Age of child.
Temporal relation of fever with rash.
Site of onset—distribution—direction—
Morphology of rash
Is patient in shock ?
Travel to endemic areas
Full exposure in natural light.
consistency,margins, surface characteristics.
If only exposed areas involved?
Involvement of genitals/mucous membrane.
Maintenance of vitals.
Isolation of patient
Stop offending drugs (if any).
Specific treatment acc to etiologies
MORPHOLOGY SMALL <0.5 CM LARGE >0.5CM
Normal texture macule patch
Indurated plaque plaque
solid papule nodule
Fluid filled vesicle bulla
Pus filled pustule pustule
IP—8 to 12 days.
Period of communicability.
Rash starts from face &
Diagnosis mostly clinical
- mild measles in people with partial
◦ Usually children vaccinated prior to age
12 months +/- coadministered
immune serum globulin or
◦ Persons receiving immunoglobulin.
-Rash begins peripherally and moves
centrally in persons receiving formalin
Respiratory infections-otitis media
Abdominal pain – appendicitis due to swelling of
Encephalitis (most serious)
Late onset: subacute sclerosing pan encephalitis
Activation of a tubercular focus.
Febrile seizures (<3%).
No specific treatment
Avoid intense light (for photophobia)
IV ribavirin .
Vitamin A .
single dose of 2 lacs iu oral- >1 yr.
1 lac iu oral -6 m to 1 yr.
if opthalmologic evidence –repeat dose next
day & 4 wks later.
-6 m to 2yrs hospitalised with measles &
- >6 m not received vit A & with risk factors.
immunodeficiency,clinical e/o vit A
def,impaired intestinal absorption,moderate to
severe malnutrition,migration from endemic
German measles/3 day
IP—2 to 3 weeks.
Most contagious-2 days
prior to 6 days after rash
Face neck trunk.
Arthritis-clasically small hand joints
Progressive rubella panencephalitis.
Others – GBS, peripheral neuritis,myocarditis.
Infection in utero: congenital rubella
◦ If infection in 1st trimester – 90% of fetuses
◦ After 16 wks of gestation –defects uncommon even
if fetal infection occurs.
Infants with CRS may shed virus in
nasopharyngeal secretions and urine for more
than 1 year – can easily transmit virus
Features of congenital rubella syndrome:
1-Intrauterine growth retardation
small for gestational age and
failure to thrive
3- Microcephaly and mental
4- Congenital heart disease (PDA, VSD)
5- Cataract, glaucoma, and cloudy cornea
6- Thrombocytopenic purpura.
IP-5 to 15 days
Children >6 months.
Abrupt high fever.
Fever resolution by CRISIS
Rash develops after fever dissipates-rainbow following the
Mainly on trunk-rash fades within 3 days.
Febrile seizure (10% of pts)
HHV-6 can cause meningoencephalitis or
Multiorgan disease can occur in
◦ Bone marrow suppression
Herpes virus varicellae
IP- 10 to 21 days
Spreads centripetally,symmetrical,mucosa &
axilla involved,spares palm &
Scab formation after 4-7 days.
Fever rises with each fresh crop of rash
Period of communicability is 2 days before
and 7 days after lesions crusted over
Secondary infections (staph/strep) most
common; may be life threatening with toxic
shock syndrome/necrotizing fasciitis
Varicella gangrenosa – thrombocytopenia with
Encephalitis (cerebellar ataxia may occur
Primary varicella in pregnant woman fetal
◦ Low birthweight, cortical atrophy, seizures, mental
retardation, chorioretinitis, cataracts, intracranial
Children exposed in utero to VZV may
develop zoster without varicella
◦ Occurs in newborns of mothers
with varicella (not shingles) 5 days
before or 2 days after delivery
◦ Child born prior to maternal
antibody response develops
◦ Treat infants ASAP with varicella zoster immunoglobulin
Oral acyclovir- indications
◦ Healthy nonpregnant teenagers and adults
◦ Children > 1 yr with chronic cutaneous or
◦ Patients on chronic salicylate therapy
◦ Patients receiving short or intermittent courses of
Dose: 80 mg/kg/day in four divided doses
for 5 days
VZIG (1 vial/5 kg IM) :
◦ Pts on high dose steroids
◦ Immunocompromised without a history of CP
◦ Pregnant women
◦ Newborns exposed 5 days prior to birth and 2 days
◦ Neonates born to nonimmune mothers
◦ Hospitalized premature infants < 28 weeks’
Human parvovirus B19.
IP-4 to 14 days.
Preschool and young
school age children.
Prodrome minimal or absent
Slapped cheek syndrome with circumoral pallor.
Lacy reticular pattern on fading.
Rash lasts for 1 to 3 weeks. Waxing and waning course.
Spread is respiratory
Initial viremia at 7-10 days; mild flu-like illness
Patients are only contagious up to presence of rash
◦ Arthritis: F>M, older>younger
◦ Aplastic crisis: usually not noticed in patients
with normal erythrocyte half-life BUT results
in severe anemia in those with any chronic
hemolytic anemia (rash follows hemolysis)
◦ Pregnancy: early miscarriage, late hydrops
◦ GLOVES & SOCKS SYNDROME-
Vasculitis of unknown etiology
Multisystem involvement and inflammation of
small and medium sized arteries with
More common among children of Asian
Usually children <5 years; peak 2-3 years.
3 CLINICAL PHASES-acute,
Coronary artery thrombosis and coronary artery aneurysm(25%)
Congestive heart failure
Hydrops of gall bladder
Sterile pyuria (urethritis)
IV Immunoglobulin (mechanism unknown)
◦ Single dose of 2 g/kg over 12 hours
Aspirin 80-100 mg/kg/day divided q 6hrs until
Aspirin 3-5 mg/kg od until 6-8 wks after illness
CORONARY ABNORMALITIES (long term therapy)
Aspirin 3-5 mg/kg od +/- clopidrogel 1mg/kg
max upto 75 mg/day,
ACUTE CORONARY THROMBOSIS.
prompt fibrinolytic therapy.
Aedes aegyptii-daytime,urban,collections of
Dengue like disease-chikungunya, o’nyong-
nyong, westnile fever.
IP-1 to 7 days.
Sudden onset of high grade fever.
Back break fever.
C/F in first 2 days ,2-6 days,after 1-2 days of
Multiple types of dengue virus.
Dengue 3 virus- severe clinical syndrome..
Relatively mild 1st phase with rapid clinical
deterioration & collapse after 2-5 days.
Hepatomegaly may be seen.
Positive tourniquet test.
20-30% - Dengue shock syndrome.
10%-gross ecchymosis/gastrointestinal bleed
Bed rest, supportive treatment, Aspirin C/I.
1. IVF NS>RL.
2. If pulse pressure <10mm Hg/elevn of
3. avoid overhydration.
4. serial hematocrit determin & vitals
IP-7 to 14 days.
Stepladder rise of fever (rare).
Maculopapular rashes/rose spot in 25%
Rose spot difficult to appreciate in dark
Acute, self limited illness,oral
IP-30 to 50 days.
Major jones criteria.
Trunk, upper arms,legs
never on face
Maculopapular, raised edges
central clearing,circular shape
Erythrogenic toxin producing
group A -hemolytic
1 to 2 days after pharyngitis
Rash from neck- trunk- extremities,blanches on
Petechiae in linear form.
More intense along elbow,axilla,groin creases.
Fade in 4 to 5 days with desquamation 1st face
Warm Sandpaper like skin
White and red strawberry tongue
Treatment –penicillin or erythromycin
Usually sudden onset of
fever,chills, myalgia, and arthralgia
Rash is macular, nonpruritic,
on extremities,relative sparing of child’s body
Petechial rash develops in 75% of cases
• Complications: permanent CNS damage, deafness,
seizures, paralysis, cognitive deficits,fever, rash,
hypotension, shock, DIC
Treatment: Pen G/ Cefotaxime/ ceftriaxone.
of the dermis
◦ Impetigo contagiosa
◦ Bullous impetigo
◦ Group A ß hemolytic streptococcus
◦ Coagulase positive S. aureus
Treatment : Erythromycin.
with polycyclic edges.
Spreads without healing.