Measles diagnostic flowchart for clinicians metro south health. Maculopapular rash may be mistakenly called macule, papule, patch, nodule, plaque, vesicle, or pustule. It is important for physicians to be diligent, as the differential diagnosis can include. If fever is present without a nikolsky sign, the differential diagnosis includes kawasaki disease, scarlet fever, erythroderma, and toxic shock syndrome tss. Associated with nonblanching rash a rapidly evolving petechial or purpuric rash is a sign of very severe disease. Fever with an accompanying rash is a common symptom constellation in patients presenting to clinicians offices and emergency departments.
Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of fever key features morbidity and mortality increase. Although the appearance of the rash is essential for diagnosis of some diseases, rashes are generally nonspecific findings, and play supportive roles in the differential diagnosis of other diseases. Fever and rash university of massachusetts medical school. Stephen paget presents the case of a 24yearold woman with fever, extremity swelling, and a fleeting rash. Webmd symptom checker helps you find the most common medical conditions indicated by the symptoms chills, fever, headache and skin rash including lyme disease, acute sinusitis, and aseptic meningitis adult.
Various studies have shown up to a 15% likelihood of a meningococcal infection in children with an acute nonblanching rash. The differential diagnosis of itchy skin dermnet nz. The differential diagnosis of acute fever and rash in an adult is quite extensive and includes a variety of infectious and noninfectious causes. Clinicians commonly refer to a febrile illness without an initially obvious etiology sometimes called fever without localizing signs as fever of unknown origin fuo. The most common type of rash was determined as maculopapular, and the most frequent five diseases were measles, drug reactions, chickenpox, asd and rickettsial infection. These include noninfectious diseases, so that comprehensive knowledge of these other diseases is required for clinical diagnosis of a febrile illness with a rash. Goldman, md although fever and rash is a common complaint in the pediatric emergency department, most causes are benign. Streptococcus pneumoniae, haemophilus influenzae, and neisseria meningitiditis should all be considered in the differential diagnosis of fever without localizing signs. Different rash like conditions can be confused with scarlet fever and are thus included in its differential diagnosis. To differentiate these skin lesions from each other, here are the pictures of each. Fever and rash is a relatively common presentation in travellers returning from the tropics. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion. Webmd symptom checker helps you find the most common medical conditions indicated by the symptoms fever and skin rash including viral pharyngitis, gastroenteritis, and phlebitis.
Fever for 5 days, generalized morbilliform rash, conjunctival injection, mucositis with strawberry tongue see figure, and genital excoriated rash with high crp and esr confirmed the diagnosis. Scarlet fever differential diagnoses medscape reference. Rashes that are directly or indirectly caused by the wearing of diapers and are often the result of poor hygiene. Fever is common in the first few days after major surgery and can pose a diagnostic challenge for the care team. There are 86 conditions associated with fever and skin rash. Epsteinbarr virus ebv infectious mononucleosis mono kawasaki disease. However, when fever or signs of illness are present, urgent evaluation and treatment must be considered. In addition to the inflammation of the joint, rheumatoid arthritis ra can cause fever, malaise, rash, lymph node or spleen enlargement, and raynaud.
Febrile illness with skin rashes pubmed central pmc. An acute or chronic itchy rash is most often due to dermatitis eczema. Various infectious and noninfectious agents can cause different skin reactions and or similar clinical syndromes or vice versa. Clinical features and etiology of adult patients with fever. Introduction viral and bacterial infections are common causes of generalized rashes in children, and patients may present with systemic signs and symptoms. When fever accompanies a rash in children, it is usually caused by viral infections. Malar rash, colloquially known as the butterfly rash, is an acute manifestation of sle, present in 4665% of patients vila et al. In table 271, a number of pediatric exanthems are summarized, as. The various conditions that should be differentiated from scarlet fever include.
Of the more severe causes, several have been greatly reduced by vaccination programs. The patient with an acute maculopapular rash presents a diagnostic challenge to the clinician. Aug 27, 2019 coccidioidomycosis is caused by coccidioides immitis, a soil fungus native to the san joaquin valley of california see the image below, and by c posadasii, which is endemic to certain aridtosemiarid areas of the southwestern united states, northern portions of mexico, and scattered areas in central america and south america. Evaluating the febrile patient with a rash american. Infectious disease emergencies and diseases that can have public health implications can present as fever and rash. Malaria, dengue fever, influenza, leptospirosis, rickettsial infections, urinary tract infection, and other causes of childhood occult bacteremia e. Gp with a twoday history of fever, malaise, rash and sore throat. Fever may be due to infectious agents found only in tropical countries, or due to infections unrelated to travel and found worldwide. In table 271, a number of pediatric exanthems are summarized, as well as some other rashes associated with fever. Most febrile illnesses either resolve before a diagnosis can be made or develop distinguishing characteristics that lead to a diagnosis. A differential diagnosis with infectious causes should be addressed. Her parents report that multiple small red spots developed over the trunk and back in the 2 days before presentation. Fever that lasts 3 weeks or longer with temperatures exceeding 100.
A patient presents with an acute, generalized vesicular or pustular rash illness and is evaluated by a healthcare practitioner, infectious disease, or dermatology specialist. It is important to know that a specific cause for fever may not be identified in approximately 25% or more of returned travelers. Aug 27, 2007 fever by itself rarely causes a problem for children unless it is extreme, i. Although viral exanthems are usually associated with benign, selflimited diseases, in some cases correct diagnosis of an exanthem may be required for proper treatment, monitoring, and initiation of preventive measures for contacts. Dermatitis can be primary, or secondary to scratching. Assessment of rash in children differential diagnosis of. Recognizing the pattern of the rash, and identifying key points in the history can help to establish the diagnosis. The presence of a rash as part of a febrile illness, although rarely pathognomonic, focuses the differential diagnosis. Fever, rash, differential diagnosis, intensive care1 3 2korean j pediatr. List the differential diagnosis of sore throat in children, 2 obtain a focused history of the relevant signs and symptoms in a child that presents with. A 9monthold girl is brought to the clinic because of worsening fever and rash. Fever and rash can occur due to several causes, but primarily bacteria, viruses and fungal infection are involved. As a highly infectious disease, identified patients must be isolated in the hospital setting.
Emergent management of pediatric patients with fever. For clinical diagnosis of diseases accompanied by skin rash and fever, a complete history must be taken, including recent travel, contact with animals, medications, and exposure to forests and other natural environments. A 28yearold polish woman presented ill to the accident and emergency department of a district general hospital. My name is charissa ho and im a medical student at the university of alberta. Then try the child with fever mnemonic for usmle step 2 cs. It is important to remember that rashes are common and can be caused by medical conditions or drug reactions unrelated to travel. Maculopapular rash pictures, causes, diagnosis 2020. A sore throat, fever and rash wiley online library. Fever is the third most common cause for visits to the emergency department and is listed in the top 20 reasons for visits to the ambulatory clinic. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. More than meets the eye introduction rash may be hallmark of disease or nonspecific an important clue to etiology of illness differential diagnosis is critical recognition is key to making a good diagnosis and instituting early and appropriate treatment and infection control. Table v the most frequent noninfectious causes of fever and rash according to type and distribution of rash. In evaluating a patient with fever and rash, determining the type of rash, and its general characteristics such.
Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever. Meningococcal disease short prodromal phase fever, lethargy, malaise, nauseavomiting, followed by the more specific and severe symptoms of meningitis and sepsis limb pain, cold handsfeet, pale or mottled skin. Differential diagnosis an overview sciencedirect topics. In the case of measles, for example, your immune system detects the virus as it travels. Viral rashes are caused by either an immune response to the virus or damage to skin cells from the virus. During an outbreak such as the ebola epidemic in west africa, special screening protocols may be needed. The differential diagnosis is broad and a systematic approach to the management of these patients is required in order to establish the diagnosis and to initiate prompt and effective treatment. After consideration of the preceding differential diagnosis, adultonset stills disease was diagnosed. Evaluation of maculopapular rash differential diagnosis. Poster features six illustrations of children with diseases involving rashes, along with explanations of the diseases and closeups of helpful diagnostic features. The differential diagnosis is extensive, ranging from selflimiting conditions e.
There are noninfectious diseases that can also show with fever and rash. History andthephysicalexaminationprovideimportantcluestothe diagnosis. The differential diagnosis of exanthems rashes is part of the daily routine in. Adult patients with fever and rash had a wide differential diagnosis.
Generally, rash in the absence of fever or systemic symptoms is not urgent. It is caused by toxinproducing group a betahemolytic streptococci gabhs found in secretions and discharge from the nose, ears, throat, and skin. We present a challenging case of an asymptomatic 7yearold girl with an atypical exanthem and discuss differential diagnoses, focusing on common viral and bacterial causes. Mar 15, 2010 sudden onset of high fever without rash or other symptoms in a child younger than 3 years. Pediatric fever of unknown origin semantic scholar. Aug 24, 2011 a thorough physical examination is also essential for conclusive diagnosis and planning further course of treatment. Approach to a the child with a fever and rash learn pediatrics. Evaluation of maculopapular rash differential diagnosis of.
The rash is characterized by a symmetrical fixed erythematous maculopapular lesion with slight scale occurring over both cheeks and nose, sparing the nasolabial folds figs 3. It is associated with a moist cough, vomiting, and decreased po intake. Clinical features and etiology of adult patients with. Child with fever differential diagnosis mnemonic best usmle step 2 cs mnemonics.
Laboratory testing for acute, generalized vesicular or pustular rash illness 1. Skin manifestations may provide the only early clue to an underlying infection, may be the hallmark of contagious disease, andor may be an early sign of a lifethreatening infection or serious noninfectious. Acute, generalized vesicular or pustular rash illness. Most early postoperative fever is caused by the inflammatory stimulus of tissue damage. Typhus, rickettsial spotted fever, rocky mountain spotted fever, lyme disease, ehrlichiosis, and tularemia. Having trouble remembering all the important questions to ask during your patient encounter. In the following 36 hours a maculopapular rash had developed on his neck, becoming more florid and extending to his trunk and arms prior to presentation. Sudden onset of high fever without rash or other symptoms in a child younger than 3 years. Sep 30, 2015 usually, early diagnostic testing for a febrile illness with a rash is inefficient.
The rash was characterised by clusters of translucent, tense vesicles located symmetrically on the extensor surfaces of the arms and legs figure 1a, b, and by erythematous papules and small plaques on the buttocks figure 1c. General presentation children frequently present at the physicians office or emergency room with a fever and rash. Her mother reports that she appears lethargic and has been. However, fever says that something is not right with the body and that the body is reacting to it, usually as a selfprotective mechanism. She was seen twice by the primary care physician pcp during this time, and she was diagnosed as having erythema toxicum. Measles is on the rise in the united kingdom and must be considered in the differential diagnosis of any patient presenting with fever and rash. Assistant professor, division of general pediatrics, doernbecher childrens hospital, oregon health sciences university, portland, or.
Use of history, location of exposure, and incubation to limit differential diagnosis. The term maculopapular is nonspecific, as many eruptions have a primary morphology of macules or papules, and the term may be misused to indicate any rash. Fever and rash infectious disease and antimicrobial agents. Diaper rash, or diaper dermatitis, is a general term describing any of a number of inflammatory skin conditions that can occur in the diaper area. The most common infectious diseases with fever and rash are transmitted by vector. Differential diagnosis a chronic systemic inflammatory autoimmune disease distinguished by joint swelling, tenderness and destruction of synovial joint leading to disability and premature death. Scarlet fever may present with a sandpaper papular rash and a strawberry tongue. Acute conjunctivitis pink eye dermatologic manifestations of viral hemorrhagic fevers. Approach to sore throat developed by charissa ho and dr. Although the differential diagnosis is very broad, adequate history and physical examination can help the clinician narrow down a list of more probable etiologies.
Fever all through the night a case of persistent fevers allison buttarazzi, pgy 3. The patients fever was first noted 3 days ago, measured at home to 103f. Pediatric dermatology cases i have no financial relationships with the manufacturers of any commercial products andor provider of commercial services discussed in this cme activity i do intend to discuss off label use of a commercial productdevice in my presentation for the treatment of sjsten, alopecia areata. The differential diagnosis is extensive but selflimited illnesses predominate. Fever chapter 11 2020 yellow book travelers health. In addition, the introduction of additional laboratory methods for differential diagnosis is required for the final classification of suspected cases with maculopapular rash and fever in the. A 10dayold girl is brought to the emergency department ed with fever and rash. Dengue haemorrhagic fever 12 chapter 2 clinical diagnosis dengue virus infections may be asymptomatic or may lead to undifferentiated fever, dengue fever df or dengue haemorrhagic fever dhf with plasma leakage that may lead to hypovolaemic shock dengue shock syndrome, dss figure 2. The differential diagnosis for febrile patients with a rash is extensive. If the itch is generalised and no primary skin rash observed, check blood count, iron studies. Besides proper history taking and physical examination, laboratory tests are also helpful in confirming the diagnosis. Aprof amanda oakley, dermatologist, hamilton, new zealand, february 2016. Patients with an erythematous rash but without a fever or nikolsky sign may be having an anaphylactic reaction or a reaction to vancomycin, scombroid, or alcohol exposure.
Fever in infants and children pediatrics merck manuals. Coccidioidomycosis and valley fever differential diagnoses. Those patients with an erythematous rash but without a fever or nikolsky sign may be having an anaphylactic reaction or an exposure reaction to scombroid or alcohol. Jun 21, 2019 scarlet fever known as scarlatina in older literature references is a syndrome characterized by exudative pharyngitis see the image below, fever, and brightred exanthem. Fever and rash clinical dermatology accessmedicine. Fever accompanied by any of the following syndromes deserves further scrutiny, because it may indicate a disease of public health importance, where immediate infection control and containment measures are indicated. Bacterial and viral infections are frequently associated with a rash and fever in children. Diseases include measles, rubella, chickenpox, roseola, scarlet fever, and fifth disease.