headache, vomiting, and change in consciousness occur in up to 88% of patients with
meningococcemia (11,13).
The rash associated with meningococcemia begins within 24 hours of clinical illness. The
petechia enlarge rapidly, becoming papular and then purpuric. Lesions most commonly occur
on the extremities and trunk, but may also be found on the head and mucous membranes (5).
Table 5 Type of Rash Lesions
Macule A circumscribed, flat lesion that differs from surrounding skin by color. Patches are very large
macular lesions.
Papule A circumscribed, solid, elevated skin lesion that is palpable and smaller then 0.5 cm in diameter.
Plaque A large, solid, elevated skin lesion that is palpable and greater the 0.5 cm in diameter, often formed
by confluence of papules.
Nodule A circumscribed, solid, palpable skin lesion with depth as well as elevation.
Pustule A circumscribed, raised lesion filled with pus
Vesicle A circumscribed, elevated, fluid-filled lesion less then 0.5 cm in diameter
Bulla A circumscribed, elevated, fluid-filled lesion greater then 0.5 cm in diameter
Source: Adapted from Refs. 5 and 9.
Table 6 Etiology of Rash and Fever Based on Type of Rash
Purpura or petechiae
Meningococcemia
RMSF
Gonococcemia
Staphylococcal/pneumococcal sepsis
Pseudomonal sepsis
Bacterial endocarditis
Typhus
Allergic vasculitis
Echovirus 9
Measles
Centrally distributed maculopapular rash
Viral exanthems (rubeola, rubella, erythema infectiosum, roseola)
Lyme disease
Drug reactions
Peripherally distributed maculopapular rash
Erythema multiforme (Table 7)
Secondary syphilis
Diffuse erythema with desquamation
Scarlet fever
TSS
Scalded skin syndrome
KD
Ehrlichiosis
TEN
Streptococcus viridansbacteremia
Vesicular, bullous, or pustular rash
Varicella
Herpes zoster
Herpes simplex
Staphylococcus aureusbacteremia
Vibrio vulnificus
Rickettsia akari
Nodular rash
Erythema nodosum (Table 8)
Disseminated fungal infections (Candida, Cryptococcus, Blastomycosis, Histoplasma, Coccidioides,andSporothrix)
Nocardia
Mycobacteria
Abbreviations: KD, Kawasaki disease, TEN, toxic epidermal necrolysis; RMSF, Rocky Mountain spotted fever;
TSS, toxic shock syndrome.
Source: Adapted from Refs. 1, 3, 5, and 8.
Fever and Rash in Critical Care 23