男孩，2岁，发热10天，为弛张热型，伴轻微咳嗽，抗生素治疗无效。入院前1天出现全身性淡红色斑疹，时隐时现。査体：浅表淋巴结无肿大，咽红无渗出物，心肺无异常，肝肋下4cm,质韧，脾肋下2cm。WBC25x109/L,中性粒细胞0.92,可见中毒颗粒，RBC4.6xlO12/L。住院9天内2次血培养均阴性。诊断应首先考虑为

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