Petechial Fever. 



i8i 



Course and Duration. These vary much with the severity of 

 the case. In subacute and tardy cases with few petechise and 

 restricted swelling in the limbs, the symptoms become remittent 

 and recovery finally takes place after one or two months. In 

 other cases the morbid phenomena which developed rapidly may 

 subside as quickly and recovery occurs in a few days. In the 

 more typical case the visible lesions may encrease or remain 

 stationary for one, two or three weeks and then terminate in 

 death or recovery. In the most violent types death may occur 

 within forty-eight hours. The average duration of the affection 

 is found to be about i6 days. 



Differential Diagnosis. In typical cases of petechial fever, 

 diagnosis is easy. The supervention on a protracted or debili- 

 tating disease of the respiratory passages of an access of hyper- 

 thermia, and marked prostration, with the appearance on the 

 nasal or other mucosa of petechiae and swellings of a dark red 

 color throughout, and of cutaneous swellings in the form of 

 nodular elevatioiis and more extended salient patches, having a 

 tendency to ooze blood or serum, to crack and fissure, is virtually 

 pathognomonic . 



Acute glanders may resemble it but lacks the extended sloughs 

 of petechial fever, and the nasal ulcers that form in glanders are 

 on a yellowish base and periphery, whereas the purpura ulcer is 

 on an uniformly dark red base, and without the elevated margin 

 seen in glanders. In cases of doubt the mallein test is not avail- 

 able as the purpuric patient is already fevered, or liable to be so at 

 any moment, and any wound in such a subject will give rise to 

 extensive swelling. 



In glanders the nodular submaxillary enlargement is almost 

 pathognomonic and still more so if the facial lymphatic vessels are 

 thickened (corded) and both symptoms fail in purpura. In cu- 

 taneous glanders with swollen joints or limbs the attendant pain 

 is much more severe, and the farcy buds, forming on the thick- 

 ened and indurated lymph vessels, bursting and discharging an 

 albuminoid fluid like oil have no counterpart in petechial fever. 

 In cases of doubt the search for the glander bacillus, and above 

 all the inoculation of a male Guinea pig in the flank and the dis- 

 covery of the bacillus mallei in the resulting exudate and diseased 

 testicle will decide. 



