Non-blanching rashes in the UK

The epidemiology of meningococcal disease is changing in the UK. It is now a rare cause of non-blanching rashes in children presenting to the emergency department. All paediatricians will have been faced with a child with a non-blanching rash. The dilemma is well rehearsed: should this child have invasive investigations and administration of intravenous antibiotics in order to treat possible meningococcal disease or should they simply be observed for some time or indeed discharged with a clinical diagnosis of probable enterovirus without any intervention. The risk is of course, missing severe sepsis and the possible unnecessary death of a child vs inflicting many more children to unnecessary investigations, over treatment with antibiotics and unnecessary hospital admission and cost and contributing to the more global issue of antimicrobial resistance. Waterfield T et al [Lancet Infectious Disease 2020 https://ift.tt/37idFwh(20)30474-6] have published a magnificent study of over 1500 children recruited...

from Archives of Disease in Childhood current issue https://ift.tt/2Wb5oE7