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Learn More Dengue Clinical Case Management E-learning

Differential Diagnosis of Dengue with Rash

Illness History Exam Tests

• Occurs most commonly in • Fever, circumoral pallor, red swollen • Rapid strep test (pharyngeal swab):
children, 1–10 years, during (strawberry) tongue, pharyngeal positive
the nonsummer months erythema with exudate and palatal
• Anti-streptolysin O titer: positive
petechiae, and tender cervical
• Family gives history of abrupt
Scarlet Fever onset of fever, sore throat,
(Group A beta- headache, malaise, and • Sandpaper-like generalized
hemolytic vomiting, 2–5 days post erythematous rash with discrete skin-
exposure colored papules and linear petechial
streaks in skin folds, particularly
infection) • Skin rash appears in all areas
axillary, inguinal, and antecubital
at same time and
desquamates and fades after
4–5 days

• Occurs most commonly in • Fever, hypotension, and a diffuse • Blood cultures: usually negative in
children, 5–15 years, during erythematous rash on trunk, palms, staphylococcal infection (S. aureus);
winter and spring and soles of feet, which desquamates might be positive in streptococcal
1–2 days after disease onset infection (S. pyogenes)
• If history of exposure to
person with cold-like • Patient can have mucous membrane • Acute and convalescent antibody
symptoms, patient would inflammation (redness of eyes, serology: positive for S. aureus
have been infected 4–14 days mouth, and throat), and evidence of infection
Toxic Shock before onset of symptoms. central nervous system and multi-
Syndrome (TSS) • Toxin serology: evidence of exotoxins
organ involvement with renal, liver, or
• Family gives history of fever,
respiratory dysfunction • Serum creatinine: elevated > 2 times
headache, runny nose, and
upper limit of normal for age
• Platelet count: < 100,000/mm3
• Patient might complain of
arthralgia • Liver function test: AST, ALT > 2 times
upper limit of normal

Centers for Disease Control and Prevention

National Center for Emerging and Zoonotic Infectious Diseases