Case 7:

“Pesteng Lamok”
 “PESTENG LAMOK”
 A 7 year old male child has been having
fever (maximum 390C) for the past 4
days.This was associated with generalized
body malaise, chilliness, headache and
muscle pains. A few hours before
admission, he complained of severe
abdominal pain. Two other classmates
were hospitalized earlier for the same
complaints.
 “PESTENG LAMOK”
 PE showed a febrile child withRR
26/min.; HR 110/min.; congested posterior
pharyngeal walls with several petechiae
on the hard palate, few petechiae on the
axilla and chest. Chest and abdominal
findings were essentially normal. He was
given IVF and CBC and platelet counts
were requested
 Guide Questions
1. What conditions will manifest with fever
and petechiae/purpura?
2. What is the most likely diagnosis of this
patient?
 Q1:
What conditions will
manifest
with fever and
petechiae/purpura?
 Fever and Petechiae
 Dengue fever & Dengue Hemorrhagic fever
 Meningococcemia
 Streptococcal pharyngitis
 Infective endocarditis
 Other viral infections: Infectious mononucleosis,
atypical measles, CMV infection and enteroviral
infection
 Noninfectious causes: drug reaction, Henoch-
Schonlein purpura, Hemolytic uremic syndrome
and leukemia
 Q2:
What is the most likely
diagnosis of this patient?
 Fever and petechiae
 The differential diagnosis will involve an
investigation of historical and
epidemiologic data,
etiologic agent and
a study of the clinical course as to the
 presence of prodromal manifestations,
 the progress of the rash and the
 presence of pathognomonic signs
 1. Meningococcemia
 The patients with purpuric
rashes often develop septic
shock or DIC while patients
with macular or petechial
rashes are likely to have a
better prognosis
 Meningeal signs may be
present but meningococcemia
can occur without meningitis

Purpura necrotica Meningococcemia

 Meningococcemia
 In the fulminating case,
death occur within hours
from overwhelming
toxemia and
uncontrollable shock –
(Waterhouse-
Friderichsen Syndrome)

 Bleeding into internal

organs occurs from
extensive capillary
damage and DIC

Adrenal hemorrhage
 Prognostic indicators for
Meningococcemia
1. Shock
2. Hyperpyrexia
3. Rapid progression of petechial skin
lesions
4. Leukopenia
5. Absence of CSF pleocytosis
 Diagnosis
 Meningococcemia is suspected
from the clinical picture of an
acute febrile illness with rapidly
progressive purpura involving
the skin and mucous
membranes esp. with
accompanying meningeal signs
 Direct film or smear from
biopsy of a purpuric lesion on
the skin
 Definitive diagnosis is achieved
by positive blood culture
2. Dengue Fever and Dengue
Hemorrhagic Fever