The recent description, in the American Journal of Diseases of Children1 of "dust-like" petechiae associated with streptococcal pharyngitis brings three questions to mind. First, why hasn't the association been made previously? The second and third questions relate to the clinical characteristics and etiology of the lesions, respectively.
Although many physicians have claimed to be aware of the association, there is little if anything in the literature to substantiate these claims. The classic description of streptococcosis by Powers and Boisvert2 and later clinical studies make no mention of petechiae, other than those seen on the palate.
The clinical characteristics of these petechiae, their size, color, distribution, and lack of elevation, are unlike the purpura manifest by illness such as meningococcemia. The presence of exudative tonsillitis together with the absence of signs of meningeal irritation mitigate against the diagnosis of meningitis. Although all cases of streptococcal pharyngitis with petechiae will