Fever and Rash

Fever and Rash
Presentation by:Marcellina Mian
Professor of Pediatrics

* Macule: discolored spot (often, but not necessarily red; often, but not necessarily round); blanches
* Papule: raised spot
* Maculopapular: a papule rising from a macule, often red
* Petechia: pinpoint purple/red bruise; does NOT blanch, often in clusters
* Ecchymosis: red/purple bruise, variable size & shape

Definitions
Case #1
Maculopapular rash
Measles
* “Stepwise” high fever
* Cough, coryza, and conjunctivitis
* Rash (exanthem) starts on head & spreads to rest of body
* Koplick spots (enanthem) prior to or at very beginning of rash
* Complications: OM, diarrhea, encephalitis, pneumonia

Koplick Spots
Measles (Rubeola)
* Highly contagious
* Most deadly of all childhood rash/fever illnesses
* Spread by droplets or direct contact with nasal or throat secretions of infected persons
* Incubation period: 8 -12 days
* Prevention: immunization (MMR) just past one year & before kindergarden

Case #2

13-year-old male with:
* fever x two days
* generalized rash
On PE:

* Well & comfortable
* Maculopapular rash
* Postauricular lymphadenopathy

Rubella (German Measles)
* Low grade fever
* Rash:
o starts on face & spreads down body, clearing in same pattern
o Light red spots, fainter than measles
o Lasts 1 - 3 days
* Mild illness, may be missed
* Adults & adolescents may have arthritis or arthralgia
* Complications: encephalitis, neuritis & in pregnancy  Congenital Rubella Syndrome in baby

Congenital Rubella

* Rash
* Cataracts
* CHD (PDA)
* Blindness
* Neurosensory deafness
* Microcephaly & mental retardation

Rubella

* Droplet transmission
* Incubation period: 2 - 3 weeks
* Prevention: Vaccination (MMR)

Case #3

* 15-month-old presents with several days of fever, & rash that looks like this:

Fifth Disease, Erythema Infectiosum
* Parvovirus B19
* Fever, malaise & headache may precede rash by up to 10 days
* “Slapped cheeks” and “lacy, reticular” rash over body that may itch
* No longer infectious once rash develops
* Virus may also cause polyarthropathy syndrome, aplastic crisis, or hydrops fetalis

Hydrops Fetalis

Case #4

* 8-month-old female with fever to 40C for past 5 days
* Baby does not look unwell
* PE reveals no source of fever
* U/A negative
* WBC mildly elevated; mostly lymphocytes
* D/C on acetaminophen
* Next day mother calls to say baby has a rash

Roseola (Sixth disease, Exanthem subitum)
* Peak incidence 6-24 months
* 20% of HHV-6 infections
* Also HHV-7
* Self-limited disease:
o 3-7 days of fever
o Rash follows defervescence
* Febrile seizures in 10-15%
* Occasionally, bulging fontanelle & encephalopathy

Case #5

* 3-year-old boy with fever & irritability x 6 days.
* PE:
o maculopapular rash
o red eyes
o strawberry tongue
o cervical lymphadenopathy

Scarlet Fever

* Group A Strep
* Generalized rash:
o Sandpapery
o Circumoral pallor
o Pastia’s lines

Pastia’s lines
Circumoral pallor
Kawasaki Syndrome Mucocutaneous Lymph Node Syndrome 3 phases:

* Acute: 1-2 wks, fever, etc
* Subacute: 2-4 wks
o After acute signs
* Convalescent: 6-8 wks
o about 4th wk; when clinical signs disappear
o Until ESR returns to normal

Kawasaki Syndrome Mucocutaneous Lymph Node Syndrome
Acute Phase:
Subacute phase
Associated findings:
Kawasaki Syndrome: Coronary aneurysm
Kawasaki Syndrome: Treatment

Case #6
Lyme disease in
Erythema chronicum migrans
* Borrelia burgdorferi transmitted by:
* Ixodes tick
o Ehrlichia, babesia
Lyme Disease: early localized
* Erythema migrans:
Lyme Disease: early disseminated
Lyme Disease: late disseminated

Case #7
Epstein Barr Virus
Infectious Mononucleosis

Case #8
Scarlet Fever
Case #9
Neisseria meningococcemia
Case #10
HSV Stomatitis
Whitlow
Case #11
Hand-Foot-and-Mouth Disease
* Coxsackie A16 & Enterovirus 71
* Oral lesions only: herpangina
* Vesicles on an erythematous base, at posterior pharynx/soft palate
* Commonly presents in spring & summer
* Supportive care

Case #12
* 2-year-old child presents with fever for four days & rash for two days.
* His father, who is visiting from Mexico to harvest strawberries, brought him to a walk-in clinic.

Varicella
* Herpes virus, vaccine preventable
* Incubation period: 14-16 days Prodrome: fever, constitutional symptoms, then rash starting on trunk & spreading to limbs (centrifugal)
* “Dewdrop on a rose petal”
* Vesicles in various states of evolution
* Contagious until all lesions crust over

Fever and Rash.ppt