. Also, the distribution of petechiae below the neck was common in well infants. The widely held belief that petechiae below the nipple line are indicative of serious disease1 may not hold true in well-appearing infants without fever. This report should reassure pediatricians regarding the presence of 1 or 2 petechiae in a well-appearing, afebrile infant. However, the presence of petechiae in a febrile child represents a different problem altogether. As many as 10% of children with both fever and petechiae have serious bacterial illness.2,3 The presence of petechiae below the nipple line and ill appearance further increase the likelihood that one is dealing with a seriously ill child.1 While 1 or 2 petechiae in a well-appearing, afebrile infant need not prompt an aggressive approach, the child with fever and petechiae should be carefully and thoroughly evaluated for the presence of serious bacterial illness. You do not currently have access to this content.

Electrocution—autopsy study with emphasis on “electrical petechiae”

Fatalities caused by electrocution ( n=37) were re-examined on the basis of the autopsy records, the police reports and the technical expertise. Accidents including two lightning deaths caused 2/3rd and suicides 1/4th of the fatalities and there were two homicides. Carelessness or ignorance were a major reason for accidental deaths while technical defects could be verified in five cases only. Low-voltage ac and male victims predominated. Electrical burns or current marks were detected in 81% including all high voltage electrocutions. The seven victims lacking burns were electrocuted in a wet environment including six cases of suicide in the bathtub with a hair drier. Petechial haemorrhages were present in 74% of the cases and the favourite sites were the skin of the eyelids, conjunctivae, visceral pleura, and the epicard. The presence of petechiae did not depend on the voltage or the current pathway relative to the heart. It is, therefore, suggested that the petechiae are not caused by asphyxia but by a combination of venous congestion due to cardiac arrest and a sudden rise in blood pressure induced by muscle contractions. Consequently, “electrical petechiae” represent a non-specific but typical finding in electrocution irrespective of the mechanism leading to death. Unlike electrical burns, petechiae also indicate the vital origin of the events. The relevance of this typical morphological sign in the examination of possible electrocution fatalities is therefore emphasised.

First Report of Visceral Leishmaniasis In An Orthotopic Heart Transplant Recipient

First Report of Visceral Leishmaniasis In An Orthotopic Heart Transplant Recipient