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The most common cause of petechiae is through physical trauma such as a hard bout of coughing, holding breath, vomiting, or crying, which can result in facial petechiae, especially around the eyes. Excessive scratching and friction, especially on thin and poorly circulated parts of the body may also cause petechiae.
The onset of the illness is nonspecific with fever, rigors, vomiting, and headache. Soon a rash appears; first macular, not much different from the rose spots of typhoid, and rapidly becoming petechial and purpuric with a dusky gray color. Low blood pressure (hypotension) develops and rapidly leads to septic shock.
Other symptoms include: headache, nausea and vomiting, abdominal pain, [14] muscle pain, [15] or a scarlatiniform rash or palatal petechiae, the latter being an uncommon but highly specific finding. [13] Symptoms typically begin one to three days after exposure and last seven to ten days. [3] [13]
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Petechiae are seen on the chest, axilla, shoulder, and mouth. [5] Occulsion of dermal capillaries by the fat emboli result in petechial rash. Petechiae rash occurs in 50 to 60% of the cases. [7] Neurologic signs such as confusion, stupor, and coma may be present. These are usually temporary and do not happen on one side of the body.
Infectious mononucleosis mainly affects younger adults. [16] When older adults do catch the disease, they less often have characteristic signs and symptoms such as the sore throat and lymphadenopathy. [16] [26] Instead, they may primarily experience prolonged fever, fatigue, malaise and body pains. [16]
Abdominal pain and/or vomiting; Development of petechiae and/or purpura; No evidence of meningitis; History of conjunctivitis within the 30 days preceding the onset of fever; At least one of the following two tests negative for Neisseria meningitidis: Blood cultures taken before antibiotic administration; Serum or urine antigen detection[CDC]
Petechiae are often also present, but do not always occur; their absence does not negate a diagnosis of meningococcal disease. Anyone with symptoms of meningococcal meningitis should receive intravenous antibiotics prior to the results of lumbar puncture being known, as delay in treatment can greatly worsen the prognosis.
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