fever with rash - indian academy of pediatrics · peripheral rash with fever erythema multiforme...
TRANSCRIPT
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Fever with Rash
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Urticaria Purpura
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Eschar near medial canthus
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History
1. Prodromal Symptoms
2. Evolution of rash
3. Associated Symptoms
4. Exposure to Infections – Persons, insects, animals
5. Travel, time of year, drug exposure
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Examinations
1. Nature of rash
2. Rash distribution – Exanthem and enanthem
3. Mucosal conjunctival lesion
4. Lymph node – Liver and spleen
5. Genital lesion and CNS involvement
6. Timing in relation to fever
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Broadly they are classified as
• Centrally distributed maculopapular
• Peripheral
• Confluent desquamative erythema
• Vesiculobullous
• Urticaria
• Purpuric
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Centrally distributed maculopapular rashes
Common viral exanthem
Drug rash
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Measles
Maculopapular rash over face Enanthem: mucus membrane
Maculopapular rash over trunk Maculopapular rash over palm
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Rubella
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Rubella Fever : Not high grade
Rash scattered
Fever disappears when rash appears
Occipital, epitrochlear lymph node appears
No significant coryza
Short duration
Relatively benign diseases
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Roseola
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Roseola infantum (HSV 6)
• Rash appears on 4th or 5th day• Fever resolves by crisis or subsides by lysis • Caused by HSV 6 • Called as “sixth disease”• May cause febrile seizures, encephalitis, aseptic meningitis
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Erythema infectiousum (Fifth disease)Parvo virus• Fever for 3-5 days • Rash on face
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Lacy reticular rash
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Drug rash
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Features Drug rash
Rhinnorhea /conjunctivitis
Uncommon
Itching Present
Enanthem Absent
Eosinophilia and raised IgE
Usually present
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Features of drug rash
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Peripheral rash with feverErythema multiforme
Secondary syphilis
Hand foot and mouth disease
Dengue – Both central and peripheral
Hand foot and mouth disease
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Morbiliform rash
Dengue rash
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Dengue rash
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Spotted Fever and Typhusbelongs to Rickettsial group
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Eschar near medial canthus and chest
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Spotted fever and typhus belongs to rickettsial group – they are not uncommon in our country as numerous reports are there
References
1. Mahajan SK. Scrub Typhus. J Assoc Physic India 2005;53:954-82. Singh P. Scrub Typhus, a case report: Military and regionalsignificance.
MJAFI 2004; 60: 89-90.3. Soman DW. Tsutsugamushi disease (scrub typhus) inBombay City
and suburbs J Indiana State Med Assoc1954;23:389-94.4. Menon RD, Padbidri VS, Gupta NP. Sero-epidemiologicalsurvey of
scrub typhus. J Hyg Epidemiol Microbiol Immunol.1978;22:306-11.5. Saxena VK. Chigger mite infestation of small mammals in aferal
biotope of a public park area of south Delhi. J CommunDis. 1989;21:360-4.
6. Sharma A, Mahajan S, Gupta ML, et al. Investigation of an Outbreak of Scrub Typhus in Himalayan Region of India. Jpn J Infect Dis 2005;58:208-10.
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Herpes Simplex Virus 2 closely related types – HSV1 and HSV2
• Type of infection :ü Primary infection – HSV seronegative, no preexisting
immunityü Non primary 1st infection – Already infected with one type
but first time infected with other type.ü Recurrent infection – virus from latent infection periodically
reactivate• Spread by direct contact between skin and mucous membrane
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Herpes labialis/cold sore (Primary)
Herpes labialis/cold sore (Recurrent)
Herpetic Gingivostomatitis
Herpangina
Genital herpes Whitlow
Herpes Simplex Infection
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Fever with diffuse erythema and desquamation
1. Scarlet fever
2. Kawasaki disease
3. Streptococcal toxic shock syndrome
4. Staphylococcal toxic shock syndrome
5. Staphylococcal scalded skin syndrome
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Scarlet fever
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Skin and mucous membrane manifestation of Kawasaki diseases
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Skin and mucous membrane manifestation of Kawasaki diseases
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Purpuric eruption with fever
Meningococcemia
Viral infection – Coxsackie A9, echo virus, EB virus
Atypical measles
Dengue hemorrhagic fever
Bacteremia
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Acute Meningococcemia
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Fever with Inflammation ofSubcutaneous tissue
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Erythema nodosum
Idiopathic
Infections
Beta hemolytic streptococciMycobacterium speciesHepatitis B and CFungal Infection
Medicines
Sulfonamides, Oral contraceptives
SLE
Sarcoidosis
Inflammatory bowel disease
Malignancy – lymphoma and leukemia
Causes of Erythema nodosum