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At 20:10 23/04/2007, you wrote: >I suspect that the purpuric rash in a child with NOTHING else is innocent, >especially in the common situation, of a parent having noticed it the night >before and ambled down to the surgery for an opinion. The purpura of >septicaemia means that DIC is occurring and that really is happening to an >ill child. I've seen this in many kids in the days when I worked at a >regional ID unit, some had no fever, but all looked sick. Of the two in GP ( >only two, thank God) both were sicker than the objective findings would have >you believe. > >Now, what we need to do is persuade the powers that be that A GP's eye, and >opinion on clinical diagnosis, are valuable. Generally agree, but I've had a patient, many (very) years ago, walked in with URTI in late teens or early 20s. I listened to his chest (young and enthusiastic) there was no pneumonia or asthma, but a clear petechial rash on his chest. Did not give Penicillin, sent to A&E. Discharged without Ix. His Mum took him back to the hospital about 8 hours later (middle of night) when she was worried about him. He had one of the somewhat more indolent meningococcal septicaemias. Diseases don't read textbooks (or perhaps they sometimes read the very small print). If the rash is there, even if they seem fairly well, they need referral. Nine out of ten won't be meningococcal, and perhaps some of these patients could get better by themselves, but life doesn't always provide second chances. Julian