1. Fever
with
rash
UMA PERUMAL

2.  A rash is a visible lesion of the skin due to
disease.
 RASH AND FEVER The condition can be
a primary skin disorder or a symptom of a
systemic process.
 When considering the differential diagnosis of a
rash, it is important to be able to describe its
feature. Ask the child’s parents about the
appearance, because rashes often change with
time.
 Diseases that present with fever and rash are
usually classified according to the morphology of
primary lesion.

3.  MEASLES
 RUBELLA
 HAND
FOOT AND
MOUTH DIEASES

4. Morphology classification of
rash
 Maculapapular
 Petechial-purpuric
 Vesicular bullous pustular
 Nodular
 Diffusely erythematous with
desqumation.

6. Approach to children with fever
and rash
 Age
 Duration
 Associated symptoms- itching( chicken
pox)-fever(infectious causes)-Pain
 Progression of the rash
 Travel/ location
 Sick contacts
 Past medical history
 Medications
 vaccinations

7. Detail of rash
 Site of onset
 Direction of spread
 Presence or absent of purities
 Temporal relationship with fever and
rash
 Important to know any topical or oral
medication applied or not.

8. Look for
 Patient’s vital sign and general
appearance
 Sign of toxicity
 Lympho Adenopathy
 Oral, genital or conjunctiva lesion
 Hepato-splenomegaly
 Evidences of excoriation and tendrenss
 Sign of neck rigidity or neurological
dysfunction.
 The scalp and hair for : areas of
inflammation, scaling or hair loss.

9. Laboratory data
 Complete blood count with differential
erythrocyte sedimentation rate
 Blood and urine culture
 Biochemical analysis- liver function test
 Biopsy sample from non healing or
persistent purpuric lesion
 Biopsy of inflammatory dermal nodules
and ulcer
 Aspirate, scraping and pustular fluid may
be obtain for gram staining and culture

11. Measles
Etiology:
Specific RNA virus. Only one serotype
is known (life long immunity after
infection).
Essentials of Diagnosis:
-History of exposure 10-12 days
previously.
-3-5 days prodroma (fever,
conjunctivitis, coryza and cough).
-Koplik spots (Pathognomonic)
-Maculopapular confluent rash.

12. Mode of Transmission:
-Contact with secretions or droplets of an infected child.
Period of Infectivity:
-4 days prior to and 5 days after appearance of the rash.
Clinical Manifestations: An incubation stage 10-12
days
 Prodromal stage with an enanthem (Koplik spots), usually lasts
3-5 days. Koplik spots are grayish white dots on an
erythematous base on the anterior portion of the buccal mucosa.
With appearance of rash, Koplik spots start to disappear.
 Final stage starts with a maculopapular rash accompanied by
high fever. The rash starts behind the ears, and along the hairline.
Then the rash spreads on the face, neck, upper arms, and upper
part of the chest within the first 24 hours.
 On 2nd day. The rash appears on the back, abdomen, arms and
thighs.
 On 3rd day. It reaches the feet and begins to fade on the face.
 An abrupt drop in temperature to normal. The rash fades
downward in the same sequence in which it appeared

13. Diagnosis: Clinical features but Laboratory tests is rarely
needed.
 Leukocytic count tends to be low with a relative lymphocytosis.
Leucocytosis is indicative of secondary bacterial infection.
Complications: *The main complications of measles are otitis
media and pneumonia. *Encephalitis; *Diarrhea and dysentery.
*Corneal ulcer and stomatitis. *Activation of a tuberculous
focus. Supportive therapy: -Antipyretics
(paracetamol)
 Bed rest and an adequate fluid intake are indicated.
 A nourishing easily digested diet and proper cleanliness.
 Vitamin A: A single dose of 50,000 to 200,000 IU.
 A broad spectrum antibiotic in presence of infections.
Prevention: *Isolation should be maintained from the 7th day
after exposure until 5 days after the rash has appeared.
*Measles vaccine. *Post-exposure prophylaxis.
- Hemorrhagic measles - PEM

16. RUBELLA
Acquired
Rubella
Congenital
Rubella

17. Acquired Rubella
Etiology: Rubella virus (an RNA virus). Incubation
Period: 2-3 weeks.
Mode of Transmission:
• Droplet infection or direct contact with a case
Prodromal stage: Very short and mild that it goes
unnoticed.
Contagiousness: Not as contagious as measles.
– Virus is present in nasopharyngeal
secretions, blood, feces and urine.
– Virus has been recovered from the nasopharynx 7
days before exanthema and 7-8 days after its
disappearance.
– Infants with congenital rubella are contagious for
at least 10-12 months.

18. Clinical Manifestations:
• Age: Any age, peak incidence 5-14 years
• Lymphadenopathy is evident at least 24hr
before the rash appears.
• The exanthem begins on the face and spreads
quickly on the first day.
• 2nd day. The rash is confluent and pinpoint like
that of scarlet fever with mild itching.
• 3rd day. The rash generally disappears with
minimal desquamation and no scaring.
• Rubella without rash may occur as fever with
enlarged tender lymphadenopathy which may
persist for a week or more.

20. Complications:
Complications are relatively uncommon in
childhood.
 Encephalitis similar to that seen with measles
 Polyarthritis
Prophylaxis:
 Active immunization (MMR vaccine)
-MMR vaccine should not be given to pregnant
women; vaccinated women should avoid
pregnancy for 3 months after vaccination.
Natural infection gives life- long immunity.
 Passive immunization. It is not indicated
except in non-immune pregnant women.
Immune serum globulin (ISG) in big doses is
given I.M within one week of exposure.
Treatment:
1- Antipyretics for fever. 2- Treatment of

21. Congenital Rubella
If rubella develops during the first trimester of
pregnancy, (which is the period of organogenesis).
Transplacental congenital infection from infected
mother.
Features of congenital rubella syndrome:
1-Intrauterine growth retardation, small for
gestational age and failure to thrive
2-Nerve deafness
3- Microcephaly and mental retardation
4- Congenital heart disease (PDA, VSD)
5- Cataract, glaucoma, and cloudy cornea
6- Thrombocytopenic purpura, hepatosplenomegaly,
and osteopathy

22.  HFMD- Is common viral infection that
primarily effected infant and young
children under 10 years old. Its caused
by virus.
 Is an endemic disease in Malaysia.
 Become an important public health
disease due to its tendency to cause
large outbreaks and deaths among
children and infants.

23. Etiology agent
 Intestinal viruses of the picornaviridae famil
 Coxsacki virus A16
 Enterovirus 71 (EV71)
Incubation period
 3 to 7 days
 Preceded by fever
 Followed by blister/rash

24. Transmitted
 Direct contact – nose & throat secretion,
saliva, blister fluid, stool of infected
person
 Infected person are most contagious
during first week of illness
 Viruses may continued to be excreted in
the stools of infected person for up to a
month
 Usually active during autumn and
summer.

25. Clinical feature
 Begin with mild fever, poor appetite, malaise
and sore throat
 1 to 2 days after onset of fever, painful sores
develop in the mouth
-----Small red spots that blister, then often
become ulcer
------Tongue, gum and insides the cheek
 Non itchy skin rashes develop over 1 to 2 days
------Flat or raised red spots sometimes with
blister

26. Blister palm of the hand

27. Blister on dorsum and sole of the
feet

28. Complication
 uncommon.
 Enterovirus EV71
 neurological complications such as
aseptic meningitis and encephalitis.
 Cases of fatal encephalitis which
occurred during outbreaks of HFMD in
Malaysia in 1997 and in Taiwan in
1998 were caused by EV71.

29. Diagnosed
 Clinical finding
 Serological test
 Throat swab
 Stool culture

30. Treatment
 Symptomatic treatment
 Fever treated with antipyrexia
 Pain with analgesia
 Mouth washes to lessen the oral pain
 Adequate fluid intake- dehydration
 No specific effective antiviral and
vaccination

31. THANK YOU!!!