Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Fever and Rash

3,487 views

Published on

A simplified guide to the most common diseases with fever & rash especially in pediatrics. The data have been trimmed as much as possible and focused on spot visual diagnosis of the disease.

Published in: Health & Medicine
  • Be the first to comment

Fever and Rash

  1. 1. By Ahmed Mo’ness 1
  2. 2. Character of “RASH” 2
  3. 3. 3
  4. 4. Important Questions with every “RASH” Blanching ? • Yes = infection/dermatological disease • No = purpera/petechie = blood/vessel disease Feverish ? • Yes = mostly systemic infection • No = mostly local dermatological disease 4
  5. 5. !! CAUTION !! Fever + Puperic rash (non blanching) = Meningococcemia till proved otherwise 5
  6. 6. MEASLES (Rubeola disease) • Fever (high ~ 40) • conjunctivitis + cough • koplik spots (2days before rash) (opposite 2nd molars) • rash = Cephalo-caudal (macules + papules) 6
  7. 7. 7
  8. 8. 8
  9. 9. 9
  10. 10. • Investigations – measles IgG , IgM • ttt – supportive + fluids + Vit.A (important) 10
  11. 11. RUBELLA (German Measles) • prodroma (not common) • Rash = as measles but not ill looking • LNs (post auricular, post cervical , sub occipital) • Forschemier spots (soft palate) (20%) 11
  12. 12. • inv – rubella IgG , IgM • ttt – supportive 12
  13. 13. MUMPS • prodroma • No rash • Parotitis / other salivery gland • complications = Meningitis/encephalitis, Orchitis/oophritis, Myocarditis, Pancreatitis, Sensory neural hearing loss • may present for the first time with one of the complications (e.g Meningitis) without any preceeding gland swelling 13
  14. 14. • Invistigations – mumps IgG , IgM – serum Amylase (parotitis or pancreatitis ) – CSF culture , CSF PCR • ttt – supportive + fluids + isolation 14
  15. 15. MMR Vaccine 12 month , 18 month , 6 y 15
  16. 16. Roseola Infantum (6th Disease) HIGH Fever 4 days suddenly disappears then rash begins (Rainbow after the storm) 16
  17. 17. • distribution = (trunk then extremities) = T-shirt distribution • typically occurs in 6- to 12- months child with high • ttt = supportive 17
  18. 18. Erythema Infectiosum (5th Disease) • Usually NO to Low grade fever • Rash appears in 2 phases 18
  19. 19. • Phase I – Slapped Cheeks • Phase II – Lace/Reticular like rash 19
  20. 20. • Complications : – if transmitted to a pregnant in 1st trimester = fetal anaemia + hydrops fetalis + fetal death – if affected a patient with haemolytic blood disease = Aplastic crisis ** Patient is Infectious only before rash ! • Invistigations – Human Parvovirus B19 IgG, IgM • ttt – supportive 20
  21. 21. Some History Pre-Vaccination Era • 1st = Measles • 2nd = Scarlet • 3rd = Rubella • 4th = SSSS (Dukes' disease) • 5th = Erythema Infectiosum • 6th = Roseola Infantum 21
  22. 22. Scarlet Fever • Fever • pharyngitis / tonsilitis • Strawberry tongue + circumoral pallor • Sandpaper-like skin rash • Pastia lines • Desquamation of the palms 22
  23. 23. 23
  24. 24. • Investigations – ASO , CBC (leukocytosis) , throat swap • ttt 24
  25. 25. Kawasaki Disease • Fever (high, resistant) at least 5 days with 4 of 5 findings : – Conjunctivitis – lips and mouth (fissured lips, strawberry tongue , red mouth mucosa) – Cervical LNs (usually unilateral) – Rash (any form , mostly non-vesicular) – Hand and foot swelling (later desquamation of fingers and toes tips) 25
  26. 26. 26
  27. 27. 27
  28. 28. Herpes Simplex • Type 1 = skin & mucus membranes Type 2 = genitalia (Sexually active adults or child abuse) • Cold sores (vesicular lesions in nasolabial fold) Gingivostomatitis (painful mouth ulcers + fever) Conjunctivitis + corneal ulcers Meningo-encephalitis (mainly neonates) Eczema Herpeticum (widespread vesicular skin lesion) 28
  29. 29. 29
  30. 30. Eczema Herpeticum 30
  31. 31. • Investigations – PCR , Culture • ttt – mainly supportive + topical lotions – Acyclovir • systemic (if sever disease/neonate) • local (oral/skin/eye preparations) 31
  32. 32. Chicken Box • Varicella-Zoster Virus Primary infection • no prodroma (usually) • Rash - itchy - vesicle + red base (macule then papule then vesicle / may crust ) - scalp , face , trunk , proximal limbs , palms , soles , mucus membranes 32
  33. 33. 33
  34. 34. • complications – 2ry bacterial infection = imptigo / cellulitis – spread of infection -> chest , heart , CNS – thrombocytopenia • ttt – mainly supportive + topical lotions – Acyclovir • systemic (if sever disease/neonate) • local (oral/skin/eye preparations) 34
  35. 35. Herpes Zoster • Varicella-Zoster Virus Reactivation • no prodroma (usually) • Rash = - painful - vesicle on red base - unilateral side of body = dermatome supplied by sensory nerve ** regional LNs may be present ** acute stage of the disease = pain only over the affected dermatome followed later by the rash 35
  36. 36. 36
  37. 37. • ttt – mainly supportive + topical lotions – Acyclovir • systemic (if sever disease/neonate) • local (oral/skin/eye preparations) 37
  38. 38. Impetigo • Most common bacterial skin infection • Strept / Staph A. / MRSA • Bullous – Thin walled , clear, yellowish Bullae later rupture without crusts. – May affect face / trunks / extremeties • Non-Bullous – More contagious – Crusts – Affect Perioral / Perinasal / Extremeties 38
  39. 39. 39 Bullous Impetigo
  40. 40. 40 Non- Bullous Impetigo
  41. 41. • ttt – Topical +/- Systemic ABs – Benzathine Penicillin (IM) or Co-trimoxazole (oral 3 days) 41
  42. 42. Acute Rheumatic Fever • Jones Criteria 42
  43. 43. 43
  44. 44. Erythema Multiforme • Self limited • Due to infections, Drugs • Minor form = affect skin only • Major form = affect skin + MM • Target lesion = pathognomonic • Arcuate lesions = atypical form 44
  45. 45. Target lesion Arcuate lesion 45
  46. 46. EM vs. SJS vs. TEN • Erythema multiforme = – Begin in extremities – Affect one or more mucus membranes (major form) – epidermal detachment involves less than 10% TBSA – Self-limited • Stevens-Johnson Syndrome – Begin in face & trunk – Affect one or more mucus membranes – epidermal detachment involves more than 10% TBSA – 5% mortality • Toxic Epidermal Necrolysis – As SJS – Involves more than 30% TBSA – 40% mortality 46
  47. 47. 47
  48. 48. Other diseases with fever & rash • SLE ( Malar rash ) • Hand, Foot & Mouth disease (HFMD) • Typhoid Fever ( 30% Rose Spots on abdomen) • IMN (10% any form of rash – mainly Morbilliform) • Lyme Disease (Erythema Migrans) 48
  49. 49. NUMBERS  Incubation Period  Fever timing to rash  Infectivity period + Mode of infection 49
  50. 50. • Measles * IP 1-2 weeks * Fever (high) 4 days then Rash * Infectious from fever to 4 days after rash * droplet • Rubella * IP 2-3 weeks * Fever (low) 5-10 days then Rash * Infectious from fever to 4 days after rash * droplet • MUMPS * IP 2-3 weeks * Infectious 9 days before to 9 days after Parotitis * droplet 50
  51. 51. • Chicken Pox (or varicella) * IP 2-3 weeks * Fever (low/absent) with Rash * Infectious 2 days before rash till crusting * droplet or vesicle discharge contact or indirect with objects soiled with vesicle discharge • Roseola Infantum / Sixth diseas / HHV 6 * IP 1-2 weeks * Infectious only before symptoms (rash/fever) * droplet • Erythema Infectiosum HPV B19 (5th disease) * IP 1-3 weeks * Infectious only before rash ! * droplet or vertical transmission (mother to fetus) 51
  52. 52. • HSV * IP 2-12 days * Fever with rash * Infectious up to 7 weeks after rash ! * droplet 52
  53. 53. THANKS 53

×