Differential diagnosis of infectious diseases with exanthema

1. Sumy State University
Medical Institute
Department of Pediatric,
Corse of Children Infectious Diseases
Differential diagnosis
infectious diseases
with exanthemas
Lecturer
Bynda Tatiana P.

2. Professional motivation
Exanthema – rashes on the skin, which
occurs in many infectious diseases.
Some rashes are typical only for one
disease; other may be present in several
diseases.
They differ by the rash morphology,
localization, time of appearing, and
dynamics of development.
That’s why it is very important to
differentiate them and perform right
diagnosis for adequate etiological and
pathogenetical treatment.

3. The exanthema - rashes on the skin
The enanthema - rashes on the
mucosa.

4. Depending on the cause
the rash is divided into infectious and
non-infectious
Іnfectious
 Connection with
infectious diseases
 Acute onset
 Fever
 Symptoms of
intoxication
 Other symptoms of
infectious diseases
 Cyclical course
 The appearance of the
disease in children after
contact with sick
Noninfectious
 Gradual onset
 Without an increase in
body temperature

5. Depending on the morphology the rash is divided
into 2 groups: hemorrhagic and inflammatory.
In addition inflammatory rash is divided into rash
with cavity and without cavity
Exanthema
Inflammatory Haemorrhagic
Macula-
papular
Vesicular

7. Characteristic of the rash
 When occurs the first elements of the
rash? (Time the rash appears after the
onset of the diseases)
 Where the first elements of the rash
appeared?
 The order of the spreading of the rash.
 Where is the rash more?
 Where no rash?
 The presence of temperature, itching,
catarrhal symptoms.

8. Characteristic of the rash
 Character (petechiae, spot, papule,
vesicle)
 Polymorphism of the rash
 Size
 Form
 Color
 Edge (clear, unclear)
 Symmetry
 The ability to confluence
 The presence of pruritus
 Background of the skin

9. Characteristic of the rash
 The duration of the rash
 The order of the fading rash
 Secondary morphological elements of the rash
(pigmentation, crust, desquamation )

10. Causes of acute
maculopapular rash
1 мм – punctiform rash
(Scarlet fever,
Pseudotuberculosis)
2-5 mm- roseola (typhoid fever)
5-10 mm – micromacula (rubella, sudden
disease (sixth disease)
10-20 mm – macromacula (measles,
urticaria, drug allergy, enterovirus
exanthema)
> 20 mm – erythema (erysipelas)

11. Causes of acute vesicle rash
- chickenpox
- herpes
- herpes zoster
- drug allergy

12. Causes of hemorrhagic rash:
Meningococcal disease
Haemorrhagic fever
Leptospirosis
Toxic Flu

13. Diseases that are
accompanied by vesicles

14. Chickenpox
Chickenpox is an
acute infectious
disease,
characterized by
vesicular eruption
with transparent
liquid on skin and
mucous membrane.

15. Chickenpox (Varicella)
Susceptibility to
chickenpox
is very high,
practically universal.
In most cases it occurs in children 2-5
years age.
The incubation period ranges from 11
to 21 days (most cases 14 - 17days).
The prodromal period consists of 1 to
2 days of fever, headache, malaise and
anorexia.

16. Chickenpox (Varicella)
The temperature
The vesicle

17. Chickenpox
The rise of temperature in
chickenpox usually coincides with
appearance of the rash.
It usually goes up to 38°C, and may
become high (39 °C or 40 °C).
The temperature curve is irregular,
each peak reflecting the dynamics
of the eruption.
The elevation of temperature is
accompanied with aggravation of
the child’s general condition

18. Chickenpox (Varicella)
At first the spots appear on the
face or trunk and, at the height of
the illness, are more numerous
centrally than distally.
The rashes, often pruritic, begin as
a maculae and progresses rapidly
through the stages of papule,
vesicle, and crusted lesion.

19. Chickenpox (Varicella)
False polymorphism
The lesions erupt in crops for 3 to
4 days and it is characteristic of the
rashes that lesions in different
stages of development
may be found
on one area
(polymorphism).
http://intranet.tdmu.edu.ua/data/kafedra/int
ernal/pediatria2/classes_stud/ru/med/lik/

20. Chickenpox (Varicella)

21. Varicella rash is always on the scalp

22. http://intranet.tdmu.edu.ua/data/kafedra/int
ernal/pediatria2/classes_stud/ru/med/lik/

23. Chickenpox
(Varicella)
The vesicle is a 2 to 5 mm oval
filled with clear fluid surrounded
by an erythematous base.
The fluid clouds and a crust forms
appear within 1 day.

24. Chickenpox
 In some patients
eruption is often seen
on the mucous
membranes of the
mouth, nasopharynx,
larynx, genital organs.
 The vesicles are
rapidly converted into
superficial erosions
with a yellowish-grey
floor, which are rather
tender but heal in a
few days.

25. Chickenpox
Lesions occurring
on the mucous
membranes do
not crust but
form a shallow
ulcer.

26. http://labstand.ru/upload/pediatriya_inf/Ped
iatr_Infec155_0134.png

28. Chickenpox (Varicella)

29. Chickenpox (Varicella)

30. Chickenpox (Varicella)

31. ВІТРЯНА ВІСПА
Chickenpox (Varicella)

32. Chickenpox (Varicella)

33. Chickenpox (Varicella)

34. Atypical forms of the disease
Atypical forms of the disease may
occur:
bullous,
pustule,
hemorrhagic,
gangrenous,
abortive.

35. The pustular eruptions

36. The pustular eruptions
http://intranet.tdmu.edu.ua/data/kafedra/int
ernal/pediatria2/classes_stud/ru/med/lik/

37. In the bullous form of chickenpox (varicella
bullosa) large flabby bullae develop (up to two
or three centimetres in diameter, with turbid
contents) in addition to the typical vesicular
rash. The bullae may burst leaving
an extensive moist surface. The outcome in
the overwhelming majority of cases is
favorable.
This form, the same as
the pustular, is related
to concomitant
secondary coccal
infection.

39. The hemorrhagic form

40. The hemorrhagic form
(varicella hemorrhagica)
http://intranet.tdmu.edu.ua/data/kafedra/int
ernal/pediatria2/classes_stud/ru/med/lik/

41. The hemorrhagic form (varicella
hemorrhagica)

42. The gangrenous form
(varicella gangrenosa)

43. Chickenpox (Varicella)
The chief blood findings in the eruptive
stage are slight leukopenia,
neutropenia, and a relative
lymphocytosis.
Postinfectious immunity is stable
lifelong.
After the disease subsides, the virus may
remain dormant for decades and may
then reappear as herpes zoster

44. Herpes Simplex
Herpes simplex is a viral disease,
manifested by vesicular rash on the
skin and mucous membrane.

45. Herpes Simplex
An incubative period is from 2 to
14 days (an average 4-5 days).
There are some clinical forms of
herpes viral infection depending
on the process localization.

46. Herpes Simplex
 Nose and lip herpes is characterized by
appearance of small vesicles with thin
fragile wall between the skin and
mucous membranes of nose and lips.
 The vesicles appear in groups and
are surrounded by an area of hyperemia.

47. Herpes Simplex
 Subjective sensations are itch, pain
and burning pain.
 The vesicles contain clear fluid, which
gradually then becomes turbid.
The vesicles dry up and crusts appear
in 3-4 days.

48. Herpes Simplex
 Constitutional symptoms of the
disease are absent, body temperature
is normal.
 Crusts fall off in 5-7 days and the
affected skin is again covered with
epithelium.

50. Herpes Simplex

51. Herpes zoster
Herpes zoster is
an infectious disease,
characterized by rash
in the form of vesicles
grouped closely and
neuralgias in certain
skin areas, innervated
by separate sensitive
nerve.

52. Herpes zoster
 The disease affects
older children and
adults.
 It is characterized by
sporadic cases.
 Epidemic outbreaks
are absent.

53. Herpes zoster
The disease has an acute onset
with low–grade fever and severe
pain along the nerves, connected
with the affected ganglion.
Reddening, burning pain and itch
appears on the corresponding
area of sensory innervation.

54. Herpes zoster
At the end of the first day after
the onset of the disease or
in at beginning of the second
one groups of vesicles,
containing clear fluid, appear
on the affected area of the
skin.

55. Herpes zoster
The elements of rash may fuse.
In the end of the first week after
the onset of the disease or
during the second one
the vesicles dry up and crusts
appear.
Mild pigmentation remains after
them.

56. Herpes zoster
The areas of the skin, which are
innervated by trigeminal or
intercostal nerves, are affected
most frequently.
The process is unilateral.
Recurrent waves of eruption
occur frequently, that is why
general background of rash
seems polymorphous.

57. Herpes zoster
Regional lymph nodes are enlarged.
Pain syndrome may remain for several
months after disappearance of local
lesions.
Atypical forms of the disease may
occur (bullous, hemorrhagic,
gangrenous, abortive).
In herpes zoster lesions of CNS have
the form of serous meningitis.