Fever and rash in children

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Fever and rash in children Microchapters

Overview

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Natural History, Complications, and Prognosis

Diagnosis

Treatment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[2]

Synonyms and Keywords: Fever and rash in kids

Overview

Fever and rash are symptoms encountered frequently in pediatrics. Disease states associated with these symptoms are varied. Febrile rashes can be classified based on morphology, distribution of spread, pattern of occurrence and cause. Fever results when exogenous (micro-organisms) and endogenous pyrogens interact with the Organum Vasculosum of the Lamina Terminalis (OVLT) causing a rise in body temperature as a result of an increase in the hypothalamic set point. Fever and rash in kids are caused by infectious (bacterial, viral, fungal, and protozoan) and non-infectious (drug-related eruptions and immune-mediated) causes. Patients of all age groups may develop diseases that present with fever and rash. Common risk factors for the development of diseases that present with fever and rash include contact with ill individuals, poor/depressed immunity, lack of vaccination, very young age, and poor hand washing habits. The symptoms of diseases associated with fever and rash usually develop in the first few days from contact. The stages/phases of most infectious processes include the incubation period, prodromal phase, illness, decline, and convalescence. Rapid clinical diagnosis is necessary in severe cases to begin immediate empiric therapy while awaiting the test results. Triaging kids who present with fever and rash into three groups on basis of early symptoms and signs is essential for making prompt diagnosis and administering possible treatment regimen. Effective measures for primary prevention of fever and rash in children may include vaccination, coughing, and sneezing into elbows or tissue, hand washing, avoiding contact with ill individuals, preventing exposure to tick bites.

Classification

Fever + Rash Morphology Disease
Non-blanching lesions (Petechiae, Purpura and Ecchymoses) a. Meningococcemia

b. Rocky Mountain Spotted Fever (RMSF)

c. Hemolytic Uremic Syndrome (HUS)

d. Henoch-Schonlein Purpura (HSP)

Blanching rash a. Kawasaki disease

b. Juvenile Rheumatoid Arthritis

c. Juvenile Dermatomyositis

Vesicular or bullous lesions a. Erythema multiforme

b. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

c. Staphylococcal Scalded Skin Syndrome (SSSS)

d. Disseminated gonococcal disease in adolescents

e. HSV I & II

Umbilicated papules and pustules a. Molluscum contagiosum

b. Varicella/Chickenpox

Sandpaper rash a. Scarlet fever
Viral syndromes(mostly maculopapular) a. Measles (Rubeola)

b. Rubella (German measles)

c. Erythema infectiosum (Parvovirus B19)

d. Herpangina (Coxsackie)

e. Hand-foot-and-mouth disease (Coxsackie)

f. Roseola infantum (Human Herpes Virus types 6 or 7)

Limited to certain geographical areas a. Babesiosis

b. Blastomycosis

c. Coccidiodomycosis

d. Histoplasmosis

e. Lyme disease

f. Relapsing fever

g. Colorado Tick Fever

Pathophysiology

Causes

  • Common causes of fever and rash in kids may include:
Infectious Disease Causative Organism
Viral Measles

German Measles

Erythema infectiosum

Roseola infantum

Herpangina

Hand-foot-and-mouth disease

Molluscum contagiosum

Chickenpox

Rubeola

Rubella

Parvovirus B19

Human Herpes Virus 6 & 7

Coxsackievirus

Coxsackie virus

Poxvirus

Varicella Zoster virus

Bacterial Meningococcemia
Neisseria meningitidis

Hemophilus influenzae

Streptococcus pneumoniae

RMSF Rickettsia rickettsii
HUS Enterohemorrhagic E.coli (EHEC)
Scarlet Fever Streptococcus pyogenes (Group A Streptococci, GAS)
Disseminated gonococcal disease in adolescents Neisseria gonorrhoea
SSSS

TSS

Staphylococcus aureus
Lyme disease Borrelia burgdorferi
Relapsing fever Borrelia recurrentis
Protozoan Babesiosis Babesia microti
Fungal Histoplasmosis

Blastomycosis

Coccidiodomycosis

Paracoccidiodomycosis

Histoplasma capsulatum

Blastomyces dermatitidis

Coccidioides immitis

Paracoccidioides brasiliensis


Non-Infectious Disease
Immune-mediated/Autoimmune Kawasaki Disease

Henoch-Schonlein Purpura

Juvenile Rheumatoid Arthritis

Juvenile Dermatomyositis

Drug-related eruptions Erythema multiforme

SJS

TEN

Epidemiology and Demographics

Age

Race

Gender

  • No known gender predilection.

Risk Factors

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

X-ray

Echocardiography or Ultrasound

Treatment

Medical therapy

Prevention

References

  1. 1.0 1.1 Kang JH (2015). "Febrile Illness with Skin Rashes". Infect Chemother. 47 (3): 155–66. doi:10.3947/ic.2015.47.3.155. PMC 4607768. PMID 26483989.
  2. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-1
  3. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-2
  4. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-3
  5. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-4
  6. 6.0 6.1 6.2 Schortgen F (2012). "Fever in sepsis". Minerva Anestesiol. 78 (11): 1254–64. PMID 22772856.
  7. 7.0 7.1 7.2 Walter EJ, Hanna-Jumma S, Carraretto M, Forni L (2016). "The pathophysiological basis and consequences of fever". Crit Care. 20 (1): 200. doi:10.1186/s13054-016-1375-5. PMC 4944485. PMID 27411542.
  8. 8.0 8.1 8.2 Mims CA (1966). "Pathogenesis of rashes in virus diseases". Bacteriol Rev. 30 (4): 739–60. PMC 441013. PMID 5342519.
  9. Tesini BL, Epstein LG, Caserta MT (2014). "Clinical impact of primary infection with roseoloviruses". Curr Opin Virol. 9: 91–6. doi:10.1016/j.coviro.2014.09.013. PMC 4267952. PMID 25462439.
  10. McQuiston JH, Wiedeman C, Singleton J, Carpenter LR, McElroy K, Mosites E; et al. (2014). "Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain Spotted Fever". Am J Trop Med Hyg. 91 (4): 767–70. doi:10.4269/ajtmh.14-0123. PMC 4183402. PMID 25092818.
  11. Jensen HE, Schønheyder HC, Hotchi M, Kaufman L (1996). "Diagnosis of systemic mycoses by specific immunohistochemical tests". APMIS. 104 (4): 241–58. doi:10.1111/j.1699-0463.1996.tb00714.x. PMID 8645463.
  12. Parija SC, Kp D, Venugopal H (2015). "Diagnosis and management of human babesiosis". Trop Parasitol. 5 (2): 88–93. doi:10.4103/2229-5070.162489. PMC 4557163. PMID 26629450.
  13. Fölster-Holst R, Kreth HW (2009). "Viral exanthems in childhood--infectious (direct) exanthems. Part 1: Classic exanthems". J Dtsch Dermatol Ges. 7 (4): 309–16. doi:10.1111/j.1610-0387.2008.06868.x. PMID 18803578.