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...and, if criticized, to show that your actions were simply reasonable. -----Original Message----- From: Andy Lee [mailto:[log in to unmask]] Sent: 24 April 2007 23:46 To: [log in to unmask] Subject: Re: Kids with fine purpuric/petechial rashes. ---- Original Message ---- From: Margaret <[log in to unmask]> >The most recent meningococcus I saw was in a young boy with a few very >untypical spots (they were slightly raised above the skin - small papules) >which he'd had for 2-3 days. He'd vomited twice in the previous 24 hours and >was complaining of a headache. He didn't look that unwell, but he was sleepy >(though fully rousable). Something told me not to send him home, thank >goodness. The meningococcus was confirmed on blood cultures - I hadn't given >Pen V But given that there is still such uncertainty about why meningitis develops and theories include that it may be opportunistic in the presence of other infecting agents and the presence of a combination of factors that make the individual susceptible at that moment, these atypical presentations are just as likely to be due to non-meningococcal rashes that simply co-incidentally precede the development of meningitis in a person unfortunately susceptible on that occasion. The atypical spots are therefore not evidence of meningitis or predictive of it on these occasions. If the general condition of an individual causes concern, occasionally they will develop something more critical and when it doesn't cause concern occasionally they will develop something more critical. In the former case, we are hailed as wonderful and the latter castigated. The real challenge of being a GP is to cope with each with equal humility and calm. Andy