The document provides an overview of various infectious diseases associated with fever and rash, including their symptoms, diagnostics, and treatment options. It emphasizes the importance of differentiating between conditions such as measles, rubella, mumps, and chickenpox while outlining specific warning signs like purpuric rashes and complications. Additionally, it covers disease management, including the role of vaccinations and supportive care.

1. By Ahmed Mo’ness
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2. Character of “RASH”
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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
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5. !! CAUTION !!
Fever + Puperic rash (non blanching) =
Meningococcemia
till proved otherwise
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6. MEASLES
(Rubeola disease)
• Fever (high ~ 40)
• conjunctivitis + cough
• koplik spots (2days before rash) (opposite 2nd
molars)
• rash = Cephalo-caudal (macules + papules)
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10. • Investigations
– measles IgG , IgM
• ttt
– supportive + fluids + Vit.A (important)
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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%)
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12. • inv
– rubella IgG , IgM
• ttt
– supportive
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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
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14. • Invistigations
– mumps IgG , IgM
– serum Amylase (parotitis or pancreatitis )
– CSF culture , CSF PCR
• ttt
– supportive + fluids + isolation
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15. MMR Vaccine
12 month , 18 month , 6 y
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16. Roseola Infantum
(6th Disease)
HIGH Fever 4 days suddenly disappears
then rash begins
(Rainbow after the storm)
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17. • distribution = (trunk then extremities) = T-shirt distribution
• typically occurs in 6- to 12- months child with high
• ttt = supportive
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18. Erythema Infectiosum
(5th Disease)
• Usually NO to Low grade fever
• Rash appears in 2 phases
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19. • Phase I
– Slapped Cheeks
• Phase II
– Lace/Reticular
like rash
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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
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21. Some History
Pre-Vaccination Era
• 1st = Measles
• 2nd = Scarlet
• 3rd = Rubella
• 4th = SSSS (Dukes' disease)
• 5th = Erythema Infectiosum
• 6th = Roseola Infantum
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22. Scarlet Fever
• Fever
• pharyngitis / tonsilitis
• Strawberry tongue + circumoral pallor
• Sandpaper-like skin rash
• Pastia lines
• Desquamation of the palms
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24. • Investigations
– ASO , CBC (leukocytosis) , throat swap
• ttt
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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)
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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)
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30. Eczema Herpeticum
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31. • Investigations
– PCR , Culture
• ttt
– mainly supportive + topical lotions
– Acyclovir
• systemic (if sever disease/neonate)
• local (oral/skin/eye preparations)
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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
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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)
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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
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37. • ttt
– mainly supportive + topical lotions
– Acyclovir
• systemic (if sever disease/neonate)
• local (oral/skin/eye preparations)
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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
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Bullous Impetigo

40. 40
Non- Bullous Impetigo

41. • ttt
– Topical +/- Systemic ABs
– Benzathine Penicillin (IM) or Co-trimoxazole (oral 3 days)
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42. Acute Rheumatic Fever
• Jones Criteria
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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
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45. Target lesion Arcuate lesion
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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
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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)
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49. NUMBERS
 Incubation Period
 Fever timing to rash
 Infectivity period
+ Mode of infection
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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
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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)
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52. • HSV
* IP 2-12 days
* Fever with rash
* Infectious up to 7 weeks after rash !
* droplet
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53. THANKS
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