Fever with a purpuric skin rash. Meningococcemia

1. Fever with a Purpuric Skin Rash
Diagnosis and Differential Diagnosis
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. (God speaking to Prophet Muhammad (PBUH)
This (the Quran) is a clear statement for all the mankind,
and a guidance for those who are conscious of Allah (the pious
persons who love Allah and abstain from His disobedience)
Al Quran surah Al-Imran 2:138
Al- Quran

3. Fever with a Skin Rash
• Rash – widespread areas of altered skin
• Macule – an area of skin that is altered in color
• Papule – elevated solid palpable lesion < 1 cm
• Vesicle – fluid-filled lesion < 1 cm
• Purpura – bleeding into skin

4. Maculopapular Skin Rash
with or without Fever
Viral Infections
• Measles
• Rubella
• Roseola infantum
• Fifth disease
• Dengue fever
• Entero viruses
• Infectious
mononucleosis (EB virus)
Other causes
• Bacterial infections
• Scarlet fever
• Staphylococcal scalded
skin syndrome
• Immune-mediated
• Allergic Rash
• Drug Rash
• Erythema multiforme

5. Papular or Vesicular Skin Rash
with or without fever
Viral infections
• Varicella
• Herpes simplex / zoster
• Hand-foot-mouth
disease
• Molluscum contagiosum
• Small pox (eradicated)
Others
• Impetigo
• Scabies

6. Purpuric Skin Rash
with or without fever
Infections
• Meningococcal infection
• Infective endocarditis
• DIC
Blood / Vascular disorders
• ITP - thrombocytopenia
• Hemophilia
• Acute leukemia
• HSP
• Vasculitis

7. ITP – Idiopathic Thrombocytopenic Purpura

8. Meningococcal Infection
Epidemiology, Etiology
Clinical Features, Complications, Management
Prognosis and Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

9. Case scenario
• A 10 year old child is brought to your clinic with complaint
of high grade fever and skin rash for the last three days
• On examination, child has a temperature of 101 F.
• A Purpuric Rash visible as irregular patches is seen on the
body
• Child is lethargic
What is the most likely diagnosis ?

10. Meningococcal Infection
• Neisseria meningitides (Meningococcus) is a Gram – ve cocci
• Spreads by Droplet Infection in close contact
• Infection is common in adolescents
• It can cause –
• Meningococcemia with purpuric skin rash (DIC)
• Meningococcal meningitis
• Managed with Antibiotics
• Meningococcal diseases have high mortality

11. Meningococcemia – Purpuric Rash

12. Prevention
• Meningococcal Vaccine (serogroups ACWY)
• Given to children, adolescents and adults
• Can be administered to children starting at 9 months or at 2
years of age
• Should be given to adolescents at 11 – 12 years of age if not
given previously
• Two doses are given two months apart

13. Vaccination is Protection