Fever and Rash

 

Fever and rash Alan R. Tumbelaka Pediatric Pedi atric decision-maki decision-making ng strategies Pomeranz, Buzey,Sabnis WB Saunders Co, Philadelhia,

 

to accomanied !elson te"tbook ediatrics #$th ed.

 

 

H and P 

%istory o& rash 

Presence o& ruritus ' ain



Aearance related to &e(er, e(olution, rogression and distribution



%istory o& contacts, e"osures %istory o& underlying immune de&iciency





Physical e"amination  

Se(erity o& illness, (ital signs and height o& &e(er Tachycardia and tachynea )indicate sesis*



%yotension  

 

Appearance of the rash 

Paular



+esicular

 

Petechial Presence o& associated enanthemas



istribution  

eneralized ' localized



Symmetric or asymmetric



Centrietal or centri&ugal  

 

Petechial Or purpuric

Fever  and

Macular or  maculopapular 

History Physical exams

!iffuse erythroderma

Rash Appearance of The Rash

Urticarial rash "rythema nodosum Vesicular, ullous, Pustular rash

!istinctive rashes

 

 

Petechial Or purpuric 



Comlete blood count 

With di&&erential count



Platelet count

Consider 

Coagulation studies



Blood culture Cerebrosinal &luid cytology and culture



 

 

Petechial or purpuric 

+iruses      





/ntero(iruses Congenital rubella C0+ Atyical measles %1+ %emorrhagic %emorrha gic &e(er

Rickettsia   



2thers 

Bacteria   

Sesis /ndocarditis P aeruginosa  

Rocky 0ountain sotted /idemic tyhus /hrlichiosis

 

%enoch Schonlein  3rticarial at beginning, later ururic +asculitis Thrombocytoenia

 

Petechial Or purpuric

Fever  and

Macular or  maculopapular 

History Physical exams

!iffuse erythroderma

Rash Appearance of The Rash

Urticarial rash "rythema nodosum Vesicular, ullous, Pustular rash

!istinctive rashes

 

 

Macular or maculopapular 

+iruses         



Bacteria

Roseola )%%P-$* /B (irus



Adeno(irus 0easles Rubella 4i&th diseases )ar(o(irus* /ntero(irus %1+ engue (irus





  





/arly R 0ountain stt Tyhus

2ther 

 

Syhilis 5etosirosis Salmonella 5yme 5y me disease di sease

Rickettsial 



0 neumoniae Scarlet &e(er

6a7asaki

 

Petechial Or purpuric

Fever  and

Macular or  maculopapular 

History Physical exams

!iffuse erythroderma

Rash Appearance of The Rash

Urticarial rash "rythema nodosum Vesicular, ullous, Pustular rash

!istinctive rashes

 

 

Diffuse erythroderma, urticarial ra rashes shes 

i&&use erythroderma erythroderma 

3rticarial rashes 

Bacteria 





Scarlet &e(er



Stahylococcus  

+iruses 

Stretococcus 





SSSS To"ic shock





Bacteria 

4ungi

 



0 neumoniae Shigella 0eningococcus

2thers   

 

/stein Barr %e B %1+ /ntero(irus

Parasites 1nsect bites rug reaction

 

Petechial Or purpuric

Fever  and

Macular or  maculopapular 

History Physical exams

!iffuse erythroderma

Rash Appearance of The Rash

Urticarial rash "rythema nodosum Vesicular, ullous, Pustular rash

!istinctive rashes

 

 

Erythema nodosum 

Consider 

  



Stretococcal cultur or Antigen detection test %e B serology Tuberculous test C8R

+iruses9  



Bacteria  Tuberculosis  



Coccidiomycosis %istolasma

2thers 

 

:ersinia Stretococcus

4ungi  



/stein Barr %e B

Sarcoidosis, S5/, Behcet etc

 

Petechial Or purpuric

Fever  and

Macular or  maculopapular 

History Physical exams

!iffuse erythroderma

Rash Appearance of The Rash

Urticarial rash "rythema nodosum Vesicular,ullous, Pustular rash

!istinctive rashes

 

 

Ve Vesicu sicular lar,, bullous, bullo us, Vesicular, bullous, pustular rash 

Consider  



ram stain Cultur o& the lession

 



% simle"



+aricella zoster



Tzanck rearation PCR







 

+iruses

Co"sackie A ; B /C%2 (irus

Bacteria 

Stah scald skin syndr



Stah bullous imetigo



Stret A imetigo

2ther 

T/!



Ste(en