approach to child with fever and Rash
- 1. APPROACH TO A THE CHILD WITH A FEVER AND RASH Maryam Majid Al Ezairej RAKMHSU
- 2. What is fever? Fever means a temperature above 100.4ºF (38ºC). Its a normal response to a variety of conditions, the most common of which is infection.
- 3. o What is rash? A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin.
- 4. Presentation Features of the rash: – Characteristic of lesions – Distribution and progression – Timing of onset in relation to fever – Morphological changes (e.g. papules to vesicles)
- 5. Common skin lesions Macule: non palpable, circumscribed, flat lesion (<1 cm in diameter) Papule: palpable , elevated lesion (<1 cm in diameter) Maculopapular: combination of macular and popular lesions Purpura: non-blanching papules or macules Vesicle: fluid-filled, elevated skin lesion (<1 cm in diameter) Bulla: fluid-filled, elevated skin lesion (>1 cm in diameter) Pustule: pus-containing vesicle
- 8. History It is important to consider the following: – Age of patient – Season – Travel history – Geographic location – Exposures to insects, animals, other people who are ill – Medications _ Immunization history
- 9. Physical examination a) Distribution pattern - symmetrical eruption - asymmetrical rashes b) Morphology - monomorphic - pleomorphic c) Configuration - linear, annular, grouped, - Koebner phenomenon (eruption in an area local trauma)
- 14. Differential Diagnosis Infectious causes 1. Measles: – Blanching erythematous maculopapular rash – Begins in head and neck à spreads centrifugally to trunk and extremities – Associated symptoms: fever, cough, coryza and conjunctivitis _Diagnosis: measeles IgM is detectable for 1 mon after illness _Treatment: Supportive
- 17. Chickenpox – Initially as small red papules that rapidly progress to oval, non umbilicated,“teardrop” vesicles on erythematous base. – Lesions are present in different stages: papules, vesicles, crusting _New crops appear for 3 to 4 days, beginning on the trunk followed by the head, the face, and, less commonly, the extremities _PCR is the current diagnostic method of choice. _ Treatment: Supportive
- 18. Dew drop on a rose petal
- 19. Rubella – Rash resembles measles, but patient is not ill looking – Prominent posta uricular, posterior cervical +/- suboccipital adenopathy – Forschemier spots: small, red spots (petechiae) on soft palate in 20% of rubella patients _Ig M antibodies diagnostic for congenital rubella syndrome _Treatment: Supportive
- 21. Scarlet fever – Exotoxin-mediated diffuse erythematous rash – Pharyngitis due to group A streptococcus – Coarse, sandpaper-like, erythematous, blanching rash à desquamation – Circumoral pallor and strawberry tongue. _diagnosis: group A Streptococcus is present in throat swab. _Treatment: rehydration, antibiotics(Amoxicillin 40 mg per kg per day).
- 23. Dengue Fever Dengue fever is a tropical, mosquito-borne( by female Aedes aegypti ) disease that causes flu-like symptoms, rashes and joint and muscle pain. High fever of 106°F (41°C) Skin rash, which appears three to four days after the onset of fever Eye and joint aches Backaches and headaches Loss of appetite Nausea and Vomiting Bleeding nose and gums Diagnosis: by isolation of the virus, by serological tests. Treatment: supportive.
- 24. Typhoid fever Is a bacterial infection caused by salmonella. Which is common in countries with poor sanitation. Persistent fever that rises gradually to 39ºC to 40ºC (102ºF to 104ºF) Temporary rash 2 to 4 mm in diameter with raised pink blanching spots on the stomach or chest. Headache and sore throat Tiredness and low energy Stomach pain, Constipation, and diarrhea Diagnosis: blood and stool culture. Treatment: rehydration and cephalosporin.
- 26. Typhus Is a disease caused by infection of rickettsial bacteria and is transmitted by invertebrate animals known as arthropods. Presents with: severe headache high fever (above 102.2°F) rash that begins on the back or chest and spreads Confusion and Stupor Hypotension eye sensitivity to bright lights severe muscle pain Diagnosis: skin biopsy of rash ,Western blot and immunofluorescence test. Treatment: Doxycycline
- 28. Inflammatory causes Kawasaki Vasculitis – Usually in kids <4 years old – Fever >5 days – Bilateral conjunctival injection, injected or fissured lips – Injected pharynx or “strawberry tongue” – Erythema of palms or soles – Edema of hands or feet – Generalized or periungual desquamation – Rash – Cervical lymphadenopath – Acute rheumatic fever _Treatment: intravenous immunoglobulin (IVIG) and Aspirin
- 30. Systemic Lupus Erythromatosis – an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body _ Pleuritis or pericarditis _ Discoid rash which affects the skin, causing a red, scaly rash with raised borders on areas of the body that are exposed to sunlight _ Malar rash and photosensitive rash _ Oral (Ulcers) – Arthritis. _Anemia, leukopenia, lymphopenia orthrombocytopenia – Renal Nephritis _Diagnosis: ANA, Immunoreactive (anti-Ds DNA, Anti-Rho, Anti-Sm, Anti-La, antiphospholipid)
- 33. Presentation Fever Malaise Tonsillopharygitis – often severe, limiting oral ingestion of fluids and food, rarely breathing can be compromised Lymphadenopathy – prominent cervical lymph nodes Petechiae on the soft palate Splenomegaly (50%), hepatomegaly (10%) Maculopapular rash (5%)
- 34. Treatment Medical Care Closely monitor patients with extreme tonsillar enlargement for airway obstruction. Steroids are indicated for impending or established airway obstruction in individuals with Epstein-Barr virus (EBV) infectious mononucleosis. Surgical Care Surgery is necessary for spontaneous splenic rupture, which occurs in rare patients with EBV infectious mononucleosis and may be the initial manifestation of the condition.