QUICK Presentation to make differential diagnosis of infectious disease which Present with Rash

1. Differential diagnosis of skin rash
Infectious diseases
Nikolaos Giannakopoulos
Paraskevi Labrou
Clerkship course of Infectious Diseases
Plovdiv Medical University 2018

2. There are no conflicts of interests to declare

3. Contents

A)The purpose of this presentation

B)Introduction about skin rashes and its
imprortance in infectious disease

C)objective to direct our thought by examing a
skin rash in infectious disease

4. 
D)The aim is to start treat and not wait.

E)Summary

5. Introduction

A)Infections diseases which obligatory includes
a skin through its course called Eruptive
Infections

B)Those which is not obligatory but noticeable

6. How to direct our mind which rash
matches to specific disease?

A) Rash morphological characteristics

B)Rash evolution time.

C)Rash dynamic evolution
1)Accompaning symptoms
2)Subjective finding
3)Remaining findings

7. Infectious disease according to rash
A)Maculo-papular rash
1)Morbilli
2)rubeola
3)Scarlatina
4)Erythema infectiosoum
5)Exanthema subitum

8. Infectious disease according to rash
2)Vesicular rash
− 1)Varicella
− 2)Herpes zoster
3)Hemorrhagic rash
-1)Hemmoragic fevers
− 2)Menningococcemia

9. Infectious disease according to rash

4)Atypical rash
1)Marseilles fever
− 2)Abdominal typhus
− 3)Typhus exanthematicus

10. Maculo-Papular rash
Morbilli

Morbilli:Rash pattern starts on face and
descents IS non Pruritic then progress with
confluency

Accomplanyng syndrom is Coryza,Conjuctivitis

Cough AND Koplik's spots on mouths mucosa
Evolution :Benign course remain only cooper
skin hyperpigmentation EXCEPTION is
HEMMORAGIC MORBILLI OF INTERNAL
ORGANS

11. Morbilli

12. Maculo papular rash
Rubella

Rubela :Starts on face with prodromal
lymphonodular theodor (symptom) syndrome
Forscheimer's spots on oral mucosa and is non
pruritic not conflent progression

Rash type is rosy-red maculopapular at
extensors site of upper-lower limps

RUBELA IN PREGNANCY AND
CONGENITAL RUBELLA*

13. Rubella

14. Maculo-Papular rash
Erythema infectiosum

E.Infectiosum:Non specific prodromal
symptoms Rash starts from face with typical
erythema rash at face lips chest which fast
evolves to butterfly fly-like erythema plaques

Then evolves to maculopapular rash at
extensors of llimps

Finally rash starts to involute became pale from
its center Geographic like pattern

15. Erythema infectiosum

16. Maculo-Papular rash
Roseola infantum

R.Infantum Abrupt onset of Hyperpyrexia and
rash appers at third day maculopapular NOT at
face NOT at limps BUT on TRUNK .Frequent
we found Nagayama Uvula Spot

17. Roseola infantum

18. Can you differentiate those rash
patterns?

19. Can you Spot the spots

20. Maculo-papular rash
Scarlet fever

Scarlet fever :Prodromal syndrome triad
Fever,throat pain and vomiting Rash appear as
rose round tip of needle like size maculi
predilection sites are folds axillary, groin folds

Specific symptoms such as in facies
scarlatinosa The Filatov's triangle. Hecht
symptom Pastia symptom and Rumbel-Leede
symptom

21. Scarlet fever

22. Strawberry tongue

23. Vesicuar rash
Varicella /HZV

Varicella/HZV :Abrupt onset of disease
together with rash Which pass through Macula-
papula-vesicula stage very fast appers
centripedally at trunk / head and mucosa called
enanthem lead to erosions and aptha with size
as a lentin.

24. VZV/HZV

HZV:Reactivation of VZV after primary
exposure Prodromal syndrome includes
subferbrility paresthesia pain rash appear as
grouped vesiculas/bullas at dermatotome
segment which the vzv has reactivaed. Could
be also in mucosa surfaces

25. VZV/HZV

26. Hemorrhagic rash

Present at hemorrhagic viral fevers At congo
hemorrhagic fever present with bleeding gums
with edemas and ivy color

hemorrhagic fever with nephotic syndrome red
hemorrhagic rash at pharyx skin of face and
chest conjactiva and eye bleeding

27. Meningococcemia
Acute meningococcal sepsis

Meningococcemia rash appears as
Hemorrhagic/Necrotic and apperas with
edematous rash edges at buttocks and limps
literally could appear everywhere in body
When this happens to internal organs specially
Friderischsen-Waterhouse syndrome or
Meningococcal sepsis .

28. Hemorrhagic rash

29. Atypical Rashes

Abdominal Typhus: Rash appear 1-2 mm size
roseoli with characteristic location upper
abdomen and lower chest

Typhus exanthematicus:Prodromal Fever reach
up to 40 degrees headache small pink macules
appear abrupt and gradually cover all body
later become petecheal black and
hemmorrhagic

30. Atypical rashes

31. Referances:1)Practical manual of infectious
diseases : Topic Infectious diseases with rash
syndrome Author of topic доц.О.Бойкинова under
the reduction of проф. М.Стойчева
2) The Merck Manual 19th
edition