Rash and Fever

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Rash and Fever : 

Rash and Fever DR . Rabie Fahmy Zahran. Tropical M . Consultant. Damietta Fever Hospital. Egypt.


A rash is a visible lesion of the skin due to disease. RASH AND FEVER The condition can be a primary skin disorder or a symptom of a systemic process. When considering the differential diagnosis of a rash, it is important to be able to describe its feature. Ask the child’s parents about the appearance, because rashes often change with time.

History : 

Onset of the rash: History sudden or gradual. Type of lesion: Vesicles Petechiae Pustules Urticaria Macules Papules Plaques Distribution: central, generalized. peripheral

Slide 4: 

Progression: direction of spread speed of progression. General well-being of the patient Infectious contacts. Drug history: Symptoms of the rash: itch, pain, burning Travel history. Contact with animals

Physical examination : 

Be sure to examine: Physical examination The entire skin surface: – To determine the true extent of the rash. – Type of lesions. – Distribution. – Evolving lesions. The mucous membranes for involvement or ulceration. The conjunctivae for injection or episcleritis.

Slide 6: 

The scalp and hair for : areas of inflammation, scaling or hair loss. For lymph-adenopathy For hepato-splenomegaly The joints for any associated arthritis.

Types of skin lesion : 

Types of skin lesion Vesicles Small, fluid-filled blisters Varicella zoster, herpes simplex

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Petechiae Small, non-blanching spots. Vasculitis, meningococcaemia, thrombocytopenia

Pustules : 

Pustules Small blisters containing purulent fluid Bacterial infection, e.g. Staphylococcus aureus.

Urticaria : 

Urticaria Raised, itchy lesions Drug eruptions, Erythema marginatum, idiopathic

Macules : 

Macules Flat spots, not palpable. Can form large sheets. Drug eruptions, viral exanthems

Papules : 

Papules Elevated, palpable, small rounded lesions. Molluscum contagiosum. warts, enteroviruses

Maculo-papular rashes : 

Maculo-papular rashes

Maculo-papular rashes : 

Many virus infections, especially entero-viruses, produce maculo- papular exanthems. Maculo-papular rashes They can be difficult to differentiate from allergic drug reaction These are often non-specific and generalized in distribution.

Maculo-papular rashes : 

Features that favour a viral aetiology 1.Occurrence along scratch marks. 2.Some lesions in straight lines. 3.Exaggeration in areas of sunburn 4.Presence of lymphadenopathy Maculo-papular rashes

Plaques : 

Plaques Elevated, flat-topped lesions. Psoriasis, pityriasis rosea

Rashes usually seen inFever Hospital. : 

1 with viral infections 2 with bacterial infections 3 with auto-immune diseases 4 Drug eruptions Rashes usually seen inFever Hospital.

Measles : 

Measles 3–5 days of prodromal features of fever, malaise, conjunctivitis, coryza and cough. High fever, which persists after the rash appears. Kopliks Spots is pathognomonic

Measles : 

Measles Downward spread of the rash from the preauricular area and the face to involve the body. Tendency of the rash to become confluent on the trunk and remain discrete lower down. Tendency of the rash to become brown and then desquamate after 2–3 days.

Rubella (German M.) : 

Rubella (German M.) erythematous, discrete exanthem that is often faint spreads down from the face. Occipital and/or post-auricular lymphadenopathy

chickenpox : 

chickenpox caused by (VZV) Short prodrome of one day of sore throat and fever,then crops of itchy, circumscribed, vesicular lesions on the scalp and trunk. become pustular before becoming crusted and then resolve without scarring, if not superinfected

Herpes zoster : 

Caused by reactivation of VZV, which has remained latent in nerve cells following earlier Chickenpox. unusual skin sensations or pain within the affected dermatome that heralds the onset of lesions by 48-72 hours + malaise, myalgia, headache, and fever Then eruption of crops of vesicles in a dermatomal distribution. It usually affects a single unilateral dermatome and rarely crosses the body midline . Herpes zoster

Herpes zoster : 

Herpes zoster Affecting : Rt anterior inter-costal nerves

Herpes zoster ophthalmicus (HZO) : 

Herpes zoster ophthalmicus (HZO) Affecting : the trigeminal (fifth cranial) nerve.

Ramsay-Hunt syndrome : 

Ramsay-Hunt syndrome Clinical There is a LMN VII palsy Prognosis of recovery is worse than Bells palsy It is a Herpes zoster infection of the geniculate ganglion vesicles erupt on the external auditory meatus or soft palate

Herpes zoster : 

Herpes zoster Affecting : Rt posterior inter-costal nerves

Herpes zoster : 

Herpes zoster Affecting : Branches of Sciatic& popliteal nerves.

Herpes zoster : 

Herpes zoster Affecting : Branches of Median nerve

Herpes simplex : 

Herpes simplex Vesicles Mostly erupted around the nostrils &the mouth. Caused by HSV

Herpes simplex : 

Herpes simplex Affecting The mucus m of bucal cavity

Meningococcemic Rash : 

Confluence of lesions results in hemorrhagic patches, often with central necrosis. Meningococcemic Rash A petechial rash is present in 50-80% of patients. It involves the axillae, flanks, wrists, and ankles. Petechiae are often located in the center of lighter-colored macules. Lesions commonly begin on the trunk and legs in areas where pressure is applied.

Meningococcemic Rash : 

Meningococcemic Rash

Meningococcemic Rash : 

Meningococcemic Rash Causative agent Neisseria meningitides Gram negative diplococci

Erysipelas : 


Erysiplo-cellulitis : 


Erythema Nodosum. : 

Erythema Nodosum.

Rose-Spots : 

Rose-Spots Seen in typhoid fever.

Erythema marginatum. : 

Erythema marginatum. Widespread urticarial rash with thin, pink margin.

Roseola Infantum(6th disease ) : 

Roseola Infantum(6th disease ) followed by a rash of small, pink, flat, or slightly raised bumps on the trunk, then the extremities. ). A mild, contagious illness, affect age 6 m to 2 ys, and is rare after age 4. symptoms are respiratory illness, followed by a high fever for up to 8 days. Fevers abruptly end

Important rashes in the newborn : 

Important rashes in the newborn Erythema toxicum red macules with overlying small yellow or white pustules. appears during the first few days of life. It is idiopathic non-infective. It can be mistaken for infection. Gram stain of the lesion shows multiple eosinophils.

Staphylococcal skin infection : 

Staphylococcal skin infection Skin desquamation with underlying erythema. is life threatening. Staphylococcal scalded skin syndrome (SSSS)

Eczema herpeticum : 

Eczema herpeticum Widespread inflammation, but discrete vesicular lesions are distinguishable.

Erythema infectiosum Fifth disease. : 

Erythema infectiosum Fifth disease. Lacy, reticular rash. caused by Parvovirus B19 infection. often asymptomatic.

Purpura. : 

Purpura. Discrete purple lesions > 2 mm in diameter, which will not blanch on pressure

Stevens–Johnson syndrome : 

Stevens–Johnson syndrome Hemorrhagic lesions, some bullas, + severe mucosal involvement.

Acral papular viral exanthem. : 

Acral papular viral exanthem. Raised papules on the hands of a child. occur with enteroviruses. associated pruritus. 2- to 4-ys-olds. take up to 10 weeks to resolve.

Erythema multiform. : 

Erythema multiform. Oval, erythematous ‘target’ lesions with dusky centres

Purple urticaria. : 

Purple urticaria. Blotchy truncal rash, purple in places.

Slide 51: 

Thank you

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