FEVER & RASH

Analyses of presenting compliant

• where it starts?
• How it spread?
• Rate of spread?
• When it start?
• Previous treatment?
• Any change over time?
 History
1.Age?
2.Seson?
3.Geographic setting?
4.Travel history?
5.Occupational exposure?
6.Immunization status?
7.Immune status?
8.Exposure to sexually transmitted ds ,risk factor for hiv ?
9.Existance of cardiac abnormality?
10.Presense of prosthetic material?
 …
11.Recent exposure to ill individual?
12.Exposure to domestic pit, other animal?
13.Hstory of animal (arthropods)bites?
14.Medication taken within the last month?
 Physical examination

• G/A
• V/S- T, PR, BP, RR
• HEENT-strawberry tongue
• Adenopathy location
• Conjectival,mucosal & genital erosion
• HSM
• Arthritis
• Nuchal rigidity(meningeal sign)
• Type (discrete or uniform)
• Desquamation
• Configuration of individual lesion –annular & target
• Distribution pattern –central or peripheral
 Investigation

• CBC
• Serum study
• U/A
• Blood culture
• CSF
• Gram stain & culture
• Write gimsa stain
• Dark field microscope
• Histologic study
• Immunofloresens study
Identification of primary skin lesion
1.Macules flat lesions ,changed color (i.e., a
bleachable erythema).
2.Papules raised, solid lesions <5 mm in
diameter.
3.Plaques >5 mm in diameter with a flat, plateau-like surface;
4.Nodules >5 mm in diameter with a more rounded
configuration.
red nodules with indistinct borders in a
teenage girl with erythema nodosum.
5.Wheals (urticarial, hives) papules or plaques that are pale pink and may
appear annular (ringlike) as they enlarge;
6.Vesicles (<5 mm) and bullae (>5 mm) are circumscribed, elevated lesions
containing fluid.
7.Pustules raised lesions
purulent exudate
vesicular processes such as varicella or herpes simplex may evolve to pustules.
8.Nonpalpable purpura flat lesion ---
bleeding into the skin
if <3 mm in diameter-petechiae;
if >3 mm -ecchymosis.
9. Palpable purpura raised lesion –
vasculitis with subsequent hemorrhage.
10.An ulcer extends at least into the upper layer of the dermis.
11. An eschar is a necrotic lesion covered with a black crust.
 Classification by type of eruption
• 1.Centrally Distributed Maculopapular Eruptions
• 2.Peripheral Eruptions
• 3.Confluent Desquamated Erythema
• 4.Vesiculobullous Eruptions
• 5.Urticarial Eruptions
• 6.Nodular Eruptions
• 7.Purpuric Eruptions
• 8.Eruptions with Ulcers and/or Eschars
 1.Centrally Distributed Maculopapular Eruptions

• Acute Rubella (measles)

• Rubella (German measles)
• Meningococcemia
• Erythema infectiosum
• Primary HIV infection
• Infectious mononucleosis
• Exanthemata's drug-induced eruption
• Epidemic typhus
 ...
• Dengue fever
• Typhoid fever
• Rat-bite fever (sodoku)
• Relapsing fever
• Erythema marginatum (rheumatic fever)
• System Still's disease
• systemic lupus erythematosis
 2.Peripheral Eruptions
• Chronic meningococcemia
• Disseminated gonococcal infection
• human parvovirus B19 infection
• Rocky Mountain spotted fever
• Secondary syphilis
• Atypical measles
• Hand-foot-and-mouth disease
• Erythema multiforme
• Rat-bite fever (Haverhill fever)
• Bacterial endocarditis
“Target” or “iris” lesions with characteristic central dusky zone on palms of a child with
erythema multiforme due to herpes simplex virus
 3.Confluent Desquamative Erythemas
• Scarlet fever
• Kawasaki disease
• Staphylococcal toxic shock syndrome
• Staphylococcal scalded-skin syndrome
• Exfoliative erythroderma syndrome
• Stevens-Johnson syndrome (SJS)
• Toxic epidermal necrolysis (TEN)
 4.Vesiculobullous Eruptions
• Hand-foot-and-mouth syndrome
• staphylococcal scalded-skin syndrome
• Toxic epidermal necrolysis
• Varicella (chickenpox)
• Pseudomonas "hot-tub" folliculitis
• Variola (smallpox
• Primary herpes simplex virus (HSV) infection
• Disseminated herpes virus infection
• Rickettsia pox
• Disseminated Vibrio vulnificus infection
• Ecthyma gangrenosum
 5.Urticarial Eruptions
• Urticarial vasculitis
 6.Nodular Eruptions
• Disseminated infection
• Erythema nodosum (septal panniculitis
• Sweet's syndrome (acute febrile neutrophilic
dermatosis
• Bacillary angiomatosis
 7.Purpuric Eruptions
• Rocky Mountain spotted fever, rat-bite fever, endocarditis;
epidemic typhus; dengue fever; human parvovirus B19
infection
• Acute meningococcemia
• Purpura fulminans
• Chronic meningococcemia
• Enteroviral petechial rash
• Bacillary angiomatosis
• Viral hemorrhagic fever
• Thrombotic thrombocytopenic purpura/hemolytic-uremic
syndrome
 8.Eruptions with Ulcers and/or Eschars
• Scrub typhus
• Rickettsia spotted fevers
• Rat-bite fever
• Rickettsia pox
• Ecthyma gangrenosum
• Tularemia
• Bacillary angiomatosis
THE END