Kawasaki disease differential diagnosis: Difference between revisions

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__NOTOC__
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{{Kawasaki disease}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Kawasaki_disease]]
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{SH}};{{EG}}


==Overview==
==Overview==
Kawasaki disease must be differentiated from other diseases that cause different [[rash]]-like conditions and can be confused with [[Kawasaki disease]]. The various conditions that should be differentiated from [[Kawasaki disease]] include
Kawasaki disease must be differentiated from other diseases that cause different [[rash]]-like conditions and can be confused with [[Kawasaki disease]]. The various conditions that should be differentiated from [[Kawasaki disease]] include; [[Polyarteritis nodosa|infantile polyarteritis nodosa]], [[juvenile idiopathic arthritis]], [[leptospirosis]], [[lyme disease]], [[measles]], [[Mercury poisoning|mercury toxicity]], [[Rocky Mountain spotted fever|pediatric rocky mountain spotted fever]], [[toxic epidermal necrolysis]], [[staphylococcal scalded skin syndrome]], [[rheumatic fever]], [[impetigo]], [[insect bites]], monkey pox, [[rubella]], atypical [[measles]], [[Coxsackievirus|coxsackie virus]], [[Acne vulgaris|acne]], [[syphilis]], [[molluscum contagiosum]], toxic [[erythema]], [[rat-bite fever]], [[parvovirus B19]], [[cytomegalovirus]], [[scarlet fever]], [[Stevens-Johnson syndrome]], [[Herpes zoster|varicella-zoster virus]], [[Chickenpox|chicken pox]], [[meningococcemia]], [[Rickettsialpox|rickettsial pox]], [[meningitis]], [[toxic shock syndrome]], [[roseola infantum]] (exanthem subitum), [[Erythema Infectiosum|erythema infectiosum]] ([[Fifth Disease|fifth disease]]), [[enterovirus]], [[Dengue Fever|dengue fever]], [[Drug induced rash|drug - induced rash]], [[Infectious Mononucleosis|infectious mononucleosis]], [[Pharyngoconjunctival Fever|pharyngoconjunctival fever]], [[herpangina]], and primary herpetic gingivostomatitis.


==Differentiating Kawasaki disease from other diseases==
==Differentiating Kawasaki disease from other diseases==
Different [[rash]]-like conditions can be confused with [[Kawasaki disease]] and are thus included in its differential diagnosis. The various conditions that should be differentiated from [[Kawasaki disease]] include:<ref name="pmid25250996">{{cite journal| author=Hartman-Adams H, Banvard C, Juckett G| title=Impetigo: diagnosis and treatment. | journal=Am Fam Physician | year= 2014 | volume= 90 | issue= 4 | pages= 229-35 | pmid=25250996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25250996  }} </ref><ref name="pmid27265069">{{cite journal| author=Mehta N, Chen KK, Kroumpouzos G| title=Skin disease in pregnancy: The approach of the obstetric medicine physician. | journal=Clin Dermatol | year= 2016 | volume= 34 | issue= 3 | pages= 320-6 | pmid=27265069 | doi=10.1016/j.clindermatol.2016.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27265069  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid26612370">{{cite journal| author=Ibrahim F, Khan T, Pujalte GG| title=Bacterial Skin Infections. | journal=Prim Care | year= 2015 | volume= 42 | issue= 4 | pages= 485-99 | pmid=26612370 | doi=10.1016/j.pop.2015.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612370  }} </ref><ref name="pmid26566601">{{cite journal| author=Ramoni S, Boneschi V, Cusini M| title=Syphilis as "the great imitator": a case of impetiginoid syphiloderm. | journal=Int J Dermatol | year= 2016 | volume= 55 | issue= 3 | pages= e162-3 | pmid=26566601 | doi=10.1111/ijd.13072 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26566601  }} </ref><ref name="pmid25855021">{{cite journal| author=Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y| title=Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. | journal=Med Mycol J | year= 2015 | volume= 56 | issue= 1 | pages= E1-5 | pmid=25855021 | doi=10.3314/mmj.56.E1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855021  }} </ref><ref name="pmid23176858">{{cite journal| author=CEDEF| title=[Item 87--Mucocutaneous bacterial infections]. | journal=Ann Dermatol Venereol | year= 2012 | volume= 139 | issue= 11 Suppl | pages= A32-9 | pmid=23176858 | doi=10.1016/j.annder.2012.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23176858  }} </ref>
Different [[rash]]-like conditions can be confused with [[Kawasaki disease]] and are thus included in its differential diagnosis. The various conditions that should be differentiated from [[Kawasaki disease]] include:<ref name="pmid25250996">{{cite journal| author=Hartman-Adams H, Banvard C, Juckett G| title=Impetigo: diagnosis and treatment. | journal=Am Fam Physician | year= 2014 | volume= 90 | issue= 4 | pages= 229-35 | pmid=25250996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25250996  }} </ref><ref name="pmid27265069">{{cite journal| author=Mehta N, Chen KK, Kroumpouzos G| title=Skin disease in pregnancy: The approach of the obstetric medicine physician. | journal=Clin Dermatol | year= 2016 | volume= 34 | issue= 3 | pages= 320-6 | pmid=27265069 | doi=10.1016/j.clindermatol.2016.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27265069  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid26612370">{{cite journal| author=Ibrahim F, Khan T, Pujalte GG| title=Bacterial Skin Infections. | journal=Prim Care | year= 2015 | volume= 42 | issue= 4 | pages= 485-99 | pmid=26612370 | doi=10.1016/j.pop.2015.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612370  }} </ref><ref name="pmid26566601">{{cite journal| author=Ramoni S, Boneschi V, Cusini M| title=Syphilis as "the great imitator": a case of impetiginoid syphiloderm. | journal=Int J Dermatol | year= 2016 | volume= 55 | issue= 3 | pages= e162-3 | pmid=26566601 | doi=10.1111/ijd.13072 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26566601  }} </ref><ref name="pmid25855021">{{cite journal| author=Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y| title=Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. | journal=Med Mycol J | year= 2015 | volume= 56 | issue= 1 | pages= E1-5 | pmid=25855021 | doi=10.3314/mmj.56.E1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855021  }} </ref><ref name="pmid23176858">{{cite journal| author=CEDEF| title=[Item 87--Mucocutaneous bacterial infections]. | journal=Ann Dermatol Venereol | year= 2012 | volume= 139 | issue= 11 Suppl | pages= A32-9 | pmid=23176858 | doi=10.1016/j.annder.2012.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23176858  }} </ref>


{| class="wikitable"
<span style="font-size:85%">'''Abbreviations:'''
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Disease}}
ABG= [[Arterial blood gas]], ANA= [[Antinuclear antibody]], ANP= [[Atrial natriuretic peptide]], ASO= [[Antistreptolysin O|Antistreptolysin O antibody]], BNP= [[Brain natriuretic peptide]], CBC= [[Complete blood count]], COPD= [[Chronic obstructive pulmonary disease]], CRP= [[C-reactive protein]], CT= [[Computed tomography]], CXR= [[Chest X-ray]], DVT= [[Deep vein thrombosis]], ESR= [[Erythrocyte sedimentation rate]], HRCT= [[High Resolution CT]], IgE= [[Immunoglobulin E]], LDH= [[Lactate dehydrogenase]], PCWP= [[Pulmonary capillary wedge pressure]], PCR= [[Polymerase chain reaction]], PFT= [[Pulmonary function test]].</span>
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Features}}
|-
| style="background: #DCDCDC; padding: 5px;" |[[Kawasaki disease]]
|
* Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Impetigo]] 
|
*It commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]]. Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Insect bite]]s
|
* The insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area, often with formation of [[vesicles]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Measles]]
|
* Commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Monkeypox]]
|
* The presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rubella]]
|
* Commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
|-
| style="background: #DCDCDC; padding: 5px;" |Atypical [[measles]]
|
* The symptoms commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Coxsackievirus]]
|
* The most commonly caused disease is the [[Coxsackie A]] disease, presenting as ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]]  or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Acne]]
|
* It is typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s may have [[acne]] as well. The upper [[arm]]s can also have [[acne]], but lesions found there are often [[keratosis pilaris]], not [[acne]]. The typical [[acne]] lesions are [[comedones]] and [[inflammatory]] [[papules]], [[pustules]], and [[nodules]]. Some of the large [[nodules]] were previously called "[[cyst]]s"
|-
| style="background: #DCDCDC; padding: 5px;" |[[Syphilis]]
|It commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] It is classically described as:
* Non-pruritic bilateral symmetrical mucocutaneous [[rash]]
* Non-tender regional [[lymphadenopathy]]
* Condylomata lata and
* Patchy [[alopecia]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Molluscum contagiosum]]
|
* The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Mononucleosis]]
|
* Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
|-
| style="background: #DCDCDC; padding: 5px;" |Toxic [[erythema]]  
|
* It is a common [[rash]] in infants, with clustered and [[vesicular]] appearance.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rat-bite fever]]
|
* It commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple plaques.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Parvovirus B19]]
|
*The [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Cytomegalovirus]]
|
* The common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]]  and [[loss of appetite]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Scarlet fever]]
|
* It commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rocky Mountain spotted fever]]
|
* The [[symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Stevens-Johnson syndrome]]
|
* The [[symptoms]] may include [[fever]], [[sore throat]]  and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Varicella-zoster virus]]
|
* It commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Chickenpox]]
|
* It commonly starts with [[conjunctival]] and catarrhal [[symptoms]] and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a [[chickenpox]] blister can also spread the disease.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Meningococcemia]]
|
* It commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]] and [[vomiting]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rickettsialpox|Rickettsial pox]]
|
* The first [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body.
|-
| style="background: #DCDCDC; padding: 5px;" |[[Meningitis]]
|
* It commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
|}
 
{| class="wikitable"
|+
! rowspan="2" |Disease
! rowspan="2" |Epidemiology
! rowspan="2" |Predisposing factors
! colspan="2" |'''Clinical features'''
! rowspan="2" |'''Lab abnormalities'''
|-
|'''Signs'''
|'''Symptoms'''
|-
|[[Kawasaki disease|Kawasaki]]
[[Kawasaki disease|disease]]
|Occurs in children, usually age 1-4 years
|Interaction of genetic and environmental factors, possibly including an infection in combination with genetic predisposition to an autoimmune mechanism ([[Vasculitis|autoimmune vasculitis]])
|Non-[[suppurative]], painless bilateral conjunctival [[inflammation]] ([[conjunctivitis]]), strawberry tongue (marked redness with prominent [[Papillae of the tongue|gustative papillae]]), deep transverse grooves across the nails may develop (Beau’s lines), [[lymphadenopathy]] present(acute, non-[[purulent]], cervical), may lead to [[Coronary arteries|coronary artery]] [[Aneurysm|aneurysms]].
|High and persistent fever that is not very responsive to normal treatment with [[acetaminophen]] or [[Non-steroidal anti-inflammatory drug|NSAIDs]],  diffuse [[Maculopapular|macular-papular]] [[erythematous]] rash
|Liver function tests may show evidence of hepatic [[inflammation]] and low serum [[albumin]] levels, low hemoglobulin and age-adjusted hemoglobulin concentrations, '''[[thrombocytosis]]''', [[anemia]].  [[Echocardiography|Echocardiographic]] abnormalities, such as [[valvulitis]] ([[Mitral valve|mitral]] or [[Tricuspid valve|tricuspid]] [[Regurgitation (circulation)|regurgitation]]) and [[Coronary arteries|coronary artery]] lesions, are significantly more common in [[Kawasaki disease]]. <ref name="pmid26222065">{{cite journal |vauthors=Lin YJ, Cheng MC, Lo MH, Chien SJ |title=Early Differentiation of Kawasaki Disease Shock Syndrome and Toxic Shock Syndrome in a Pediatric Intensive Care Unit |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=11 |pages=1163–7 |year=2015 |pmid=26222065 |doi=10.1097/INF.0000000000000852 |url=}}</ref> [[Pyuria]] of uretheral origin.
|-
|[[Toxic shock syndrome]]
|Occurs in  both adults and children (9:1 female predominance)
|Occurs in association with [[vaginitis]] during [[menstruation]] following tampon use (S. aureus); as a complication of soft tissue infections ([[Streptococcus pyogenes|S. pyogenes]] or GAS) or in females undergoing medical [[abortion]] ([[Clostridium sordellii|C. sordellii]]).
|[[Hypotension]], [[tachycardia]], [[mucous membrane]] [[Hyperaemia|hyperemia]] (vaginal, oral, [[Conjunctiva|conjunctival]])
|Fever, diarrhea, vomiting, diffuse scarlantiform rash
|[[Hyponatremia]] and [[uremia]]. Hepatic dysfunction (total [[bilirubin]], serum asparate aminotransferase or serum alanine aminotransferase levels >2 times upper normal limit), [[leukocytosis]] with a [[Polymorphonuclear cells|polymorphonuclear shift]] to the left. [[Platelet|Platelets]] < 100,000 per mm<sup>3</sup> ([[thrombocytopenia]]), [[pyuria]] of [[renal]] origin.
|-
|[[Scarlet fever]]
|Distributed equally among both genders. Most commonly affects children between five and fifteen years of age.
|Occurs after streptococcal [[pharyngitis]]/[[tonsillitis]]
|Pastia's sign (puncta and skin crease accentuation of the [[erythema]]), strawberry tongue, cervical [[lymphadenopathy]] may be present. [[Scarlet fever]] appears similar to [[Kawasaki disease|Kawasaki's disease]] in some aspects, but lacks the eye signs or the swollen, red fingers and toes
|Characteristic sandpaper-like rash which appears days after the illness begins (although the rash can appear before illness or up to 7 days later), rash may first appear on the neck, underarm, and groin
|[[Leukocytosis]] with [[left shift]] and possibly [[eosinophilia]] a few weeks after convalescence. Anti-deoxyribonuclease B, [[Antistreptolysin O titer|antistreptolysin-O]] titers (antibodies to streptococcal [[extracellular]] products), antihyaluronidase, and antifibrinolysin may be positive.
|}
Kawasaki disease must be differentiated from other causes of fever and rash in infants
{|


|}
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 83%;"
! colspan="2" rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Diseases
|+ '''Differential Diagnosis of Measles.''' Table adapted from CDC Pinkbook.<ref name="CDC90">{{cite web | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | url = http://www.cdc.gov/vaccines/pubs/pinkbook/table-of-contents.html }}</ref>
| colspan="8" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations'''
|-
! colspan="9" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Para-clinical findings
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Disease}}
| colspan="1" rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Gold standard'''
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Agent}}
! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Additional findings
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Typical Season}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Typical Age}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Prodrome}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Fever}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Duration of the rash (days)}}
! style="width: 500px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Rash}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Other Signs & Symptoms}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Kawasaki disease]]'''
| style="background: #DCDCDC; padding: 5px;" | Unknown
| style="background: #F5F5F5; padding: 5px;" | Winter - Spring
| style="background: #DCDCDC; padding: 5px;" | < 5 years
| style="background: #F5F5F5; padding: 5px;" | 3 days of abrupt [[fever]]
| style="background: #DCDCDC; padding: 5px;" | High; [[fever]] of 5 days is a diagnostic criteria
| style="background: #F5F5F5; padding: 5px;" | 5 - 7
| style="background: #DCDCDC; padding: 5px;" | Erythematous, morbilliform, maculopapular or scarlatiniform, central distribution; erythematous, indurated palms and soles
| style="background: #F5F5F5; padding: 5px;" | Acute: dry, fissured and injected lips, [[strawberry tongue]]; [[irritability]]; cervical [[lymphadenopathy]]; [[conjunctival injection]]; peripheral [[edema]]; Subacute: finger-tip desquamation; Complications: [[arthritis]], [[carditis]]
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Measles]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Paramyxovirus]]<br>Measles virus
| style="background: #F5F5F5; padding: 5px;" | Winter - Spring
| style="background: #DCDCDC; padding: 5px;" | 1 to 20 years
| style="background: #F5F5F5; padding: 5px;" | 2-4 days of [[cough]], [[conjunctivitis]], and [[coryza]]
| style="background: #DCDCDC; padding: 5px;" | High
| style="background: #F5F5F5; padding: 5px;" | 5 - 6
| style="background: #DCDCDC; padding: 5px;" | Erythematous, irregular size, maculopapular; starts on temples and behind ears; progresses down from face; fades to brownish
| style="background: #F5F5F5; padding: 5px;" | Koplik's spots: C blue-white papules (salt grains) on bright red [[mucosa]] opposite premolar [[teeth]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Roseola Infantum (exanthem subitum)'''
| colspan="5" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms'''
| style="background: #DCDCDC; padding: 5px;" | Human [[herpes virus]] type 6
! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" | Physical examination
| style="background: #F5F5F5; padding: 5px;" | Any season
| style="background: #DCDCDC; padding: 5px;" | 6 months to 2 years
| style="background: #F5F5F5; padding: 5px;" | None
| style="background: #DCDCDC; padding: 5px;" | High
| style="background: #F5F5F5; padding: 5px;" | 1-2; it follows defervescence
| style="background: #DCDCDC; padding: 5px;" | Discrete erythematous macules, rarely involves face, begins as fever ends
| style="background: #F5F5F5; padding: 5px;" | [[Lymphadenopathy]], [[irritability]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Rubella]]'''
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings
| style="background: #DCDCDC; padding: 5px;" | [[Togavirus]]
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
| style="background: #F5F5F5; padding: 5px;" | Spring
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Histopathology
| style="background: #DCDCDC; padding: 5px;" | 7 months to 29 years
| style="background: #F5F5F5; padding: 5px;" | 0 - 4 days; mild malaise, fever; absent in children
| style="background: #DCDCDC; padding: 5px;" | Low grade
| style="background: #F5F5F5; padding: 5px;" | 1 - 3
| style="background: #DCDCDC; padding: 5px;" | Discrete, rose-pink, diffuse, maculopapular; progresses downward from face, may change quickly
| style="background: #F5F5F5; padding: 5px;" | [[Arthralgia]] (usually in adults), tender posterior cervical and suboccipital [[lymphadenopathy]], [[malaise]], [[petechiae]] on [[soft palate]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Scarlet Fever]]'''
! style="background:#4479BA; color: #FFFFFF;" align="center" |Headache
| style="background: #DCDCDC; padding: 5px;" | ß-hemolytic [[streptococci]]
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever  
| style="background: #F5F5F5; padding: 5px;" | Winter
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| style="background: #DCDCDC; padding: 5px;" | > 2 years
! style="background:#4479BA; color: #FFFFFF;" align="center" |Arthralgia
| style="background: #F5F5F5; padding: 5px;" | 0 - 6 day, marked
! style="background:#4479BA; color: #FFFFFF;" align="center" |Claudication
| style="background: #DCDCDC; padding: 5px;" | Low to high
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bruit
| style="background: #F5F5F5; padding: 5px;" | 2 - 7
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |HTN
| style="background: #DCDCDC; padding: 5px;" | Scarlet "sunburn" with punctate papules "sandpaper", circumoral pallor, increased intensity in [[skin]] folds, blanches stars face/head, upper trunk and progresses downward
! style="background:#4479BA; color: #FFFFFF;" align="center" |Focal neurological disorder
| style="background: #F5F5F5; padding: 5px;" | [[Sore throat]], exudative [[tonsillitis]], [[vomiting]], [[abdominal pain]], [[lmphadenopathy]], white then red [[strawberry tongue]]
! style="background:#4479BA; color: #FFFFFF;" align="center" |Biomarker
! style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |ESR
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
! style="background:#4479BA; color: #FFFFFF;" align="center" |CT scan
! style="background:#4479BA; color: #FFFFFF;" align="center" |Angiography
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ultrasound/ Echocardiography
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Erythema Infectiosum]] ([[Fifth Disease]])'''
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Kawasaki disease]]<ref name="pmid21447126">{{cite journal| author=Takahashi K, Oharaseki T, Yokouchi Y| title=Pathogenesis of Kawasaki disease. | journal=Clin Exp Immunol | year= 2011 | volume= 164 Suppl 1 | issue=  | pages= 20-2 | pmid=21447126 | doi=10.1111/j.1365-2249.2011.04361.x | pmc=3095860 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21447126  }}</ref>
| style="background: #DCDCDC; padding: 5px;" | [[Human parvovirus]] type B19
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #F5F5F5; padding: 5px;" | Spring
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | 5 - 10 years
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #F5F5F5; padding: 5px;" | None, usually in children, may occur in adults
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | None to low-grade
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | 2 - 4
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #DCDCDC; padding: 5px;" | Starts as “slapped cheek”, maculopapular; progresses to reticular (lacy) pattern; can recur with environmental changes such as sunlight exposure
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #F5F5F5; padding: 5px;" | [[Arthralgia]]/[[arthritis]] in adults, [[adenopathy]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[NT-proBNP]], [[Meprin A]], [[Filamin A interacting protein 1 like|Filamin C]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Normochromic anemia]], ↑[[WBC]] with a [[left shift]], [[Thrombocytosis]] 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Acute phase reactant|Acute-phase reactants]], ↓[[Cholesterol]], ↓[[HDL]], ↓[[Apolipoprotein A1|ApolipoA]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Coronary artery]] [[Calcification|calcifications]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Coronary artery aneurysm|Coronary artery aneurysms]], [[Coronary artery stenosis|stenosis]] or [[Coronary artery anomaly|occlusion]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Coronary artery anomaly]] in [[echocardiography]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Electron beam tomography|Electron beam CT (EBCT)]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Acute destruction of the [[Tunica media|media]] by [[neutrophils]], with loss of [[elastic fibers]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |History and [[physical examination]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Diarrhea]], [[Vomiting]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Enterovirus]]'''
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Polyarteritis nodosa]]<ref name="pmid25770638">{{cite journal| author=Howard T, Ahmad K, Swanson JA, Misra S| title=Polyarteritis nodosa. | journal=Tech Vasc Interv Radiol | year= 2014 | volume= 17 | issue= 4 | pages= 247-51 | pmid=25770638 | doi=10.1053/j.tvir.2014.11.005 | pmc=4363102 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25770638  }}</ref>
| style="background: #DCDCDC; padding: 5px;" | [[Echovirus]]<br>[[Coxsackie virus]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | Summer - Fall
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Mainly childhood
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | 0 - 1 day fever and myalias
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Low to high
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | 1 - 5
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Fine, pink, always affects face; variant is Boston exanthem (large ~ 1 cm, discrete maculopapules)
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #F5F5F5; padding: 5px;" | [[Sore throat]], [[headache]], [[malaise]], no [[lymphadenopathy]], [[gastroenteritis]]  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[LAMP2|LAMP-2 protein autoantibodies]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Normochromic anemia]], [[Thrombocytosis]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ [[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]],
↑ [[ALT]] or [[AST]], [[Proteinuria]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Focal regions of [[infarction]] or [[hemorrhage]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Multiple [[Aneurysm|microaneurysms]], [[Hemorrhage]] due to focal [[rupture]], [[Occlusion]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aneurysms]] and [[renal]] [[arteriovenous fistula]] in [[Doppler sonography|color Doppler sonography]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Necrotizing]] [[inflammatory]] lesions
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Angiography]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Sudden [[weight loss]], [[Abdominal pain]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Dengue Fever]]'''
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis B virus]]-associated [[polyarteritis nodosa]]<ref name="pmid25755502">{{cite journal |vauthors=Sharma A, Sharma K |title=Hepatotropic viral infection associated systemic vasculitides-hepatitis B virus associated polyarteritis nodosa and hepatitis C virus associated cryoglobulinemic vasculitis |journal=J Clin Exp Hepatol |volume=3 |issue=3 |pages=204–12 |date=September 2013 |pmid=25755502 |pmc=4216827 |doi=10.1016/j.jceh.2013.06.001 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px;" | [[Flavivirus]]<br>[[Dengue virus]] types 1 - 4
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #F5F5F5; padding: 5px;" |  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #DCDCDC; padding: 5px;" |  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | None
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | High
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #F5F5F5; padding: 5px;" |1 - 5
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #DCDCDC; padding: 5px;" | Generalized maculopapular rash after defervescence; spares palms and soles
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | [[Headache]], [[myalgia]], [[abdominal pain]], [[pharyngitis]], [[vomiting]]  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatitis B surface antigen|HBsAg]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Normochromic anemia]], [[Thrombocytosis]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ [[ALT]] or [[AST]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Focal regions of [[infarction]] or [[hemorrhage]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aneurysms|Microaneurysms]] in [[mesenteric artery]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aneurysms]] and [[renal]] [[arteriovenous fistula]] in [[Doppler sonography|color Doppler sonography]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Necrotizing]] [[inflammatory]] lesions
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Angiography]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Peripheral neuropathy]], [[Livedo reticularis]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Drug induced rash]]'''
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infectious disease]]
| style="background: #DCDCDC; padding: 5px;" | Many
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Parvovirus B19 infection]]<ref name="pmid12097253">{{cite journal| author=Heegaard ED, Brown KE| title=Human parvovirus B19. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 3 | pages= 485-505 | pmid=12097253 | doi= | pmc=118081 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12097253  }}</ref>
| style="background: #F5F5F5; padding: 5px;" | Any
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Any
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | Possible due to underlying [[illness]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Possible
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | Varies
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #DCDCDC; padding: 5px;" | Typically diffuse but may be concentrated in diaper area, typically no progression, erythema multiform rash can progress over a few days
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #F5F5F5; padding: 5px;" | Possibly due to underlying [[illness]] or [[complications]]  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Parvovirus B19|B19]] [[DNA]], ↓[[Reticulocyte count]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |anti–[[parvovirus B19]] [[IgM]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hydrops]] in fetal [[ultrasonography]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Parvovirus B19|B19]] [[DNA]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Purpura|Purpuric rash]], [[Erythema multiforme]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Infectious Mononucleosis]]'''
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Scarlet fever]]<ref name="pmid29081840">{{cite journal| author=Basetti S, Hodgson J, Rawson TM, Majeed A| title=Scarlet fever: a guide for general practitioners. | journal=London J Prim Care (Abingdon) | year= 2017 | volume= 9 | issue= 5 | pages= 77-79 | pmid=29081840 | doi=10.1080/17571472.2017.1365677 | pmc=5649319 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29081840  }}</ref>
| style="background: #DCDCDC; padding: 5px;" | [[Epstein-Barr Virus]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | None
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | 10 - 30 years
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
| style="background: #F5F5F5; padding: 5px;" | 2 - 5 days of [[malaise]] and [[fatigue]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Low to high
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #F5F5F5; padding: 5px;" | 2 - 7
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #DCDCDC; padding: 5px;" | Trunk and proximal extremities. Rash common if [[Ampicillin]] given
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #F5F5F5; padding: 5px;" | [[Pharyngitis]], [[lymphadenopathy]], [[splenomegaly]], [[malaise]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antistreptococcal antibodies|Antistreptolysin-O (ASO) titers]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[CRP]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Thickened [[pulmonary]] markings if [[pneumonia]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Sparse [[Neutropenia|neutrophilic]] [[Perivascular cell|perivascular infiltrate]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |History and [[physical examination]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Sand-paper rashes, [[Sore throat]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Pharyngoconjunctival Fever]]'''
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic shock syndrome]]<ref name="pmid22180682">{{cite journal| author=Vostral SL| title=Rely and Toxic Shock Syndrome: a technological health crisis. | journal=Yale J Biol Med | year= 2011 | volume= 84 | issue= 4 | pages= 447-59 | pmid=22180682 | doi= | pmc=3238331 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22180682  }}</ref>
| style="background: #DCDCDC; padding: 5px;" | [[Adenovirus]] types 2, 3, 4, 7, 7a
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" | Winter - Spring
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | < 5 years
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #F5F5F5; padding: 5px;" |
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
| style="background: #DCDCDC; padding: 5px;" | Low to high
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #F5F5F5; padding: 5px;" | 3 - 5
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #DCDCDC; padding: 5px;" | Starts on face and spreads down to trunk and extremities
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
| style="background: #F5F5F5; padding: 5px;" | [[Sore throat]], [[conjunctivitis]], [[headache]], [[anorexia]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
|}
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Procalcitonin]]
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]] with [[left shift]]
The following table is a list of differential diagnosis oral lesions presenting similar to measles:
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
<div style="width: 70%;">
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Myoglobinuria]], [[Pyuria|Sterile pyuria]]
{| class="wikitable"
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Acute respiratory distress syndrome]]
!Disease
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
!Presentation
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
!Risk Factors
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
!Diagnosis
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Necrosis|Necrolysis]] of [[keratinocytes]] in [[epidermis]], Perivascular [[lymphocytic]] infiltrate
!Affected Organ Systems
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical criteria
!Important features
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Peeling or [[rashes]], Organ dysfunction
!Picture
|-
|-
!
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mononucleosis]]<ref name="pmid25774295">{{cite journal| author=Balfour HH, Dunmire SK, Hogquist KA| title=Infectious mononucleosis. | journal=Clin Transl Immunology | year= 2015 | volume= 4 | issue= 2 | pages= e33 | pmid=25774295 | doi=10.1038/cti.2015.1 | pmc=4346501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25774295  }}</ref>
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epstein Barr virus|EBV]] [[DNA]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Atypical lymphocyte]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Heterophile antibody test|Heterophile antibodies]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[CNS Disease|CNS involvement]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Splenomegaly]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Encephalitis]] in [[MRI]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lymphoproliferative response]] in [[oropharynx]], [[Lymphocytic|Lymphocytic infiltration]] in [[spleen]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Heterophile antibody test]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Splenomegaly]], [[Palatal]] [[petechiae]]
|-
|-
|[[Coxsackie virus]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Leptospirosis]]<ref name="pmid11292640">{{cite journal |vauthors=Levett PN |title=Leptospirosis |journal=Clin. Microbiol. Rev. |volume=14 |issue=2 |pages=296–326 |date=April 2001 |pmid=11292640 |pmc=88975 |doi=10.1128/CMR.14.2.296-326.2001 |url=}}</ref>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Fever]]  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Sores]] in the [[mouth]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Rash]] with [[blisters]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Aches]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Pregnancy]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[immunodeficiency]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Interleukin 6|IL-6]], [[IL-8]] and [[IL-10]]
*[[History]] and [[Physical exam]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]]
*[[Throat swabs]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Swabs from the lesion
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]],
*[[Tzanck test]]
↑[[ALT]] or [[AST]], [[Proteinuria]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse [[alveolar]] [[hemorrhage]]
*[[Oral cavity]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Skin]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Symptomatic treatment
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Toxin]]-mediated break down of [[endothelial cell]] membranes of [[capillaries]]
|<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Hand foot mouth disease 07a.jpg|473x473px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Culture and the [[Agglutination|microscopic agglutination test]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Red eyes]], [[Skin rash]]
|-
|-
|[[Chickenpox|Chicken pox]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lyme disease|Lyme Disease]]<ref name="pmid23319969">{{cite journal| author=Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T| title=Lyme disease: review. | journal=Arch Med Sci | year= 2012 | volume= 8 | issue= 6 | pages= 978-82 | pmid=23319969 | doi=10.5114/aoms.2012.30948 | pmc=3542482 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23319969  }}</ref>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
*[[Conjunctival symptoms]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Catarrhal symptoms]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
*Characteristic [[spots]] on the trunk appearing in two or three waves
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Itching]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Pregnancy]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Premature infants]] born to susceptible mothers
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh ≤1000 grams
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[CXCL9|CXCL9 (MIG)]], [[CXCL10|CXCL10 (IP-10)]] and [[CCL19|CCL19 (MIP3B)]]
*[[Immunocompromised]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukopenia]], [[Thrombocytopenia]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[History]] and [[physical exam]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Microscopic hematuria]], [[Proteinuria]], ↑[[ALT]] or [[AST]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[maculopapular lesions]])
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Punctate lesions in periventricular [[white matter]] in [[brain]] [[SPECT]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Oral cavity]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Skin]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Acrodermatitis chronica atrophicans]]
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Serological testing|Serologic '''tests''']]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Erythema migrans]]
*[[Prednisolone]] is [[contraindicated]]
|<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Chickenpox18a.jpg|700x700px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
|-
|-
|[[Measles]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Measles]]<ref name="pmid22510638">{{cite journal| author=White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM| title=Measles, mumps, and rubella. | journal=Clin Obstet Gynecol | year= 2012 | volume= 55 | issue= 2 | pages= 550-9 | pmid=22510638 | doi=10.1097/GRF.0b013e31824df256 | pmc=3334858 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22510638 }}</ref>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
*[[Fever]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Rash]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
*[[Cough]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Coryza]] (runny nose)
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Conjunctivitis]] (pink eye)
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Malaise]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Koplick spots]] in mouth
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Measles]] [[Immunoglobulin M|IgM]]
*[[Unvaccinated]] individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778 }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukopenia]], [[Lymphocytosis]], [[Thrombocytopenia]]
*Crowded and/or [[unsanitary]] conditions
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Traveling to less developed and [[developing countries]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[ALT]] or [[AST]]
*[[Immunocompromized]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pneumonia]]
*[[Winter]] and [[spring]] seasons
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Born after 1956 and never fully vaccinated
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Health care workers
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Chest X-ray|CXR]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Spongiosis and vesiculation in the [[epidermis]] with scattered dyskeratotic [[keratinocytes]]
*[[History]] and [[examination]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[PCR]]
*[[PCR]] for [[Measles]]-specific [[IgM antibody]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Rash|Generalized rash]], [[Cough]], [[Coryza]], or [[Conjunctivitis]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[virus particles]]
|<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Koplikspot1a.jpg|700x700px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
|-
|-
|[[Herpangina]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rocky Mountain Spotted Fever]]<ref name="pmid2504480">{{cite journal| author=Walker DH| title=Rocky Mountain spotted fever: a disease in need of microbiological concern. | journal=Clin Microbiol Rev | year= 1989 | volume= 2 | issue= 3 | pages= 227-40 | pmid=2504480 | doi= | pmc=358117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2504480  }}</ref>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*Sudden [[fever]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Sore throat]] and [[dysphagia]]- These can occur several hours(up to 24 hours), before the appearance of the enanthem.
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Vomiting]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Abdominal pain]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Myalgia]]  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Headache]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Pharyngeal lesions
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |''[[Rickettsia rickettsii infection|R rickettsii]]'' [[serology]]
*Attendance at a kindergarten/child care center
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thrombocytopenia]], [[Anemia]] 
*Contact with herpangina cases
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Residence in rural areas
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[ALT]] or [[AST]], [[Hyponatremia]]
*Overcrowding
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Infarction]], [[edema]], and [[meningeal]] enhancement
*Poor hygiene
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Low socioeconomic status
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Myocardial]] or conduction abnormalities in [[echocardiography]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Clincial diagnosis
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Immunofluorescent]] or [[immunoperoxidase]] staining of ''[[Rickettsia rickettsii infection|R rickettsii]]''
*Pharyngeal [[viral]] and [[bacterial]] cultures can be taken to exclude [[HSV]] infection and [[streptococcal pharyngitis]].
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical criteria and [[tick]] exposure
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Rash on the [[Palms of the hands|palms]] and [[soles]]
*Skin
*Oral Cavity
|
*Characteristic enanthem- Punctate [[macule]] which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate.
*The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the [[soft palate]] and [[uvula]]. The lesions can also be seen on the [[tonsils]], posterior pharyngeal wall and the [[buccal mucosa]].
|
[[File:Herpangina3.jpg|center|300x300px|alt=Erythema, vesicles and ulcerating lesions in herpangina|Erythema, vesicles and ulcerating lesions in herpangina]]
|-
|-
|Primary herpetic gingivoestomatitis<ref name="KolokotronisDoumas2006">{{cite journal|last1=Kolokotronis|first1=A.|last2=Doumas|first2=S.|title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis|journal=Clinical Microbiology and Infection|volume=12|issue=3|year=2006|pages=202–211|issn=1198743X|doi=10.1111/j.1469-0691.2005.01336.x}}</ref>
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Staphylococcal scalded skin syndrome|Staphylococcal Scalded Skin Syndrome]]<ref name="pmid27651848">{{cite journal| author=Mishra AK, Yadav P, Mishra A| title=A Systemic Review on Staphylococcal Scalded Skin Syndrome (SSSS): A Rare and Critical Disease of Neonates. | journal=Open Microbiol J | year= 2016 | volume= 10 | issue= | pages= 150-9 | pmid=27651848 | doi=10.2174/1874285801610010150 | pmc=5012080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27651848 }}</ref>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*Pin-head [[vesicles]] rupture to form painful irregular ulcerations covered by yellow-grey membrane
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*Severe pain
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Submandibular lymphadenopathy]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Halitosis]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*It involves [[buccal mucosa]], [[tongue]], posterior [[pharynx]], and [[gingival]] and palatal [[mucosa]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
*Direct contact
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
*[[HIV infection]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti exfoliatin and [[Alpha toxin|anti alpha-toxin antibodies]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]] with [[left shift]]
*[[Tzanck test]] demonstrates multinucleated epithelial giant cells<ref name="pmid12626280">{{cite journal| author=Chauvin PJ, Ajar AH| title=Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. | journal=J Can Dent Assoc | year= 2002 | volume= 68 | issue= 4 | pages= 247-51 | pmid=12626280 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12626280 }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
*Viral [[culture]] is the gold standard for diagnosis
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Blood culture]]
*Direct [[immunofluorescence]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pneumonia]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Oral cavity
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Mucous membranes
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epidermal bullosa simplex|Intraepidermal blister]], dense superficial perivascular lymphohistiocytic infiltrate 
*Ulcers are common on lips, gums, throat, front of tongue, inside of the cheeks and roof of the mouth
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Blood culture]] and clinical findings
*Treatment is with antiviral agents such as [[Valacyclovir]] and [[Famciclovir]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Erythroderma|'''Widespread''' skin erythema]], [[Blisters|fluid-filled '''blisters''']]
|
<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Herpes labialis - opryszczka wargowa.jpg|1600x1600px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline>
 
|}
 
Koplik spots must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.
 
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
|-
! colspan="3" |Diseases predominantly affecting the oral cavity
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic Epidermal Necrolysis]]<ref name="pmid27239294">{{cite journal| author=Hoetzenecker W, Mehra T, Saulite I, Glatz M, Schmid-Grendelmeier P, Guenova E et al.| title=Toxic epidermal necrolysis. | journal=F1000Res | year= 2016 | volume= 5 | issue=  | pages=  | pmid=27239294 | doi=10.12688/f1000research.7574.1 | pmc=4879934 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27239294  }}</ref>
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
!
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[MicroRNA|MicroRNA-124]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Normocytic normochromic anemia|Normochromic normocytic anemia]], [[Eosinophilia]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fluid loss]] and [[electrolyte abnormalities]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tracheobronchial]] [[inflammation]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Necrotic]] [[keratinocytes]] with full-thickness [[epithelial]] [[necrosis]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology]] and clinical findings
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Erythematous rash|Erythematous macular rash]] with [[purpuric]] centers
|-
|-
|[[Oral candidiasis|Oral Candidiasis]]
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic disease]]
|
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Antiphospholipid syndrome|Antiphospholipid Syndrome]]<ref name="pmid26637701">{{cite journal| author=Chaturvedi S, McCrae KR| title=The antiphospholipid syndrome: still an enigma. | journal=Hematology Am Soc Hematol Educ Program | year= 2015 | volume= 2015 | issue=  | pages= 53-60 | pmid=26637701 | doi=10.1182/asheducation-2015.1.53 | pmc=4877624 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26637701  }}</ref>
* [[Dysphagia]] or [[odynophagia]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
* White patches on the mouth and tongue
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Newborn]] babies
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Denture users
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Poorly controlled [[diabetes]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antiphospholipid antibodies]]
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thrombocytopenia]], [[Hemolytic anemia]]
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]].
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lupus anticoagulant|Lupus anticoagulant (LA)]]
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Stroke]],
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment).
 
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]].
 
*[[Organ transplantation]] patients
|
* Clinical diagnosis
* Confirmatory tests rarely needed
|'''Localized candidiasis'''
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
* [[Candida vulvovaginitis]]
* [[Chronic mucocutaneous candidiasis]]


'''Invasive candidasis'''
[[Pulmonary embolism]], [[Budd-Chiari syndrome]]
* [[Candidiasis|Candidaemia]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thrombus]] in major [[vessels]]
* [[Endocarditis|Candida endocarditis]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Valve thickening, vegetations, or insufficiency in [[echocardiography]]
* [[Osteoarthritis|Candida osteoarticular disease]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Noninflammatory bland [[thrombosis]] without perivascular [[inflammation]]
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hx of [[thrombosis]] and [[antiphospholipid antibodies]]
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Miscarriage]], [[Pulmonary hypertension]]
|-
|[[Herpes simplex|Herpes simplex oral lesions]]
|
* [[Fever]] 
* [[Sore throat]]
* Painful [[ulcer]]s
|
* Stress
* Recent [[URTI]]
* Female sex
|
* Physical examination
* [[Viral culture]]
* [[Tzanck smear]]
|
* Orofacial Infection
* [[Herpes simplex anogenital infection|Anogenital Infection]]
* [[Herpes simplex ocular infection|Ocular Infection]]
* [[Herpes simplex encephalitis|Herpes Encephalitis]]
* [[Herpes simplex neonatorum|Neonatal Herpes]]
* [[Herpetic whitlow|Herpetic Whitlow]]
* [[Herpes gladiatorum|Herpes Gladiatorum]]
|
* The symptoms of primary [[HSV]] infection generally resolve within two weeks
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]]
|-
|[[Aphthous ulcer|Aphthous ulcers]]
|
* Painful, red spot or bump that develops into an open [[ulcer]]
|
* Being a female
* Between the ages of 10-40
* Family history of [[Aphthous ulcer|aphthous ulcers]]
|
* Physical examination
* Diagnosis of exclusion
|
* Oral cavity
|
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]]
|-
|[[Squamous cell carcinoma]]
|
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
* Chronic sun or [[Ultraviolet|UV exposure]]
* Fair [[skin]]
* [[Elderly]] age (>45 yrs)
* [[Male sex]]
* [[Smoking]]
|
*[[Physical exam]]
*[[Biopsy]]
|
*[[Oral Cavity]]
**Floor of [[mouth]]
**Lateral [[tongue]]
*[[Throat]]
*[[Esophagus]]
|
*[[Malignant]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
|[[File:PLoS oral cancer.png|thumb|400x400px|Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]
|-
|[[Leukoplakia]]
|
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]]
*Lateral borders of [[tongue]]
|
*Atypical [[Tobacco]] use
*Chronic [[irritation]]
*[[Immunodeficiency]]
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]])
|
*[[Physical exam]]
*Diagnosis of exclusion
*[[Biopsy]]
|
*[[Vulva|Vulvar]] lesions occur independent of oral lesions
|
*Associated with [[HIV]]
*Persistant white spots
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
| journal = [[Advances in anatomic pathology]]
| volume = 20
| issue = 6
| pages = 416–423
| year = 2013
| month = November
| doi = 10.1097/PAP.0b013e3182a92df1
| pmid = 24113312
}}</ref>
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]]
|-
|[[Melanoma]]
|
*A lesion with [[ABCD]]
**[[Asymmetry]]
**Border irregularity
**Color variation
**[[Diamete]]r changes
*[[Bleeding]] from the lesion
|
*[[Ultraviolet|UV radiations]]
*[[Genetic predisposition]]
*[[Old age]]
*[[Male gender]]
*Family or personal history of [[melanoma]]
*Multiple benign or atypical [[Nevus|nevi]]
|
*[[ABCD]] characteristics
*[[Bleeding]] or [[ulceration]] may show [[malignancy]]
*Serum [[LDH]] may be elevated in case of [[malignancy]]
*[[Biopsy]]
|
*Can [[metastasize]]
*All [[UV radiation]] or sun exposed areas can be effected independently
*1-2 to hundreds of [[granules]]
|
*[[Neural crest cell]] derivative
*Development begins with disruption of [[nevus]] growth control
*Progression involves [[MAPK/ERK pathway]]
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]]
|-
|[[Fordyce spots]]
|
*Rice-like [[granules]] or [[spots]]
*Small, [[painless]], [[raised]], [[pale]], red or white
*1 to 3 mm in [[diameter]]
|
*Greasy skin types
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums)
**[[Vestibular system|Vestibular mucosa]]
|
*[[Physical exam]]
*Small [[keratin]]-filled [[pseudocysts]]
*May be seen on [[incidental]] [[mucosal]] [[biopsy]]
**[[Biopsy]] not done for them primarily
|
*[[Oral cavity]]
**[[Vermillion border|Vermilion border]] of the lips
**[[Oral mucosa]] of the upper lip
*[[Buccal mucosa]] in the commissural region often bilaterally
*[[Genitals]]
|
*[[Benign neoplasms]] with [[sebaceous]] features
*Visible [[sebaceous glands]]
*No surrounding [[mucosal]] change
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]]
|-
|[[Burning mouth syndrome]]
|
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]]
|
*[[Nutritional deficiencies]]
*Chronic [[anxiety]] or [[depression]]
*[[Diabetes type 2]]
*[[Menopause]]
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste
*[[Female gender ]]
*[[Menopause]]
|
*[[Presentation]]
*[[Physical exam]]
|
*[[Oral cavity]]
|
*Pain typically is low in the morning and builds up over the day
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective
|
|-
|[[Torus palatinus]]
|
*Bony growth on midline of the [[hard palate]]
*[[Nodular]] mass covered with normal [[mucosa]]
|
*[[Genetic predisposition]]
**[[Autosomal dominant]]
|
*[[Physical exam]]
*Types
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]]
**[[Torus palatinus|Lobular tori]]
|
*[[Hard palate]]
|
*More common in [[Asian]] and Inuit populations
*Twice more common in [[females]]
*Repeated [[trauma]] can cause [[bleeding]]
*[[Surgery]] may be required in symptomatic
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]]
|-
| colspan="4" |'''Diseases involving oral cavity and other organ systems'''
|
|
|
|-
|[[Behçet's disease|Behcet's disease]]
|
*Painful [[mouth sores]]
*[[Acne]] like skin lesions
*Headache, [[fever]], poor [[balance]], [[disorientation]]
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]]
*[[Uveitis]]
*Joint [[swelling]] and joint [[pain]]
*Genital [[sores]] wit [[pain]] and [[scaring]]
*[[Aneurysms]]
|
*Over active [[immune system]]
|
*[[Physical examination]]
|
*[[Mouth]]
*[[Genitals]]
*[[GIT]]
*[[Eye]]
*[[Joints]]
*[[Skin]]
*[[Vascular system]]
*[[Brain]]
|
*[[Outbreaks]] of exaggerated [[inflammation]]
*Affects smaller [[blood vessels]]
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]]
|-
|[[Crohn's disease]]
|
*Chronic, episodic [[diarrhea]] or [[constipation]]
*[[Abdominal pain]]
*[[Vomiting]]
*[[Weight loss]] or [[weight gain]]
|
*[[Smoking]]
*[[Whites]] and [[European]] [[Jews]]
*[[Hormonal contraception]]
*Diets high in microparticles, sweet, fatty or refined foods
*Industrialized country
|
*Typical [[history]] and [[symptoms]]
*[[Skip lesions]] on [[biopsy]]
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]]
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]])
|
*[[Eyes]]
*[[Joints]]
*[[Skin]]
|
*May lead to
**[[Obstruction]]s
**[[Abscess]]es
**Free [[perforation]]
**[[Hemorrhage]]
|
|-
|[[Agranulocytosis]]
|
*[[Fever]] or [[chills]]
*Frequent [[infections]]
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound
*Mouth [[ulcers]]
*[[Abdominal pain]]
*[[Burning sensation when urinating]]
*[[Sore throat]]
|
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref>
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]]
*[[Hematological malignancy|Hematologic malignancies]]
*[[Autoimmune disorders]]
|
*[[Neutropenia]] <100 cells per micro litre
*[[Eosinopenia]]
*[[Basopenia]]
|
*[[Oral cavity]]
*[[Skin]]
*[[GIT]]
*[[Urinary system]]
*[[Conjunctiva]]
|
*[[Immunocompromised|Immunocompromization]]
*Types
**[[Drug-induced]]
**[[Malignant]]
**[[Autoimmune]]
|
|-
|[[Syphilis]]<ref>title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref>
|
*[[Chancre]]
*Regional [[lymphadenopathy]]
|
*[[Multiple sexual partners]]
*Illicit [[drug use]]
*[[Unprotected sex]]
*[[Homosexual men|Men who have sex with men]]
*Residence in highly prevalent areas
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection
*Presence of other [[STI]]s
*Previous history of [[Sexually transmitted disease|STIs]]
*[[Intravenous drug use]]
|
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]])
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
*[[Oral cavity]]
*[[Penis]]
*[[Cervix]]
*[[Labia]]
*[[Anal canal]]
*[[Rectum ]]
*[[CNS]]
*[[Cardiovascular|CVS]]
|
*[[Primary syphilis]]
**[[Chancre]]
*[[Secondary syphilis]]
**[[Condyloma latum|Condylomata lata]]
*[[Latent syphilis]]
**[[Asymptomatic]]
*[[Tertiary syphilis]]
**[[Gumma|Gummas]]
**[[Neurosyphilis]]
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]]
|-
|[[Coxsackie virus]]
|
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Coxsackie virus stomatitis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>]]
|-
|-
|[[Chickenpox|Chicken pox]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Juvenile Idiopathic Arthritis]]<ref name="pmid22753788">{{cite journal |vauthors=Espinosa M, Gottlieb BS |title=Juvenile idiopathic arthritis |journal=Pediatr Rev |volume=33 |issue=7 |pages=303–13 |date=July 2012 |pmid=22753788 |doi=10.1542/pir.33-7-303 |url=}}</ref>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Conjunctival]] symptoms
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Catarrhal]] symptoms
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*Characteristic [[spots]] on the trunk appearing in two or three waves
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
*[[Itching]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/-
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Pregnancy]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*[[Premature infants]] born to susceptible mothers
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh ≤1000 grams
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Rheumatoid factor|Rheumatoid factor (RF)]], [[S100A12]]
*[[Immunocompromised]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lymphocytosis]], [[Thrombocytopenia]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
*[[History]] and [[physical exam]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Myeloid-related proteins 8/14 (MRP8/14)
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]])
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Synovial]] [[hypertrophy]], Joint effusions
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebral vasculitis]]
*[[Oral cavity]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Inflamed [[synovium]]
*[[Skin]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bone scan|Bone scanning]]
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Vascular congestion]], [[Extravasation|RBC extravasation]], Venular lumen occlusion
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Conventional [[radiography]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Rash|Evanescent rash]], [[Dactylitis]] 
*[[Prednisolone]] is [[contraindicated]]
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]]
|-
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or unsanitary conditions
*Traveling to less developed and developing countries
*Immunocompromized
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]]
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]]
|}
|}
</div>


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
 
[[Category:Medicine]]
[[Category:Pediatrics]]
[[Category:Cardiovascular diseases]]
[[Category:Angiology]]
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Dermatology]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date]]

Latest revision as of 22:27, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2];Eiman Ghaffarpasand, M.D. [3]

Overview

Kawasaki disease must be differentiated from other diseases that cause different rash-like conditions and can be confused with Kawasaki disease. The various conditions that should be differentiated from Kawasaki disease include; infantile polyarteritis nodosa, juvenile idiopathic arthritis, leptospirosis, lyme disease, measles, mercury toxicity, pediatric rocky mountain spotted fever, toxic epidermal necrolysis, staphylococcal scalded skin syndrome, rheumatic fever, impetigo, insect bites, monkey pox, rubella, atypical measles, coxsackie virus, acne, syphilis, molluscum contagiosum, toxic erythema, rat-bite fever, parvovirus B19, cytomegalovirus, scarlet fever, Stevens-Johnson syndrome, varicella-zoster virus, chicken pox, meningococcemia, rickettsial pox, meningitis, toxic shock syndrome, roseola infantum (exanthem subitum), erythema infectiosum (fifth disease), enterovirus, dengue fever, drug - induced rash, infectious mononucleosis, pharyngoconjunctival fever, herpangina, and primary herpetic gingivostomatitis.

Differentiating Kawasaki disease from other diseases

Different rash-like conditions can be confused with Kawasaki disease and are thus included in its differential diagnosis. The various conditions that should be differentiated from Kawasaki disease include:[1][2][3][4][5][6][7]

Abbreviations: ABG= Arterial blood gas, ANA= Antinuclear antibody, ANP= Atrial natriuretic peptide, ASO= Antistreptolysin O antibody, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure, PCR= Polymerase chain reaction, PFT= Pulmonary function test.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Headache Fever Weight loss Arthralgia Claudication Bruit HTN Focal neurological disorder Biomarker CBC ESR Other CT scan Angiography Ultrasound/ Echocardiography Other
Kawasaki disease[8] - + +/- + + - +/- - NT-proBNP, Meprin A, Filamin C Normochromic anemia, ↑WBC with a left shift, Thrombocytosis  ↑ Acute-phase reactants, ↓Cholesterol, ↓HDL, ↓ApolipoA Coronary artery calcifications Coronary artery aneurysms, stenosis or occlusion Coronary artery anomaly in echocardiography Electron beam CT (EBCT) Acute destruction of the media by neutrophils, with loss of elastic fibers History and physical examination Diarrhea, Vomiting
Polyarteritis nodosa[9] + + + + + + +/- +/- LAMP-2 protein autoantibodies Leukocytosis, Normochromic anemia, Thrombocytosis ↑ ↑ Cr or BUN,

↑ ALT or AST, Proteinuria

Focal regions of infarction or hemorrhage Multiple microaneurysms, Hemorrhage due to focal rupture, Occlusion Aneurysms and renal arteriovenous fistula in color Doppler sonography - Necrotizing inflammatory lesions Angiography Sudden weight loss, Abdominal pain
Hepatitis B virus-associated polyarteritis nodosa[10] +/- +/- + + +/- +/- + - HBsAg Leukocytosis, Normochromic anemia, Thrombocytosis ↑ ↑ ALT or AST Focal regions of infarction or hemorrhage Microaneurysms in mesenteric artery Aneurysms and renal arteriovenous fistula in color Doppler sonography - Necrotizing inflammatory lesions Angiography Peripheral neuropathy, Livedo reticularis
Infectious disease Parvovirus B19 infection[11] + + + + - - - +/- B19 DNA, ↓Reticulocyte count Anemia ↑ anti–parvovirus B19 IgM - - Hydrops in fetal ultrasonography - - B19 DNA Purpuric rash, Erythema multiforme
Scarlet fever[12] + + +/- + - - - - Antistreptolysin-O (ASO) titers Leukocytosis ↑ ↑CRP Thickened pulmonary markings if pneumonia - - - Sparse neutrophilic perivascular infiltrate History and physical examination Sand-paper rashes, Sore throat
Toxic shock syndrome[13] + + + + - - - +/- Procalcitonin Leukocytosis with left shift ↑ Myoglobinuria, Sterile pyuria Acute respiratory distress syndrome - - - Necrolysis of keratinocytes in epidermis, Perivascular lymphocytic infiltrate Clinical criteria Peeling or rashes, Organ dysfunction
Mononucleosis[14] + + + + - - - - EBV DNA Atypical lymphocyte ↑ Heterophile antibodies CNS involvement - Splenomegaly Encephalitis in MRI Lymphoproliferative response in oropharynx, Lymphocytic infiltration in spleen Heterophile antibody test Splenomegaly, Palatal petechiae
Leptospirosis[15] + + + + +/- - - - IL-6, IL-8 and IL-10 Anemia - ↑Cr or BUN,

↑ALT or AST, Proteinuria

 Diffuse alveolar hemorrhage - - - Toxin-mediated break down of endothelial cell membranes of capillaries Culture and the microscopic agglutination test Red eyes, Skin rash
Lyme Disease[16] +/- + +/- + +/- - - - CXCL9 (MIG), CXCL10 (IP-10) and CCL19 (MIP3B) Leukopenia, Thrombocytopenia - Microscopic hematuria, Proteinuria, ↑ALT or AST Punctate lesions in periventricular white matter in brain SPECT - - - Acrodermatitis chronica atrophicans Serologic tests Erythema migrans
Measles[17] +/- + +/- + - - - - Measles IgM Leukopenia, Lymphocytosis, Thrombocytopenia - ↑ALT or AST Pneumonia - - CXR Spongiosis and vesiculation in the epidermis with scattered dyskeratotic keratinocytes PCR Generalized rash, Cough, Coryza, or Conjunctivitis
Rocky Mountain Spotted Fever[18] + + + + - - - - R rickettsii serology Thrombocytopenia, Anemia  - ↑ALT or AST, Hyponatremia Infarction, edema, and meningeal enhancement - Myocardial or conduction abnormalities in echocardiography - Immunofluorescent or immunoperoxidase staining of R rickettsii Clinical criteria and tick exposure Rash on the palms and soles
Staphylococcal Scalded Skin Syndrome[19] + + + + - - +/- +/- Anti exfoliatin and anti alpha-toxin antibodies Leukocytosis with left shift ↑ Blood culture Pneumonia - - - Intraepidermal blister, dense superficial perivascular lymphohistiocytic infiltrate  Blood culture and clinical findings Widespread skin erythema, fluid-filled blisters
Toxic Epidermal Necrolysis[20] - + + - - - - +/- MicroRNA-124 Normochromic normocytic anemia, Eosinophilia ↑ Fluid loss and electrolyte abnormalities Tracheobronchial inflammation - - - Necrotic keratinocytes with full-thickness epithelial necrosis Histopathology and clinical findings Erythematous macular rash with purpuric centers
Systemic disease Antiphospholipid Syndrome[21] + + - - - - - +/- Antiphospholipid antibodies Thrombocytopenia, Hemolytic anemia - Lupus anticoagulant (LA) Stroke,

Pulmonary embolism, Budd-Chiari syndrome

Thrombus in major vessels Valve thickening, vegetations, or insufficiency in echocardiography - Noninflammatory bland thrombosis without perivascular inflammation Hx of thrombosis and antiphospholipid antibodies Miscarriage, Pulmonary hypertension
Juvenile Idiopathic Arthritis[22] - - - + +/- - - - Rheumatoid factor (RF), S100A12 Lymphocytosis, Thrombocytopenia ↑ Myeloid-related proteins 8/14 (MRP8/14) Synovial hypertrophy, Joint effusions Cerebral vasculitis Inflamed synovium Bone scanning Vascular congestion, RBC extravasation, Venular lumen occlusion Conventional radiography Evanescent rash, Dactylitis 

References

  1. ↑ Hartman-Adams H, Banvard C, Juckett G (2014). "Impetigo: diagnosis and treatment". Am Fam Physician. 90 (4): 229–35. PMID 25250996.
  2. ↑ Mehta N, Chen KK, Kroumpouzos G (2016). "Skin disease in pregnancy: The approach of the obstetric medicine physician". Clin Dermatol. 34 (3): 320–6. doi:10.1016/j.clindermatol.2016.02.003. PMID 27265069.
  3. ↑ Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
  4. ↑ Ibrahim F, Khan T, Pujalte GG (2015). "Bacterial Skin Infections". Prim Care. 42 (4): 485–99. doi:10.1016/j.pop.2015.08.001. PMID 26612370.
  5. ↑ Ramoni S, Boneschi V, Cusini M (2016). "Syphilis as "the great imitator": a case of impetiginoid syphiloderm". Int J Dermatol. 55 (3): e162–3. doi:10.1111/ijd.13072. PMID 26566601.
  6. ↑ Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y (2015). "Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan". Med Mycol J. 56 (1): E1–5. doi:10.3314/mmj.56.E1. PMID 25855021.
  7. ↑ CEDEF (2012). "[Item 87--Mucocutaneous bacterial infections]". Ann Dermatol Venereol. 139 (11 Suppl): A32–9. doi:10.1016/j.annder.2012.01.002. PMID 23176858.
  8. ↑ Takahashi K, Oharaseki T, Yokouchi Y (2011). "Pathogenesis of Kawasaki disease". Clin Exp Immunol. 164 Suppl 1: 20–2. doi:10.1111/j.1365-2249.2011.04361.x. PMC 3095860. PMID 21447126.
  9. ↑ Howard T, Ahmad K, Swanson JA, Misra S (2014). "Polyarteritis nodosa". Tech Vasc Interv Radiol. 17 (4): 247–51. doi:10.1053/j.tvir.2014.11.005. PMC 4363102. PMID 25770638.
  10. ↑ Sharma A, Sharma K (September 2013). "Hepatotropic viral infection associated systemic vasculitides-hepatitis B virus associated polyarteritis nodosa and hepatitis C virus associated cryoglobulinemic vasculitis". J Clin Exp Hepatol. 3 (3): 204–12. doi:10.1016/j.jceh.2013.06.001. PMC 4216827. PMID 25755502.
  11. ↑ Heegaard ED, Brown KE (2002). "Human parvovirus B19". Clin Microbiol Rev. 15 (3): 485–505. PMC 118081. PMID 12097253.
  12. ↑ Basetti S, Hodgson J, Rawson TM, Majeed A (2017). "Scarlet fever: a guide for general practitioners". London J Prim Care (Abingdon). 9 (5): 77–79. doi:10.1080/17571472.2017.1365677. PMC 5649319. PMID 29081840.
  13. ↑ Vostral SL (2011). "Rely and Toxic Shock Syndrome: a technological health crisis". Yale J Biol Med. 84 (4): 447–59. PMC 3238331. PMID 22180682.
  14. ↑ Balfour HH, Dunmire SK, Hogquist KA (2015). "Infectious mononucleosis". Clin Transl Immunology. 4 (2): e33. doi:10.1038/cti.2015.1. PMC 4346501. PMID 25774295.
  15. ↑ Levett PN (April 2001). "Leptospirosis". Clin. Microbiol. Rev. 14 (2): 296–326. doi:10.1128/CMR.14.2.296-326.2001. PMC 88975. PMID 11292640.
  16. ↑ Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T (2012). "Lyme disease: review". Arch Med Sci. 8 (6): 978–82. doi:10.5114/aoms.2012.30948. PMC 3542482. PMID 23319969.
  17. ↑ White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM (2012). "Measles, mumps, and rubella". Clin Obstet Gynecol. 55 (2): 550–9. doi:10.1097/GRF.0b013e31824df256. PMC 3334858. PMID 22510638.
  18. ↑ Walker DH (1989). "Rocky Mountain spotted fever: a disease in need of microbiological concern". Clin Microbiol Rev. 2 (3): 227–40. PMC 358117. PMID 2504480.
  19. ↑ Mishra AK, Yadav P, Mishra A (2016). "A Systemic Review on Staphylococcal Scalded Skin Syndrome (SSSS): A Rare and Critical Disease of Neonates". Open Microbiol J. 10: 150–9. doi:10.2174/1874285801610010150. PMC 5012080. PMID 27651848.
  20. ↑ Hoetzenecker W, Mehra T, Saulite I, Glatz M, Schmid-Grendelmeier P, Guenova E; et al. (2016). "Toxic epidermal necrolysis". F1000Res. 5. doi:10.12688/f1000research.7574.1. PMC 4879934. PMID 27239294.
  21. ↑ Chaturvedi S, McCrae KR (2015). "The antiphospholipid syndrome: still an enigma". Hematology Am Soc Hematol Educ Program. 2015: 53–60. doi:10.1182/asheducation-2015.1.53. PMC 4877624. PMID 26637701.
  22. ↑ Espinosa M, Gottlieb BS (July 2012). "Juvenile idiopathic arthritis". Pediatr Rev. 33 (7): 303–13. doi:10.1542/pir.33-7-303. PMID 22753788.

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