Fever and rash in children: Difference between revisions

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{{Fever and rash in children}}                                                                
{{Fever and rash in children}}
{{SI}}                                                               
{{CMG}} {{AE}} {{Ifeoma Anaya}}
{{CMG}} {{AE}} {{Ifeoma Anaya}}


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==Overview==
==Overview==
[[Fever]] and [[skin rash]] are very common [[symptoms]] seen in [[pediatric]] [[populations]] both in [[clinic]] and [[hospital]] [[settings]]. [[Disease states]] associated with these symptoms are varied and can range from [[benign]] to extremely [[severe illness]] requiring prompt [[intervention]] in the [[emergency room]] or even [[ICU]]. Therefore, a vast knowledge of these disease states is very important as oftentimes, [[diagnosis]] is mainly [[clinical]].
[[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]] [[Pyrogen|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 [[Eruption|eruptions]] and [[Immune-mediated disease|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 [[Illness|ill]] individuals, poor/depressed [[immunity]], lack of [[vaccination]], very [[Young adult|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]] [[Process (anatomy)|processes]] include the [[incubation period]], [[prodromal]] [[Phase (matter)|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 [[Illness|ill]] individuals, [[Prevention|preventing]] exposure to [[tick bites]].


==Classification==
==Classification==
[[Febrile]] rashes can be classified based on:
*[[Morphology]] ([[maculopapular]], [[Pustular rash|pustular]], [[vesicular]], etc)
*[[Distribution of spread]] ([[systemic]] and [[Localized disease|localized]]
*[[Pattern]] of occurrence ([[acute]] and [[chronic]])
*Cause ([[infectious]] and [[non-infectious]]) <ref name="pmid26483989">{{cite journal| author=Kang JH| title=Febrile Illness with Skin Rashes. | journal=Infect Chemother | year= 2015 | volume= 47 | issue= 3 | pages= 155-66 | pmid=26483989 | doi=10.3947/ic.2015.47.3.155 | pmc=4607768 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26483989  }} </ref>


Types of [[rashes]] found among pediatric patients include the following: [[macules]], [[papules]], [[nodules]], [[pustules]], [[vesicles]], [[bullae]], [[petechiae]], [[purpura]] and [[ecchymoses]]. <ref name="pmid26483989">{{cite journal| author=Kang JH| title=Febrile Illness with Skin Rashes. | journal=Infect Chemother | year= 2015 | volume= 47 | issue= 3 | pages= 155-66 | pmid=26483989 | doi=10.3947/ic.2015.47.3.155 | pmc=4607768 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26483989  }} </ref>
*[[Febrile]] [[rashes]] can be classified based on:
**[[Morphology]] ([[maculopapular]], [[Pustular rash|pustular]], [[vesicular]] etc)
**[[Distribution of spread]] ([[systemic]] and [[Localized disease|localized]])
**[[Pattern]] of occurrence ([[acute]] and [[chronic]])
**Cause ([[infectious]] and [[non-infectious]])<ref name="pmid26483989">{{cite journal| author=Kang JH| title=Febrile Illness with Skin Rashes. | journal=Infect Chemother | year= 2015 | volume= 47 | issue= 3 | pages= 155-66 | pmid=26483989 | doi=10.3947/ic.2015.47.3.155 | pmc=4607768 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26483989  }} </ref>
*Types of [[rashes]] found among [[pediatric]] [[patients]] include the following:<ref name="pmid26483989" />
**[[Macules]]
**[[Papules]]
**[[Nodules]]
**[[Pustules]]
**[[Vesicles]]
**[[Bullae]]
**[[Petechiae]]
**[[Purpura]]
**[[Ecchymoses]]
*Classification of [[febrile]] [[rashes]] based on [[rash]] [[morphology]] is as follows:<ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-1</ref><ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-2</ref><ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-3</ref><ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-4</ref>


Classification of febrille rashes based on rash morphology are as follows:<ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-1</ref> <ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-2</ref> <ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-3</ref> <ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-4</ref>
{| class="wikitable"
{| class="wikitable"
|+
|+
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| align="center" style="background:#DCDCDC;" + |Non-[[blanching]] [[lesions]] ([[Petechiae]], [[Purpura]] and [[Ecchymoses]])
| align="center" style="background:#DCDCDC;" + |Non-[[blanching]] [[lesions]] ([[Petechiae]], [[Purpura]] and [[Ecchymoses]])
|a. [[Meningococcemia]]
|a. [[Meningococcemia]]
b. [[Rocky Mountain Spotted Fever]] (RMSF)
b. [[Rocky Mountain Spotted Fever]] ([[Rocky Mountain spotted fever|RMSF]])


c. [[Hemolytic Uremic Syndrome]] (HUS)
c. [[Hemolytic Uremic Syndrome]] ([[Hemolytic-uremic syndrome|HUS]])


d. [[Henoch-Schonlein Purpura]] (HSP)
d. [[Henoch-Schonlein Purpura]] ([[HSP]])
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Blanching]] [[rash]]
| align="center" style="background:#DCDCDC;" + |[[Blanching]] [[rash]]
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b. [[Juvenile Rheumatoid Arthritis]]
b. [[Juvenile Rheumatoid Arthritis]]


c. Juvenile Dermatomyositis
c. [[Juvenile (organism)|Juvenile]] [[Dermatomyositis]]
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Vesicular]] or [[bullous]] [[lesions]]
| align="center" style="background:#DCDCDC;" + |[[Vesicular]] or [[bullous]] [[lesions]]
|a. [[Erythema multiforme]]
|a. [[Erythema multiforme]]
b. [[Stevens-Johnson Syndrome]] (SJS) and [[Toxic Epidermal Necrolysis]] (TEN)
b. [[Stevens-Johnson Syndrome]] ([[Stevens-Johnson syndrome|SJS]]) and [[Toxic Epidermal Necrolysis]] ([[Toxic epidermal necrolysis|TEN]])


c. Staphylococcal Scalded Skin Syndrome ([[SSSS]])
c. [[Staphylococcal scalded skin syndrome|Staphylococcal Scalded Skin Syndrome]] ([[SSSS]])


d. [[Disseminated gonococcal infection|Disseminated]] [[gonococcal]] disease in adolescents
d. [[Disseminated gonococcal infection|Disseminated]] [[gonococcal]] [[disease]] in [[Adolescent|adolescents]]


e. [[Herpes simplex virus|HSV]] I & II
e. [[Herpes simplex virus|HSV]] I & II
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|a. [[Scarlet fever]]
|a. [[Scarlet fever]]
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Viral]] [[syndromes]]
| align="center" style="background:#DCDCDC;" + |[[Viral]] [[syndromes]](mostly [[maculopapular]])
|a. [[Measles]] ([[Rubeola]])
|a. [[Measles]] ([[Rubeola]])
b. [[Rubella]] ([[German measles]])
b. [[Rubella]] ([[German measles]])
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e. [[Hand-foot-and-mouth disease]] ([[Coxsackie]])
e. [[Hand-foot-and-mouth disease]] ([[Coxsackie]])


f. [[Roseola infantum]] (Human Herpes Virus types 6 or 7)
f. [[Roseola infantum]] ([[Human herpesvirus 6|Human Herpes Virus types 6]] or 7)
|-
|-
| align="center" style="background:#DCDCDC;" + |Limited to certain [[Geographical pole|geographical]] areas
| align="center" style="background:#DCDCDC;" + |Limited to certain [[Geographical pole|geographical]] [[Area|areas]]
|a. [[Babesiosis]]
|a. [[Babesiosis]]
b. [[Blastomycosis]]
b. [[Blastomycosis]]
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f. [[Relapsing fever]]
f. [[Relapsing fever]]


g. Colorado Tick Fever
g. [[Colorado tick fever|Colorado Tick Fever]]
|}
|}


==Pathophysiology==
==Pathophysiology==
It is understood that [[infectious]] processes accounts for up to 74% of [[fever]] in hospitalized [[patients]], the remainder being caused by [[malignancy]], [[ischemia]] and [[drug]]-related reactions <ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>.
[[Fever]] results when [[exogenous]] ([[micro-organisms]]) and [[endogenous]] ([[Interleukin]][<nowiki/>[[IL-1|IL]]]-1, [[IL-6]] and Tumor Necorsis Factor[<nowiki/>[[Tumor necrosis factor-alpha|TNF]]]-α) pyrogens interact with the Organum Vasculosum of the Lamina Terminalis (OVLT) <ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>. The OVLT is highly [[vascular]] [[Organ (anatomy)|organ]] located in the [[anterior hypothalamus]], lacking the Blood-Brain-Barrier (BBB) thus easily accessible to pyrogens. The resultant increased production of [[Prostaglandin E2]] (PGE2) results in raised body [[temperature]] <ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref> .
Another mechanism is by production of PGE2 by [[Lipopolysaccharide]] (LPS) on [[gram negative bacteria]] and by the [[Toll-like receptor]] [[cascade]] <ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>.


[[Skin]] [[lesions]] ([[rash]]) could be primarily [[vascular]] or from [[infection]] spread to [[tissues]] (e.g. [[skin]]) <ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>. The first step in the formation of a [[skin]] [[lesion]]/[[rash]] is localization of the [[micro-organism]] in the [[blood vessel]] walls <ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>. A [[macule]] forms from sustained local [[dilation]] of subpapilary [[dermal]] [[blood vessels]]. [[Edema]] with [[Infiltration (medical)|infiltration]] of [[Cells (biology)|cells]] turns a [[macule]] to [[papule]]. Primary [[epidermal]] involvement results in [[vesicles]], [[ulcers]] and scabs and secondary [[Epidermis (skin)|epidermal]] changes can lead to [[desquamation]] and [[pigment]] changes <ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>.
*When core [[Body temperature|body temperatures]] vary outside normal ranges, [[Thermoregulation|thermoregulatory]] responses are triggered.<ref name="pmid22772856">{{cite journal| author=Schortgen F| title=Fever in sepsis. | journal=Minerva Anestesiol | year= 2012 | volume= 78 | issue= 11 | pages= 1254-64 | pmid=22772856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22772856  }} </ref>
*It is understood that [[infectious]] [[Process (anatomy)|processes]] accounts for up to 74% of [[fever]] in [[Hospital|hospitalized]] [[patients]], the remainder being caused by [[malignancy]], [[ischemia]] and [[drug]]-related reactions.<ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>
*[[Fever]] results when [[exogenous]] ([[micro-organisms]]) and [[endogenous]] [[Pyrogen|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]].
*This rise in the [[hypothalamic]] [[set point]] is due to an increased production of [[Prostaglandin E2]] ([[PGE2]]) by [[endothelial cells]] of the [[vascular]] OVLT located in the [[preoptic area]] of the [[anterior hypothalamus]]. It lacks the [[Blood brain barrier|Blood-Brain-Barrier (BBB)]] thus easily accessible to [[Pyrogen|pyrogens]]. This resultant increased production of [[PGE2]] results in raised [[body temperature]].<ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>
*[[Lipopolysaccharide]] (LPS) on [[gram negative bacteria]] is a common [[exogenous]] [[pyrogen]] which stimulates the production of [[endogenous]] [[cytokines]] such as [[IL-1|IL]]-1, [[IL-6]] an<nowiki/>d [[Tumor necrosis factor-alpha|TNF]]-α via the [[Toll-like receptor]] (TL<nowiki/>Rs) [[cascade]].<ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref><ref name="pmid22772856">{{cite journal| author=Schortgen F| title=Fever in sepsis. | journal=Minerva Anestesiol | year= 2012 | volume= 78 | issue= 11 | pages= 1254-64 | pmid=22772856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22772856  }} </ref>
*[[PGE2]] production can also be stimulated via the [[vagus nerve]] by [[inflammatory processes]] and directly by [[microbial]] [[Product (biology)|products]] through [[TLR10|TLRs]].<ref name="pmid22772856">{{cite journal| author=Schortgen F| title=Fever in sepsis. | journal=Minerva Anestesiol | year= 2012 | volume= 78 | issue= 11 | pages= 1254-64 | pmid=22772856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22772856  }} </ref>
*[[Skin]] [[lesions]] ([[rash]]) could be primarily [[vascular]] or from [[infection]] spread to [[tissues]] (e.g. [[skin]]).<ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>
*The first step in the formation of a [[skin]] [[lesion]]/[[rash]] is the presence of the [[micro-organism]] in the [[vascular]] [[endothelium]].<ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>
*A [[macule]] forms from sustained [[local]] [[dilation]] of subpapilary [[dermal]] [[blood vessels]].
*[[Edema]] with [[Infiltration (medical)|infiltration]] of [[Cells (biology)|cells]] turns a [[macule]] to [[papule]].
*Primary [[epidermal]] involvement results in [[vesicles]], [[ulcers]], [[Scab|scabs]], and secondary [[Epidermis (skin)|epidermal]] changes can lead to [[desquamation]] and [[pigment]] changes.<ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>


==Causes==
==Causes==
Common causes of [[fever]] and [[rash]] in kids may include:
 
*Common causes of [[fever]] and [[rash]] in kids may include:


{| class="wikitable"
{| class="wikitable"
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[[Parvovirus B19]]
[[Parvovirus B19]]


Human Herpes Virus 6 & 7
[[Human herpesvirus 6|Human Herpes Virus]] 6 & 7


[[Coxsackie virus]]
[[Coxsackie virus|Coxsackievirus]]


[[Coxsackie virus]]
[[Coxsackie virus]]
Line 138: Line 156:
|-
|-
|[[Hemolytic-uremic syndrome|HUS]]
|[[Hemolytic-uremic syndrome|HUS]]
|Enterohemorrhagic E.coli ([[EHEC]])
|[[Enterohemorrhagic escherichica coli|Enterohemorrhagic E.coli]] ([[EHEC]])
|-
|-
|[[Scarlet Fever]]
|[[Scarlet Fever]]
|[[Streptococcus pyogenes]] (Group A Streptococci, GAS)
|[[Streptococcus pyogenes]] (Group A [[Streptococci]], GAS)
|-
|-
|[[Disseminated gonococcal infection|Disseminated gonococcal]] disease in adolescents
|[[Disseminated gonococcal infection|Disseminated gonococcal]] [[disease]] in [[Adolescent|adolescents]]
|[[Neisseria gonorrhoeae|Neisseria gonorrhoea]]
|[[Neisseria gonorrhoeae|Neisseria gonorrhoea]]
|-
|-
Line 188: Line 206:
[[Juvenile Rheumatoid Arthritis]]
[[Juvenile Rheumatoid Arthritis]]


Juvenile Dermatomyositis
[[Juvenile (organism)|Juvenile]] [[Dermatomyositis]]
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Drug]]-related eruptions
| align="center" style="background:#DCDCDC;" + |[[Drug]]-related [[Eruption|eruptions]]
|[[Erythema multiforme]]
|[[Erythema multiforme]]
[[SJS]]
[[SJS]]
Line 200: Line 218:
===Age===
===Age===


*Patients of all age groups may develop diseases that present with [[fever]] and [[rash]].
*[[Patients]] of all [[age]] [[Group (sociology)|groups]] may develop [[diseases]] that present with [[fever]] and [[rash]].


===Race===
===Race===


*There is no racial predilection to diseases that present with [[fever]] and [[rash]].
*There is no [[racial]] predilection to [[diseases]] that present with [[fever]] and [[rash]].


===Gender===
===Gender===
Line 210: Line 228:
*No known gender predilection.
*No known gender predilection.


Most children become susceptible to some of the diseases from 6 months of age when maternal [[antibodies]] begin to wane <ref name="pmid25462439">{{cite journal| author=Tesini BL, Epstein LG, Caserta MT| title=Clinical impact of primary infection with roseoloviruses. | journal=Curr Opin Virol | year= 2014 | volume= 9 | issue=  | pages= 91-6 | pmid=25462439 | doi=10.1016/j.coviro.2014.09.013 | pmc=4267952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462439  }} </ref>.
*Most [[children]] become susceptible to some of the [[diseases]] from 6 months of [[age]] when [[maternal]] [[antibodies]] begin to wane.<ref name="pmid25462439">{{cite journal| author=Tesini BL, Epstein LG, Caserta MT| title=Clinical impact of primary infection with roseoloviruses. | journal=Curr Opin Virol | year= 2014 | volume= 9 | issue=  | pages= 91-6 | pmid=25462439 | doi=10.1016/j.coviro.2014.09.013 | pmc=4267952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462439  }} </ref>


==Risk Factors==
==Risk Factors==
Common [[risk factors]] for the development of diseases that present with [[fever]] and [[rash]] include:


*Contact with ill individuals
*Common [[risk factors]] for the [[development]] of [[diseases]] that present with [[fever]] and [[rash]] include:
*Poor/depressed [[immunity]]
**Contact with [[Illness|ill]] individuals
*Lack of [[vaccination]]
**Poor/depressed [[immunity]]
*Very young age (6 months-12 months)
**Lack of [[vaccination]]
*Poor [[hand washing]] habits
**Very young [[age]] (6 months-12 months)
**Poor [[hand washing]] habits


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
*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 (between exposure to an infection and the appearance of the first symptoms).
*The [[symptoms]] of [[diseases]] associated with [[fever]] and [[rash]] usually develop in the first few days from contact. The stages/phases of most [[infectious]] [[Process (anatomy)|processes]] include the:
** Prodromal phase (period of early symptoms of a disease)
**[[Incubation period]] is defined as the period between [[Exposure (photography)|exposure]] to an [[infection]] and the [[appearance]] of the first [[symptoms]].
** Illness (characteristic symptoms of the disease appear at this stage)
**[[Prodromal]] [[Phase (matter)|phase]] is defined as the [[period]] of early [[symptoms]] of a [[disease]].
** Decline and
**[[Illness]] is defined as [[appearance]] of characteristic [[symptoms]] of the [[disease]].
** Convalescence
**Decline phase
**[[Convalescence]] phase


===Complications===
===Complications===
*Common complications of diseases presenting with fever and rash include:
 
**Febrille seizures
*Common [[complications]] of [[diseases]] presenting with [[fever]] and [[rash]] include:
**Rhabdomyolysis
**[[Febrile seizure]]
**Shock (septic or hypovolemic)
**[[Rhabdomyolysis]]
**Disseminated Intravascular Coagulation (in Meningococcemia)
**[[Shock]] ([[septic]] or [[hypovolemic]])
**Reye syndrome (especially in children that have been given aspirin).
**[[Disseminated Intravascular Coagulation]] (in [[Meningococcemia]])
**[[Reye syndrome]] (especially in [[children]] that have been given [[aspirin]]).


===Prognosis===
===Prognosis===
*Prognosis is generally excellent for viral syndromes. Prompt diagnosis, treatment and close follow-up of patients presenting with other causes of fever and rash also results in good prognosis.
 
*[[Prognosis]] is generally excellent for [[viral]] [[syndromes]]. Prompt [[diagnosis]], [[treatment]], and close follow-up of [[patients]] presenting with other [[causes]] of [[fever]] and [[rash]] also result in a good [[prognosis]].


==Diagnosis==
==Diagnosis==
In severe cases, quick [[clinical]] [[diagnosis]] is necessary in order to institute immediate [[empiric therapy]] while awaiting test results. It is therefore important to have detailed knowledge of [[Symptoms and Signs|symptoms]] and [[Signs and Symptoms|signs]] of the common diseases in kids that present with [[fever]] and [[rash]].
 
*Rapid [[clinical]] [[diagnosis]] is necessary in severe cases to begin immediate [[empiric therapy]] while awaiting test results.


===Symptoms===
===Symptoms===
Besides [[fever]] and [[rash]], additional symptoms of diseases includes the following:


*[[runny nose]]
*Besides [[fever]] and [[rash]], additional [[symptoms]] may include:
*[[cough]]
**[[Cough]]
*[[sore throat]]
**[[Sore throat]]
*history of [[upper respiratory tract infections]] or [[diarrheal]] illness
**[[Runny nose]]
*[[earpain]]
**[[Red eyes]] ([[conjunctivitis]])
*[[red eyes]] ([[conjunctivitis]])
**[[Irritability]]
*[[pruritus]] (which could be severe in drug related rashes)
*The above additional [[symptoms]] are usually seen in the [[prodromal]] [[Phase (matter)|phase]] of most [[infectious diseases]]. Other [[symptoms]] are:
*[[poor appetite]]
**Recent [[upper respiratory tract infections]] or [[diarrheal]] [[illness]]
*[[headaches]]
**[[Ear pain]]
*[[diarrhea]]
**[[Pruritus]] (which could be severe in [[drug]] related [[rashes]])
*[[pallor]]
**[[Poor appetite]]
*[[irritability]]
**[[Headaches]]
*[[pains]] in certain body areas ([[arthritis]])
**[[Diarrhea]]
 
**[[Pallor]]
Important details to watch out for in the history include:
**[[Pains]] in certain [[body]] [[Area|areas]] ([[arthritis]])
 
*Important details in the history include:
*time of onset and progression of [[symptoms]]
**Onset and progression of [[symptoms]]
*[[location]] of the [[rash]]([[central]] or peripheral) and the rate of emergence
**[[Site]] of the [[rash]] ([[central]] or peripheral)
*seasonal occurrence
**Relation with the season(s)
*recent travel
**Travel history
*any [[Tick bites|tick bite]](s)?
**[[Tick bites|Tick bite]](s)
*contact with an ill individual or animal
**Contact with an [[Illness|ill]] [[person]] or animal
*detailed [[medication]] history (especially [[sulfonamides]], [[NSAIDs]] and [[anticonvulsants]])
**[[Medication]] history (most especially [[sulfonamides]], [[NSAIDs]] and [[anticonvulsants]])
*[[exposure]] to forest or other natural environment
**[[Exposure]] to [[Forest plot|forest]] or other [[natural environment]]
*also important to evaluate the [[immune]] status of the patient
**Also important to evaluate the [[immune]] status of the [[patient]]


===Physical Examination===
===Physical Examination===
In addition to [[symptoms]] already listed above, additional findings on [[Physical examination|examination]] include;


*state of the child (how ill?)
*Findings on [[examination]] include:
*[[rash]] [[morphology]] and its location/distribution
**[[Illness]] severity
*[[lymph node]] enlargement
**Type of [[rash]], its [[Location parameter|location]], and [[Distribution constant|distribution]]
*conjuctival, [[oral]] and [[genital]] findings
**[[Lymphadenopathy]]
*[[nuchal rigidity]] (in older kids)
**[[Conjunctival]], [[oral]] and [[genital]] changes
*[[Nikolsky's sign]]
**[[Nuchal rigidity]] (especially in older kids)
*[[tenderness]] (at the joints)
**[[Nikolsky's sign]]
*[[hepatomegaly]], [[splenomegaly]] or both
**[[Area|Areas]] of [[tenderness]] (e.g. at the [[joints]])
*[[tachycardia]]
**[[Hepatomegaly]]
*[[hypotension]]
**[[splenomegaly]]
**[[Hypotension]]
**[[Tachycardia]]


===Laboratory Findings===
===Laboratory Findings===
[[Laboratory]] tests for the various [[diseases]] is largely dependent on [[etiology]]. They are needed mostly to support [[diagnosis]]. Some lab findings needed to support diagnosis of some diseases are as follows:


*Non-[[blanching]] [[lesions]];
*[[Laboratory]] findings needed to support [[diagnosis]] or determine [[illness]] severity of some [[diseases]] are as follows:
**[[Complete blood count]] with differentials- may show [[anemia]], [[thrombocytopenia]], [[elevated white blood cell count]].
**[[Complete blood count]] with differentials which might reveal:
**[[Factor analysis|Factor]] assays- depleted [[coagulation factors]] in severe [[meningococcemia]] with [[Disseminated Intravascular Coagulation]] (DIC)
***[[anemia]]
**[[Serum]] metabolic panel: [[Electrolyte imbalance|electrolyte]] derangements ([[HUS]], [[Meningococcemia]])
***[[thrombocytopenia]]
**Other labs to isolate offending [[organism]] in order to switch to appropriate [[antibiotics]] include;
***[[elevated white blood cell count]]
**[[Factor analysis|Factor]] assays show low [[coagulation factors]] in severe [[Meningococcemia]] with [[Disseminated Intravascular Coagulation]] ([[Disseminated intravascular coagulation|DIC]])
**[[Serum]] chemistries: [[Electrolyte imbalance|Electrolyte imbalance]] in ([[HUS]], [[Meningococcemia]])
**Labs to isolate offending [[organisms]] in [[Infectious disease|infectious diseases]] for targeted [[antibiotics]] regimen are:
***[[Nasal]]/[[throat]] [[Swabbing|swab]] for [[rapid strep test]] and/or [[Culture collection|culture]]
***[[Nasal]]/[[throat]] [[Swabbing|swab]] for [[rapid strep test]] and/or [[Culture collection|culture]]
***[[Blood cultures]]
***[[Blood cultures]]
***[[Stool culture|Stool]] and [[Urine culture|urine]] [[microscopy]]/culture/[[Sensitivity (tests)|sensitivity]]
***[[Stool culture|Stool]] and [[Urine culture|urine]] [[microscopy]]/[[Culture medium|culture]]/[[Sensitivity (tests)|sensitivity]]
***[[Cerebrospinal fluid]] (CSF) [[analysis]]
***[[Cerebrospinal fluid]] ([[CSF]]) [[analysis]]
***[[Antibody]] and [[Polymerase chain reaction|PCR]] assays- [[Rocky Mountain spotted fever|RMSF]] <ref name="pmid25092818">{{cite journal| author=McQuiston JH, Wiedeman C, Singleton J, Carpenter LR, McElroy K, Mosites E | display-authors=etal| title=Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain Spotted Fever. | journal=Am J Trop Med Hyg | year= 2014 | volume= 91 | issue= 4 | pages= 767-70 | pmid=25092818 | doi=10.4269/ajtmh.14-0123 | pmc=4183402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25092818  }} </ref>
***[[Antibody]] and [[Polymerase chain reaction|PCR]] assays- [[Rocky Mountain spotted fever|RMSF]]<ref name="pmid25092818">{{cite journal| author=McQuiston JH, Wiedeman C, Singleton J, Carpenter LR, McElroy K, Mosites E | display-authors=etal| title=Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain Spotted Fever. | journal=Am J Trop Med Hyg | year= 2014 | volume= 91 | issue= 4 | pages= 767-70 | pmid=25092818 | doi=10.4269/ajtmh.14-0123 | pmc=4183402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25092818  }} </ref>
***[[Skin biopsy]] of [[lesions]] in [[HSP]] showing [[leukocytoclastic vasculitis]]
***[[Skin biopsy]] of [[lesions]] in [[HSP]] show [[leukocytoclastic vasculitis]]
***[[Immunofluorescence assay|Immunofluorescence]]
***[[Immunofluorescence assay|Immunofluorescence]]
*[[Immunohistochemistry]] for diagnosing [[Systemic]] [[mycoses]] ([[fungal infections]] related to certain [[Geographical isolation|geographical]] [[Area|areas]]).<ref name="pmid8645463">{{cite journal| author=Jensen HE, Schønheyder HC, Hotchi M, Kaufman L| title=Diagnosis of systemic mycoses by specific immunohistochemical tests. | journal=APMIS | year= 1996 | volume= 104 | issue= 4 | pages= 241-58 | pmid=8645463 | doi=10.1111/j.1699-0463.1996.tb00714.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8645463  }} </ref>
*The [[viral]] [[syndromes]], [[varicella]], [[molluscum contagiosum]], [[lyme disease]], [[immune-mediated disease|immune-mediated]] [[vasculitis]] and [[drug]]-related [[Eruption|eruptions]] rely heavily on a good [[History and Physical examination|history]] and [[physical examination]] findings to make a [[diagnosis]].
*Peripheral thick and thin [[blood smear]] shows [[Babesia microti]].<ref name="pmid26629450">{{cite journal| author=Parija SC, Kp D, Venugopal H| title=Diagnosis and management of human babesiosis. | journal=Trop Parasitol | year= 2015 | volume= 5 | issue= 2 | pages= 88-93 | pmid=26629450 | doi=10.4103/2229-5070.162489 | pmc=4557163 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629450  }} </ref>


*[[Immunohistochemistry]] of tissue specimens is an invaluable tool in diagnosing [[systemic]] [[Mycosis|mycotic]] [[infection]] ([[fungal infections]] related to certain geographical areas) <ref name="pmid8645463">{{cite journal| author=Jensen HE, Schønheyder HC, Hotchi M, Kaufman L| title=Diagnosis of systemic mycoses by specific immunohistochemical tests. | journal=APMIS | year= 1996 | volume= 104 | issue= 4 | pages= 241-58 | pmid=8645463 | doi=10.1111/j.1699-0463.1996.tb00714.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8645463  }} </ref>.
===X-ray===


*The [[viral]] [[syndromes]], [[Varicella]], [[Molluscum contagiosum]], [[Lyme disease]], the [[Immune-mediated disease|Immune-mediated]] [[vasculitis]] and [[Drug]] related eruptions rely heavily on a good [[History and Physical examination|history]] and [[physical examination]] findings to make a [[diagnosis]].
*[[X-rays]] might be useful in managing severely [[Illness|ill]] individuals to look for [[complications]] but not routinely needed to make [[diagnosis]].
*Peripheral thick and thin [[blood smear]] shows [[Babesia microti]] <ref name="pmid26629450">{{cite journal| author=Parija SC, Kp D, Venugopal H| title=Diagnosis and management of human babesiosis. | journal=Trop Parasitol | year= 2015 | volume= 5 | issue= 2 | pages= 88-93 | pmid=26629450 | doi=10.4103/2229-5070.162489 | pmc=4557163 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629450  }} </ref>.
 
===Electrocardiogram===
There are no ECG findings associated with fever and rash.
 
===X-ray===
Might be useful in managing severely ill individuals to look for [[complications]] but not routinely needed to make [[diagnosis]].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography findings associated with fever and rash but can be used to [[Monitor role|monitor]] for [[coronary aneurysm]] in a patient with [[Kawasaki disease]].


===CT scan===
*There are no [[echocardiography]] findings associated with [[fever]] and [[rash]] but can be used to [[Monitor role|monitor]] for [[coronary aneurysm]] in a [[patient]] with [[kawasaki disease]].
There are no [[CT scan]] findings associated with any of the diseases.
 
===MRI===
There are no MRI findings associated with fever and rash.
 
===Other Imaging Findings===
There are no other imaging findings associated with fever and rash in children.


==Treatment==
==Treatment==
===Medical therapy===
===Medical therapy===
A practical approach to [[triage]] kids who present with [[fever]] and [[rash]] for near accurate [[diagnosis]] and treatment is to divide them into 3 groups on basis of initial presenting [[symptoms]]:


*Group 1- Children presenting with severe illness and require immediate intervention based on [[History and Physical examination|history]] and [[physical examination]]. This is especially true for the non-[[blanching]] [[lesions]].
*[[Triaging]] kids who present with [[fever]] and [[rash]] into three groups based on early [[symptoms and signs]] is essential for making prompt [[diagnosis]] and administering possible treatment regimen. These groups are:
*Group 2- Children who present with recognizable [[viral]] [[syndromes]] that requires [[symptomatic]] [[treatment]] and reassurance.
**[[Children]] presenting with severe [[illness]] necessitating immediate [[Intervention (counseling)|intervention]]. This is especially true for the non-[[blanching]] [[lesions]].
*Group 3- Children with [[undifferentiated]] [[rashes]] which could either be [[benign]] or atypical presentation of serious illness.
**[[Children]] presenting with [[viral]] [[syndromes]] which are easily recognized and require [[symptomatic]] [[treatment]] and reassurance.
**[[Children]] presenting [[undifferentiated]] [[rashes]] which could be [[benign]] or an unusual presentation of severe [[illness]].
*The '''first group''' is usually managed in the [[hospital]] with:
**[[Intravenous fluids|Intravenous fluid]] [[therapy]] with/without [[Vasopressors|vasopressor]]
**Initiation of [[empirical]] [[antibiotics]] while awaiting [[Culture collection|culture]] results.
**Third generation [[Cephalosporins|cephalosporin]] is first line [[drug]] for [[meningococcemia]].
**[[Doxycycline]] is drug of choice for [[Rocky Mountain spotted fever|RMSF]].
**[[Treatment]] for [[Hemolytic-uremic syndrome|HUS]] is supportive with a [[consultation]] to [[Nephrologist]] to manage [[renal failure]].
*The '''second group''' as earlier mentioned is managed conservatively with measures like:
**[[Antipyretics]]
**[[Fluid]] [[therapy]]
**[[antihistamines]] to soothe the [[patient]]
**Reassurance to care-givers
**Most recover without any [[complications]]
**Majority of [[children]] in this [[Group (sociology)|group]] have [[benign]] [[viral]] [[illness]] that resolves spontaneously.
**Others may have unusual presentations of serious [[illness]] and would require close monitoring with further evaluation and easy access to care. Maybe sometimes needful to admit.
*In general, most [[bacterial diseases]] are treated with the appropriate [[antibiotics]], [[Antifungal drug|antifungal]] therapy for diseases of [[fungal]] origin, [[viral]] [[syndromes]] tend to resolve spontaneously with [[symptomatic]] [[treatment]], [[drug]] related eruption require cessation of offending [[drug]] with adequate [[treatment]] of [[symptoms]], and [[fluid]] [[therapy]].


a. Group 1: managed in the [[hospital]] with aggressive [[Intravenous fluids|intravenous fluid]] [[therapy]] and [[Vasopressors|vasopressor]] support, initiation of [[empirical]] [[antibiotics]] while awaiting [[Culture collection|culture]] results. Third generation [[Cephalosporins|Cephalosporin]] are first line for [[meningococcemia]]. [[Doxycycline]] is drug of choice for [[Rocky Mountain spotted fever|RMSF]]. [[Treatment]] for [[Hemolytic-uremic syndrome|HUS]] is supportive with a [[consultation]] to the [[Nephrologist]] to manage [[renal failure]].
b. Group 2: [[Viral]] [[syndromes]] are managed conservatively with measures like [[antipyretics]], fluid therapy, [[antihistamines]] to soothe the patient and reassurance to care-givers. Most recover without any [[complications]].
c. Group 3: Vast majority of children in this group have [[benign]] [[viral]] illness which resolves spontaneously. Others may have atypical presentations of serious illness and would require close monitoring with further evaluation and easy access to care. May be sometimes needful to admit.
In general, most [[bacterial diseases]] are treated with the appropriate [[antibiotics]], [[Antifungal drug|antifungal]] therapy for diseases of [[fungal]] origin, [[viral]] [[syndromes]] tend to resolve spontaneously with [[symptomatic]] [[treatment]], [[drug]] related eruption require cessation of offending [[drug]] with adequate [[treatment]] of [[symptoms]] and fluid therapy.
===Surgery===
Surgical intervention is not recommended for the management of fever and rash in children.
===Prevention===
===Prevention===
Effective measures for primary prevention of fever and rash in children may include:


*[[Vaccinations|Vaccination]] done in a timely manner can prevent occurrence of many childhood illnesses presenting with [[fever]] and [[rash]] such as the viral symdromes <ref name="pmid18803578">{{cite journal| author=Fölster-Holst R, Kreth HW| title=Viral exanthems in childhood--infectious (direct) exanthems. Part 1: Classic exanthems. | journal=J Dtsch Dermatol Ges | year= 2009 | volume= 7 | issue= 4 | pages= 309-16 | pmid=18803578 | doi=10.1111/j.1610-0387.2008.06868.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18803578  }} </ref>.
*Effective measures for [[primary prevention]] of [[fever]] and [[rash]] in [[children]] may include:
*[[Hand washing]]frequently and thoroughly with soap and water
**[[Vaccinations|Vaccination]] done in a timely manner can [[Prevention|prevent]] occurrence of many [[childhood]] [[illnesses]] presenting with [[fever]] and [[rash]] such as the [[viral]] [[syndromes]].<ref name="pmid18803578">{{cite journal| author=Fölster-Holst R, Kreth HW| title=Viral exanthems in childhood--infectious (direct) exanthems. Part 1: Classic exanthems. | journal=J Dtsch Dermatol Ges | year= 2009 | volume= 7 | issue= 4 | pages= 309-16 | pmid=18803578 | doi=10.1111/j.1610-0387.2008.06868.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18803578  }} </ref>
*Sneeze and cough into elbows and/or tissues(which should be thrown away)
**Frequently and thoroughly [[washing]] [[hands]] with [[soap]] and [[water]].
*Avoid contact with infected individuals and contaminated surfaces.
**[[Sneeze]] and [[cough]] into [[elbows]] and/or [[tissues]] (which should be thrown away).
**Avoid contact with [[infected]] individuals and contaminated surfaces.
**Wearing clothes to cover upper and [[lower limbs]] to [[Prevention|prevent]] [[tick bites]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]

Latest revision as of 21:10, 24 February 2021

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
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