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Clinical Characteristics of Children With Viral Single- and Co-infections and a Petechial Rash

Schneider, Henriette MD*; Adams, Ortwin MD; Weiss, Christel ScD; Merz, Ulrich MD§; Schroten, Horst MD*; Tenenbaum, Tobias MD*

The Pediatric Infectious Disease Journal: May 2013 - Volume 32 - Issue 5 - p e186–e191
doi: 10.1097/INF.0b013e318280618d
Original Studies

Background: Children with petechial rash are more likely to undergo invasive diagnostics, to be treated with antibiotics for potential bacterial infection and to be hospitalized. However, viruses have also been associated with petechial rash. Nonetheless, a systematic analysis of viral infections with modern available techniques as quantitative real-time polymerase chain reaction in the context of petechial rash is lacking. The purpose of this pediatric study was to prospectively uncover viral pathogens that may promote the emergence of petechiae and to analyze the correlation with the clinical characteristics and course.

Methods: We conducted a prospective study in children (0 to 18 years) presenting with petechiae and signs or symptoms of infection at the emergency department between November 2009 and March 2012. In nasopharyngeal aspirates the following viruses were analyzed by quantitative real-time polymerase chain reaction: cytomegalovirus, Epstein–Barr virus, parvovirus B19, influenza A and B, parainfluenza viruses, human respiratory syncytial virus A and B, human metapneumovirus, rhinovirus, enterovirus, adenovirus, human coronavirus OC43, 229E, NL63 and human bocavirus.

Results: A viral pathogen was identified in 67% of the analyzed 58 cases with petechial rash. Virus positive patients showed a significantly higher incidence of lower respiratory tract infections. Forty-one percent were viral coinfections, which were significantly younger than virus negative patients, had a higher leukocyte count and were hospitalized for a longer time.

Conclusions: A petechial rash is frequently associated viral single- and coinfections and can rapidly be identified via quantitative real-time polymerase chain reaction.

From the *Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Heidelberg University, Mannheim, Germany; Institute of Virology, University Children’s Hospital, Heinrich-Heine-University, Düsseldorf, Germany; Department of Statistics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; and §Children’s Hospital St. Annastiftkrankenhaus, Ludwigshafen, Germany.

Accepted for publication November 28, 2012.

H.S. and O.A. contributed equally to this article and share first authorship.

The concept of the study was honored in 2011 by the German Society of Paediatric Infectious Diseases (DGPI) with an Investigator Award (5000 Euro). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Henriette Schneider, MD, Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.