D/D of infectious diseases with exanthema. Exanthema are characterized by generalized eruption or rash mainly in the skin.

(A) Macular papular rash Causative agent Disease VIRUS Infectious (1) EBV mononucleosis Measles (2)Rubeola RNA Paramyxovirus Site Trunk

W – 20 pg-1

Specific Characteristics May resemble measles accompanied by palatine exanthema Palatine exanthema & koplik spots in buccal mucosa. 1mm macules

(3)Rubella. RNA virus (1)Chlamydia psittaci Bacteria (1)Listeria monocytogenes (2) Salmonella Gr(3) Streptococcus pyogenes group A (B haemolytic) Gr+

German measles Psittacosis Listeriosis

Forehand going to upper body ,lower body & distal extremities after sometime. Fades in cephalocaudal direction. Red copper brown. (rash appears in days-DD with rubella) frontal & retroauricular Then spreading over body & limbs. Trunk Trunk & legs

Rash appears in hours DD with rubeola Faint macules occasionally erythema nodosum or erythema multiforme Red macules undergoing central necrosis with formation of pustules 5mm rose spots occurs in chest punctuate red papules which give sand paper like texture & blanches under pressure – circumoral pallor.Hyperpigmented transverse lines in extensor surface (antecubital fossa) tongue at first white then red strawberry Rapidly spreading ringed eruptions with raised margins that confluence into annular patterns Bright red edematous tender plaques Accompanying periorbital oedema myositis ,fever

Typhoid fever Scarlet fever

Abdomen & chest Exanthematous skin with accentuation in flexor regions (buttocks,axilla,groin)

Acute rheumatic fever Erysipelas Nematodes (1)Trichinella spiralis (2)Necator americanus Spirochaetes (1)Treponema pallidum Trichinellosis

Erythema nodosum

Face, extremities Face,eyelids and conjunctiva

Hookworm disease Secondary syphillis

Toes,toe clefts, soles Trunk & proximal extremities Bilateral symmetrical macular. Papular rash alopecia,mucous patches,condyloma lata Generalized lymphadenopathy W – 20 pg - 2

(B) Vescicular or Bullous Causative agent Disease VIRUS Gingivostomatis (!) Herpes simplex vulvovaginitis, balanitis keratoconjunctivitis (2)Coxackie Virus Hand foot & mouth disease (3)Varicella Zoster Herpes zoster Chicken pox

Site Anywhere may be sensory noninvolvement with deep pain Margins of palms & soles. Dorsum of hands & feet Dermatomal distribution unilateral Starting from head going to trunk & extremities also in mucus of mouth & uvula

Specific Characteristics Grouped vescicles or erythematous plate

Painful vescicles on erythematous base(involved area hyperaesthetic,↑ pain) Starts as pruritic macular popular rashvescicles fluid filled vescicles fluid becomes cloudy umbilicationcrust Vescicles which becomes pustules, bullas

Bacteria (1)strep .pyogenes (gr+)


Extremities face

(C) Petechial or Haemorrhagic Causative agent Disease (1) Rickettsia Epidemic typhus prowazeki Meningococcaemia Bacteria (1)N. meningitides,gr(2)N.gonorrheae(gr-) gonococcaemia infectious endocarditis (3)streptococci(gr+)

Site Sides of trunk & spreads centrifugally but spares palms, soles& face. Generalized

Specific Characteristics Macules becoming haemorragic during 2nd week. Petechia , purpura, ecchimosis containing meningococci

Extremities frequently over tender joints & fingers Oropharynx,conjunctiva Petechia,splinter janeway spots clubbing , osler nodes.

D)Pustules Causative agent (1) staph aureus Disease Furunculosis / boils Site Face,neck, arms,wrists,fingers, buttocks, anogenital area. Face,upper back, chest Specific Characteristics Follicular inflammatory nodule becoming pustular & painful.

(2)propionobacter acne+ staph.epidermidis


W – 20 pg - 3 E)Ulcerations Causative agent (1)Chlamydia Disease Lymphogranuloma venerum Site Penis, labia Specific characteristics Small, usually single ulceration accompanying lymphadenopathy

(2)C. diphtheria

Cutaneous or wound diphtheria primery syphilis chancre

Extremities, face Penis,vulva,cervix, Rectum,lips Raised papula ulcerates into shallow based punched out well defined borders single ulcer regional lymphadenopathy Eythematous lesions of mucousa & skin “satellite pustules”

(3)T. pallidum

(4)C, albicans

Cutaneous candidosis,moniliasis,thrush, Intertrigous area ,mouth vaginitis

(F)Nodules Site Causative agent molluscum contagiosum(viral-pox virus bacteria (1) strep. Pyogenes (2) M.Tbc M.leprae Disease Cutaneous candidosis,moniliasis,thrush, vaginitis Erythema nodosum Exposed areas in children s pubic area & genitals of adults Shin & other extensor surfaces Specific characteristics Flesh coloured to pink umbilicated papules Tender erythematous nodules

1 Macule- nonpalpable area of altered colour 2 Papule – palpable elevated small area of skin.(<0.5cm) 3 Plaque - palpable flat-topped discoid lesion(.2cm) 4Nodule – solid, palpable lesion within the skin (>0.5. 1 vescicle-small,fluid filled blister(<0.5) 2 Bulla – large fluid filled blister(.0.5) 3 Pustule- blister containing pus. 1 Wheal- elevated lesion often white with red margin due to dermal edoema. 1 Petechiae- pinsized macules of blood. 2 Purpura- larger petechiae which do not blanch on pressure. 3 Ecchymosis- large extravasation of blood in skin.(bruising) 4 Haematoma- swelling due to gross bleeding. 5 Erythema- redness of the skin. 6 Ulcer – atleast the full thickness of the epithelium lost . Healing occurs with scarring. 1 Crust- dried exudate.

Report on: D/D of infectious diseases with exanthema Report prepared by 1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom. 2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia. 3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania. Contact: publications [at] infekcijas.eu