Fever and rash
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Fever and rash






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    Fever and rash Fever and rash Presentation Transcript

    • introduction Common problem. vary from simple one to an early sign of a life-threatening condition . Mostly due to infection .
    • definitions Macule — Nonpalpable, circumscribed flat ,< 1 cm Papule — Palpable ,solid, elevated, < 1 cm Maculopapular -erythematous rash made up of both macular and papular lesions. Purpura — Papular or macular nonblanching lesions Nodule — Deep-seated, roundish < 1.5 cm Plaque — A palpable elevated > 1 Vesicle —elevated ,contains fluid ,<1 cm Bulla —vesicle > 1 cm Pustule —vesicle + pus
    • history Characteristics of the lesions Distribution and progression of the rash Timing of the onset in relation to fever Change in morphology, such as papules to vesicles or petechiae
    • History (important clues) Age of the patient Season of the year Travel history Exposures including to insects and ill contacts Medications Immunizations and history of childhood illnesses
    • Physical examination Vital signs General appearance lymph nodes. mucous membranes, conjunctivae, ABDOMIN: Liver and spleen size CNS: Meningeal signs CVS: murmur
    • DDx
    • Measles (rubeola)
    • Measles (rubeola) maculopapular rash beginning in the head and neck area and spreading centrifugally to the trunk and extremities; fever, cough, coryza, and conjunctivitis high-dose vitamin A does seem to decrease the morbidity and mortality
    • Important sign: Koplik’s spots
    • Chickenpox
    • Chickenpox is characterized by classic vesicular lesions on an erythematous base that appear in crops . present in different stages from papules through vesicles to crusting . Don’t underestimate few vesicles in era of vaccination
    • Rubella
    • Rubella not sick. prominent postauricular, posterior cervical, and/or suboccipital adenopathy. Treatment : supportive . 3 days measles
    • Rubella Clinical sign: Forchheimer’s sign. Petechiae on the hard palate
    • Erythema infectiosum (fifth disease)
    • Erythema infectiosum (fifth disease) Erythema infectiosum (fifth disease) is due to human parvovirus B19. rash with a "slapped cheeks" appearance Treatment: supportive . Pregnant and those with chronic hemolytic anemia at high risk
    • Roseola infantum ( exanthem subitum)
    • Roseola infantum ( exanthem subitum) a human herpesvirus 6 or 7 infection. primarily seen in infants. is characterized by high fever for three to four days followed by generalized maculopapular rash that spreads from the trunk to the extremities . Assosiated with febrile convulsion Fever then rash not at same time
    • Scarlet fever
    • Scarlet fever Caused by group A streptococcus (GAS) infection. manifested by a coarse, sandpaper-like, erythematous, blanching rash. This is accompanied by a strawberry tongue. Treatment: antibiotics you will feel it
    • Acute rheumatic fever (ARF)
    • Acute rheumatic fever The classic dermatologic manifestations of ARF are erythema marginatum transient macular lesions with central clearing found on the extensor surfaces of the proximal extremities and trunk. Less than 5 %
    • Kawasaki
    • Kawasaki a disease of unknown etiology. is usually seen in children less than 5 years of age. In addition to fever lasting >5 days, bilateral conjunctival injection. injected or fissured lips, injected pharynx or 'strawberry tongue' . erythema of the palms or soles, edema of the hands or feet or generalized or periungual desquamation. Don’t forget Rash. cervical lymphadenopathy . atypical
    • MYCOPLASMA Mild maculopapular rash. Eythema multiforme. Stevens –johnson syndrome.
    • Infectious mononucleosis
    • Infectious mononucleosis present with fever, sweats, anorexia, nausea, chills, sore throat, posterior cervical lymphadenopathy, splenomegaly, and a maculopapular rash. especially after the administration of ampicilin . Gentle abdominal exam
    • Bacterial endocarditis
    • Bactrial endocarditis mucocutaneous lesions include petechiae, splinter hemorrhages, Janeway lesions, and Osler's nodes Staph aurues is most common organisim
    • Meningococcal infection
    • Meningococcal infection In addition to fever, headache, and nausea, rash Early lesions may be macular, but rapidly increasing numbers of petechial or purpuric lesions can develop on the distal extremities and trunk, usually sparing the palms and soles ANTIBOTICS, ANTIBOTICS, ANTIBOTICS,