Rash with fever resident survival guide: Difference between revisions

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❑  Caused by [[Rickettsia rickettsii]] <br><br/>❑ History of travel to wooden areas, primarily in the south-Atlantic region of the United States ❑ [[Erythematous]] and [[maculopapular]] that initially begins on wrists and ankles, then spreads and becomes [[petechial]]<br/><br/> ❑ Ill appearing patient, can be in [[shock]]<br/><br/> ❑ High [[fever]]  <br><br/>  </div> |s09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑  Caused by [[Rickettsia rickettsii]] <br><br/>❑ History of travel to wooden areas, primarily in the south-Atlantic region of the United States ❑ [[Erythematous]] and [[maculopapular]] that initially begins on wrists and ankles, then spreads and becomes [[petechial]]<br/><br/> ❑ Ill appearing patient, can be in [[shock]]<br/><br/> ❑ High [[fever]]  <br><br/>  </div> |s09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑  Caused by [[Neiserria Gonorrhoea]] <br><br/>❑ [[Rash]] maybe present in case of [[disseminated gonococcal infection]]. <br/><br/>  ❑  Affects the trunk, limbs, palms and soles, and usually spare the face, scalp and mouth. <br><br/>  </div> |c09=<div style="float: left; text-align: left; height: 36em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑  Caused by [[Neiserria Gonorrhoea]] <br><br/>❑ [[Rash]] maybe present in case of [[disseminated gonococcal infection]]. <br/><br/>  ❑  Affects the trunk, limbs, palms and soles, and usually spare the face, scalp and mouth. <br><br/>  </div> |c09=<div style="float: left; text-align: left; height: 39em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑ Autoimmune systemic [[vasculitis]] that affects the legs, buttocks, and arms and kidneys.<br/><br>❑ Usually preceded by an infection or drug exposure.<br/><br/>  ❑ The classic triad  comprises of [[purpura]], [[abdominal pain]], and [[arthritis]] in the knees, ankles, and elbows.<br/><br/>  ❑ [[Pruritic]]  <br><br/>❑ [[Nausea]] <br><br/>❑ [[Vomiting]] <br><br/>❑ [[Intussusception]] <br><br/>❑ [[Diarrhoea]]/[[Constipation]]  </div>  |p09=<div style="float: left; text-align: left; height: 25em; width: 12em; padding:1em;"> '''Characteristics:'''<ref name="GomesTiberto2016">{{cite journal|last1=Gomes|first1=Rafael Tomaz|last2=Tiberto|first2=Larissa Rezende|last3=Bello|first3=Viviane Nardin Monte|last4=Lima|first4=Margarete Aparecida Jacometo|last5=Nai|first5=Gisele Alborghetti|last6=Abreu|first6=Marilda Aparecida Milanez Morgado de|title=Dermatologic manifestations of infective endocarditis|journal=Anais Brasileiros de Dermatologia|volume=91|issue=5 suppl 1|year=2016|pages=92–94|issn=0365-0596|doi=10.1590/abd1806-4841.20164718}}</ref>
❑ Autoimmune systemic [[vasculitis]] that affects the legs, buttocks, and arms and kidneys.<br/><br>❑ Usually preceded by an infection or drug exposure.<br/><br/>  ❑ The classic triad  comprises of [[purpura]], [[abdominal pain]], and [[arthritis]] in the knees, ankles, and elbows.<br/><br/>  ❑ [[Pruritic]]  <br><br/>❑ [[Nausea]] <br><br/>❑ [[Vomiting]] <br><br/>❑ [[Intussusception]] <br><br/>❑ [[Diarrhoea]]/[[Constipation]]  </div>  |p09=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Characteristics:'''<ref name="GomesTiberto2016">{{cite journal|last1=Gomes|first1=Rafael Tomaz|last2=Tiberto|first2=Larissa Rezende|last3=Bello|first3=Viviane Nardin Monte|last4=Lima|first4=Margarete Aparecida Jacometo|last5=Nai|first5=Gisele Alborghetti|last6=Abreu|first6=Marilda Aparecida Milanez Morgado de|title=Dermatologic manifestations of infective endocarditis|journal=Anais Brasileiros de Dermatologia|volume=91|issue=5 suppl 1|year=2016|pages=92–94|issn=0365-0596|doi=10.1590/abd1806-4841.20164718}}</ref>
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❑ History of IV drug use,[[Infective Endocarditis]], [[Rheumatic fever]]<br><br/>❑ Mostly caused by [[Staphylococcus]] and [[Streptococcus]]<br> ❑ Look for [[Janeway lesion]]s which are painless purple or brown [[erythematous]] [[macular]] lesions, usually affects the palms, soles, and fingers <br><br/>  </div>}}
❑ History of IV drug use,[[Infective Endocarditis]], [[Rheumatic fever]]<br><br/>❑ Mostly caused by [[Staphylococcus]] and [[Streptococcus]]<br><br/> ❑ Look for [[Janeway lesion]]s which are painless purple or brown [[erythematous]] [[macular]] lesions, usually affects the [[palms]], soles, and fingers <br><br/>  </div>}}
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{{Family tree | | | | | | | | | | |p09| | |l09| | | | |u09| | | | | | | | | | | | | | |p09=[[DIC]]|u09=Purpura
{{Family tree | | | | | | | | | | |p09| | |l09| | | | |u09| | | | | | | | | | | | | | |p09=[[DIC]]|u09=[[Purpura
fulminans |l09=[[TTP]] |}}
fulminans]] |l09=[[TTP]] |}}
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{{Family tree | | | | | | | | | | |p09| | |s09| | | |u09| | | | | | | | | | | | |u09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
{{Family tree | | | | | | | | | | |p09| | |s09| | | |u09| | | | | | | | | | | | |u09=<div style="float: left; text-align: left; height: 39em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑Very ill patient<br/> ❑H/O previous infection most commonly by [[meningococcal]] or gram-negative organisms, pregnancy, massive trauma, end-stage malignant disease, [[hepatic failure]], snakebites, [[transfusion reactions]], and anything else that may precipitate [[DIC]]s<br/> ❑Fever<br/> ❑ Shock <br/> ❑Rapid subcutaneous [[hemorrhage]]<br/> ❑Widespread organ involvement<br> </div> |s09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<ref name="urlThrombotic Thrombocytopenic Purpura | NHLBI, NIH">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/thrombotic-thrombocytopenic-purpura |title=Thrombotic Thrombocytopenic Purpura &#124; NHLBI, NIH |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><br>
❑ Very ill patient<br/><br/> ❑ H/O previous infection most commonly by [[meningococcal]] or gram-negative organisms, [[pregnancy]], massive [[trauma]], end-stage [[Malignant|malignant disease]], [[hepatic failure]], snakebites, [[transfusion reactions]], and anything else that may precipitate [[DIC]]s<br/><br/> ❑ [[Fever]]<br/><br/> ❑ [[Shock]] <br/> ❑ Rapid subcutaneous [[hemorrhage]]<br/><br/> ❑ Widespread organ involvement<br><br/> </div> |s09=<div style="float: left; text-align: left; height: 29em; width: 12em; padding:1em;"> '''Characteristics:'''<ref name="urlThrombotic Thrombocytopenic Purpura | NHLBI, NIH">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/thrombotic-thrombocytopenic-purpura |title=Thrombotic Thrombocytopenic Purpura &#124; NHLBI, NIH |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><br>
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❑Purplish bruises or [[purpura]]/[[petechiae]] in the mouth<br/> ❑Yellowish color of the skin and sclera<br/> ❑[[Fatigue]]<br/> ❑[[Tachycardia]]  <br> ❑ [[Shortness of Breath]]|p09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑ Purplish bruises or [[purpura]]/[[petechiae]] in the mouth<br/><br/> ❑ Yellowish color of the skin and sclera<br/><br/> ❑ [[Fatigue]]<br/><br/> ❑ [[Tachycardia]]  <br><br/> ❑ [[Shortness of Breath]]|p09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑Very ill patient<br/> <br/> ❑Complication of different serious and life-threatening diseases<br/> ❑Due to uncontrolled activation of clotting factors in the blood vessels, causing [[Clot|clotting]] of blood in the whole body<br/> ❑Bleeding in other tissues <br> </div>}}
❑ Very ill patient.<br/><br/>❑ Complication of different serious and life-threatening diseases<br/><br/> ❑ Due to uncontrolled activation of clotting factors in the [[blood vessels]], causing [[Clot|clotting]] of blood in the whole body.<br/> ❑ Bleeding in other tissues.<br/><br> </div>}}
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{{Family tree | |p09| |u09| |l09| | | | | |y09| | | | | |!| | | | | | | | | | | | | | |p09=[[Varicella]]|l09=[[Disseminated gonococcal disease]]|u09=[[Purpura fulminans]]|y09=[[DIC]]}}
{{Family tree | |p09| |u09| |l09| | | | | |y09| | | | | |!| | | | | | | | | | | | | | |p09=[[Varicella]]|l09=[[Disseminated gonococcal disease]]|u09=[[Purpura fulminans]]|y09=[[DIC]]}}
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{{Family tree | |p09| | |s09| |l09| | | |y09| | | | | | |!| | | | | | |y09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
{{Family tree | |p09| | |s09| |l09| | | |y09| | | | | | |!| | | | | | |y09=<div style="float: left; text-align: left; height: 30em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑Very ill patient<br/> <br/> ❑Complication of different serious and life-threatening diseases<br/> ❑Due to uncontrolled activation of [[Clotting factor|clotting factors]] in the blood vessels, causing [[clotting]] of blood in the whole body<br/> ❑Bleeding in other tissues  <br> </div> |l09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑ Very ill patient.<br/><br/> ❑ Complication of different serious and life-threatening diseases<br/><br/> ❑ Due to uncontrolled activation of [[Clotting factor|clotting factors]] in the [[blood vessels]], causing [[clotting]] of blood in the whole body<br/><br/> ❑ Bleeding in other tissues  <br><br/> </div> |l09=<div style="float: left; text-align: left; height: 29em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑  Caused by [[Neiserria Gonorrhoea]] <br>❑[[Rash]] maybe present in case of [[disseminated gonococcal infection]]. <br/>  ❑ Affects the trunk, limbs, palms and soles, and usually spare the face, scalp and mouth. <br>  </div>|s09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑  Caused by [[Neiserria Gonorrhoea]] <br><br/>❑ [[Rash]] maybe present in case of [[disseminated gonococcal infection]]. <br/><br/>  ❑ Affects the trunk, limbs, palms and soles, and usually spare the face, [[scalp]] and mouth. <br><br/>  </div>|s09=<div style="float: left; text-align: left; height: 39em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑Very ill patient<br/> ❑H/O previous infection most commonly by [[meningococcal]] or [[Gram negative bacteria|gram-negative organisms]], pregnancy, massive trauma, end-stage malignant disease, [[hepatic failure]], snakebites, [[transfusion reactions]], and anything else that may precipitate [[DIC]]s<br/> ❑Fever<br/> ❑ Shock <br/> ❑Rapid subcutaneous [[hemorrhage]]<br/> ❑Widespread organ involvement<br> </div> |p09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<ref name="urlChickenpox | For Healthcare Professionals | Varicella | CDC">{{cite web |url=https://www.cdc.gov/chickenpox/hcp/index.html |title=Chickenpox &#124; For Healthcare Professionals &#124; Varicella &#124; CDC |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><br>
❑ Very ill patient<br/><br/> ❑ H/O previous infection most commonly by [[meningococcal]] or [[Gram negative bacteria|gram-negative organisms]], pregnancy, massive [[trauma]], end-stage [[malignant]] disease, [[hepatic failure]], snakebites, [[transfusion reactions]], and anything else that may precipitate [[DIC]]s<br/><br/> ❑ [[Fever]]<br/><br/> ❑ [[Shock]] <br/><br/> ❑ Rapid subcutaneous [[hemorrhage]]<br/><br/> ❑ Widespread organ involvement<br> </div> |p09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Characteristics:'''<ref name="urlChickenpox | For Healthcare Professionals | Varicella | CDC">{{cite web |url=https://www.cdc.gov/chickenpox/hcp/index.html |title=Chickenpox &#124; For Healthcare Professionals &#124; Varicella &#124; CDC |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><br>
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❑ It is caused by [[varicella-zoster virus]] (VZV)<br/> ❑Temperature up to 102°F<br/> ❑ Rash is generalized and [[Pruritis|pruritic]],usually strats from chest, back, and face, then spreads over the entire body<br/> ❑ Rash progresses rapidly from [[macular]] to [[Papule|papular]] to [[vesicular]] lesions before crusting<br/> ❑ [[Malaise]]<br/> </div> | | | | | | | | |}}
❑ It is caused by [[varicella-zoster virus]] (VZV).<br/><br/> ❑ [[Temperature]] up to 102°F.<br/> ❑ [[Rash]] is generalized and [[Pruritis|pruritic]],usually starts from [[chest]], [[back]], and face, then spreads over the entire body.<br/><br/> ❑ Rash progresses rapidly from [[macular]] to [[Papule|papular]] to [[vesicular]] lesions before crusting.<br/><br/> ❑ [[Malaise]]<br/><br/> </div> | | | | | | | | |}}
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{{Family tree | | | | | | | | | | | | | | | | | |u09| | | | | | |p09  | | | | | | | | | | |u09=[[Necrotizing fasciitis]] |p09=[[Hand-foot-and-mouth disease]] | |}}
{{Family tree | | | | | | | | | | | | | | | | | |u09| | | | | | |p09  | | | | | | | | | | |u09=[[Necrotizing fasciitis]] |p09=[[Hand-foot-and-mouth disease]] | |}}
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{{Family tree | | | | | | | | | | | | | | | | | |u09| | | | | |t09| | | | | | | |t09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
{{Family tree | | | | | | | | | | | | | | | | | |u09| | | | | |t09| | | | | | | |t09=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑  Mainly seen in young children, caused by [[enterovirus]] <br>❑Symmetrical [[vesicles]] mainly hands, feet and mouth <br/>  ❑Can extend to limbs and buttocks <br>  </div> |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑  Mainly seen in young children, caused by [[enterovirus]] <br><br/>❑ Symmetrical [[vesicles]] mainly hands, feet and mouth <br/><br/>  ❑ Can extend to limbs and buttocks <br><br/>  </div> |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑  Very sick patient, may be in [[septic shock]] <br>❑Rapid spread of [[cellulitis]] with [[purpura]]/[[blister|blistering]], [[genitalia]] may be involved <br/>  ❑Affercted area may have decreased sensation<br>  </div>  | | | |}}
❑  Very sick patient, may be in [[septic shock]] <br><br/>❑ Rapid spread of [[cellulitis]] with [[purpura]]/[[blister|blistering]], [[genitalia]] may be involved <br/><br/>  ❑ Affected area may have decreased sensation<br><br/>  </div>  | | | |}}
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Patient comes with Erythematous rash, follow the algorithm below:<ref name="Murphy-LavoieLeGros2018">{{cite journal|last1=Murphy-Lavoie|first1=Heather|last2=LeGros|first2=Tracy|title=The Algorithmic Approach to the Unidentified Rash|year=2018|pages=1–5|doi=10.1007/978-3-319-75623-3_1}}</ref>
Patient comes with [[Erythematous]] [[rash]], follow the algorithm below:<ref name="Murphy-LavoieLeGros2018">{{cite journal|last1=Murphy-Lavoie|first1=Heather|last2=LeGros|first2=Tracy|title=The Algorithmic Approach to the Unidentified Rash|year=2018|pages=1–5|doi=10.1007/978-3-319-75623-3_1}}</ref>
{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | | | | A01 | | | |A01=[[Fever]] with [[Erythematous]] rash}}
{{Family tree | | | | | | | A01 | | | |A01=[[Fever]] with [[Erythematous]] rash}}
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{{Family tree | |u09| | | | | |t09| | | | |q09| |w09| | |e09| | | | |q09=[[Kawasaki disease]]|w09=[[Scarlet fever]] |e09=[[Toxic Shock Syndrome]] | | |u09=[[Scalded-skin syndrome|Staphylococcal Scalded Skin Syndrome]]:|t09=[[Toxic Epidermal Necrolysis]]| | | | | | |}}
{{Family tree | |u09| | | | | |t09| | | | |q09| |w09| | |e09| | | | |q09=[[Kawasaki disease]]|w09=[[Scarlet fever]] |e09=[[Toxic Shock Syndrome]] | | |u09=[[Scalded-skin syndrome|Staphylococcal Scalded Skin Syndrome]]:|t09=[[Toxic Epidermal Necrolysis]]| | | | | | |}}
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{{Family tree | | |!| | | | | | |!| | | | | | | |!| | | | |!| | |!| | | | | | | | | | | | | | |}}
{{Family tree | |u09| | | | |t09| | | | | |p09| |q09| | |s09| | | | | | | |p09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
{{Family tree | |u09| | | | |t09| | | | | |p09| |q09| | |s09| | | | | | | |p09=<div style="float: left; text-align: left; height: 39em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑  Mainly seen in young children,[[vasculitis]] due to [[autoimmune]] or infective cause<br>❑Affects many systems, including the skin, mucous membranes, [[lymphatics]], and [[blood vessels]]. <br/>  ❑high fever for at least 5 days <br/>  ❑Diffuse [[erythroderma]] <br/>  ❑[[Strawberry tongue]] <br/>  ❑Significant cervical [[lymphadenopathy]] <br/>  ❑[[Conjunctival injection]], peeling of the fingers and toes<br/> ❑[[Edema]] of the extremities <br>  </div> |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑  Mainly seen in young children,[[vasculitis]] due to [[autoimmune]] or [[infective]] cause<br>❑Affects many systems, including the skin, mucous membranes, [[lymphatics]], and [[blood vessels]]. <br/><br/>  ❑ High fever for at least 5 days.<br/><br/>  ❑ Diffuse [[erythroderma]] <br/>  ❑[[Strawberry tongue]] <br/><br/>  ❑ Significant [[cervical]] [[lymphadenopathy]] <br/><br/>  ❑ [[Conjunctival injection]], peeling of the fingers and toes<br/> <br/> ❑[ [Oedema]] of the extremities <br><br/>  </div> |q09=<div style="float: left; text-align: left; height: 29em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑ [[Strawberry tongue]]<br>❑ Tiny red [[macules]] or rough [[papules]] <br/>  ❑Swollen then peeling hands<br>❑Evidence of [[streptococcal infection]]<br> </div> |s09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑ [[Strawberry tongue]]<br><br/>❑ Tiny red [[macules]] or rough [[papules]] <br/><br/>  ❑ Swollen then peeling hands<br><br/>❑ Evidence of [[streptococcal infection]]<br><br/> </div> |s09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
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❑ Associated with tampon use in female,[[abscesses]], nasal packing, surgical wounds, and [[postpartum]] conditions<br>❑Patient is [[toxic]], in [[shock]], and [[febrile]]<br/>  ❑Diffuse [[erythematous]] [[rash]] that eventually leads to [[desquamation]] of the hands and feet.  </div> | |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑ Associated with tampon use in female,[[abscesses]], nasal packing, surgical wounds, and [[postpartum]] conditions<br><br/>❑ Patient is [[toxic]], in [[shock]], and [[febrile]]<br/><br/>  ❑ Diffuse [[erythematous]] [[rash]] that eventually leads to [[desquamation]] of the hands and feet.<br/><br/> </div> | |u09=<div style="float: left; text-align: left; height: 29em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
----
----
❑  Mainly seen in young children,usually less than 5 years of age.<br>❑Sudden onset of [[Fever|fever.]] <br/>  ❑[[Erythema]] of the neck, [[axilla]], and [[groin]], and extreme skin tenderness <br><br>❑[[Mucous membrane]] not included<br>❑Shallow skin cleavage plane  </div> |t09=<div style="float: left; text-align: left; height: 38 em; width: 14em; padding:1em;"> '''Characteristics:'''<br>
❑  Mainly seen in young children,usually less than 5 years of age.<br><br/>❑ Sudden onset of [[Fever|fever.]] <br/><br/>  ❑[[Erythema]] of the neck, [[axilla]], and [[groin]], and extreme skin tenderness <br><br>❑[[Mucous membrane]] not included<br><br/>❑ Shallow skin cleavage plane  </div> |t09=<div style="float: left; text-align: left; height: 45 em; width: 14em; padding:1em;"> '''Characteristics:'''<br>
----
----
❑  Caused by drug reaction and most commonly associated with [[sulfa drugs]]. Other drugs include [[anticonvulsants]], [[antivirals]], [[NSAIDs]], and [[allopurinol]]. <br>❑sudden-onset diffuse [[erythema]] with tender skin and sloughing <br/>  ❑[[Rash]] starts from the face and around the eyes,then spread to whole body.<br/>  ❑Massive skin sloughing in large sheets <br>  ❑ Patient is [[toxic]] <br/>  ❑[[Myalgia]]<br/>  ❑[[Mucous membrane]] is involved<br/>  ❑[[Immunocompromised]] patients,[[HIV]] patients,patient with [[SLE]],[[brain tumor]] are the high risk population</div> | | | | | |}}
❑  Caused by drug reaction and most commonly associated with [[sulfa drugs]]. Other drugs include [[anticonvulsants]], [[antivirals]], [[NSAIDs]], and [[allopurinol]]. <br><br/>❑ Sudden-onset diffuse [[erythema]] with tender skin and sloughing.<br/><br/>  ❑ [[Rash]] starts from the face and around the eyes, then spread to whole body.<br/><br/>  ❑ Massive skin sloughing in large sheets <br><br/>  ❑ Patient is [[toxic]] <br/><br/>  ❑ [[Myalgia]]<br/><br/>  ❑ [[Mucous membrane]] is involved.<br/><br/>  ❑ [[Immunocompromised]] patients,[[HIV]] patients, patient with [[SLE]],[[brain tumor]] are the high risk population.<br/><br/></div> | | | | | |}}
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{{Family tree | | | | | |P08| | |P09| | | | | |p07| | | | |a01| | | |b01| |c01| |c01=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
{{Family tree | | | | | |P08| | |P09| | | | | |p07| | | | |a01| | | |b01| |c01| |c01=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
----
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[[Doxycycline]] is the first-line treatment in nonpregnant adult patients <br> ❑ Children can be treated with amoxicillin.<br/>  </div> |b01=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
❑ [[Doxycycline]] is the first-line treatment in nonpregnant adult patients <br><br/> ❑ Children can be treated with amoxicillin.<br/><br/>  </div> |b01=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
----
----
❑ [[Doxycycline]] is the drug of choice in all nonpregnant patients and children.<br> ❑  Pregnant patients can be treated with [[chloramphenicol]] <br/>  </div> |a01=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
❑ [[Doxycycline]] is the drug of choice in all nonpregnant patients and children.<br><br/> ❑  Pregnant patients can be treated with [[chloramphenicol]] <br/><br/>  </div> |a01=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
----
----
[[Ceftriaxone]] is first-line therapy. [[Vancomycin]] should be added <br> ❑[[Rifampin]] is used as prophylaxis in close contacts of the patients,alternatively  single-dose [[ciprofloxacin]] and IM [[ceftriaxone]] can be administered<br/>❑ [[Dexamethasone]] can reduce neurologic sequelae if given early,even before administering antibiotics<br/>  </div> |P08=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
❑ [[Ceftriaxone]] is first-line therapy. [[Vancomycin]] should be added. <br><br/> ❑ [[Rifampin]] is used as prophylaxis in close contacts of the patients, alternatively  single-dose [[ciprofloxacin]] and IM [[ceftriaxone]] can be administered<.br/><br/> ❑ [[Dexamethasone]] can reduce neurologic sequelae if given early, even before administering [[antibiotics]].<br/><br/>  </div> |P08=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
----
----
Discontinuation of the offending agent <br> ❑Optimizing fluid and electrolyte levels <br/>❑ Admit to ICU<br/>  </div>|P09=<div style="float: left; text-align: left; height: 62em; width: 10em; padding:1em;"> '''Treatment:'''<br>
❑ Discontinuation of the offending agent <br><br/> ❑ Optimizing fluid and electrolyte levels <br/><br/> ❑ Admit to ICU<br/><br/>  </div>|P09=<div style="float: left; text-align: left; height: 69em; width: 10em; padding:1em;"> '''Treatment:'''<br>
----
----
Mild cases (EM minor) require only symptomatic support  <br> ❑Give [[analgesics]], cold compresses, topical [[steroid]]s<br/>❑ Treatment of the specific cause if it is found and dermatological followup visit should be scheduled<br/> ❑In [[Erythema major]]  more aggressive care is needed, start with discontinuation of the causative agent<br/> ❑Fluid and electrolyte balance, analgesics for pain<br/> ❑Clean the wounded area, Silver sulfadiazine should NOT be used<br> ❑If oral lesions are present, soothing solution can be used<br> ❑[[Steroid]] use may give rise to further complications than benefit<br> ❑Dermatological and opthalmologic consultation (if eyes are involved).</div>|p07=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
❑ Mild cases (EM minor) require only symptomatic support  <br/><br> ❑ Give [[analgesics]], cold compressions, topical [[steroid]]s.<br/><br/>❑ Treatment of the specific cause if it is found and dermatological followup visit should be scheduled.<br/><br/> ❑ In [[Erythema major]]  more aggressive care is needed, start with discontinuation of the causative agent.<br/><br/> ❑ [[Fluid]] and electrolyte balance, [[analgesics]] for pain.<br/><br/> ❑ Clean the wounded area, Silver sulfadiazine should not be used.<br><br/> ❑ If oral lesions are present, soothing solution can be used.<br/><br> ❑ [[Steroid]] use may give rise to further complications than benefit.<br> ❑ Dermatological and [[ophthalmologic]] consultation is needed if eyes are involved.</div>|p07=<div style="float: left; text-align: left; height: 32em; width: 10em; padding:1em;"> '''Treatment:'''<br>
----
----
[[Doxycycline]] is the first-line treatment in nonpregnant adult patients <br> ❑[[Amoxicillin]] can be used in children </div>}}
❑ [[Doxycycline]] is the first-line treatment in non-pregnant adult patients.<br/><br> ❑ [[Amoxicillin]] can be used in children. </div>}}


{{Family tree/end}}
{{Family tree/end}}
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{{Family tree | |p09| | |c09| |s09| |u09| |q09| | |a01| |b01| | |c01| |a01=<div style="float: left; text-align: left; height: 56em; width: 12em; padding:1em;"> '''Treatment:'''<ref name="pmid19222477">{{cite journal |vauthors=Levi M, Toh CH, Thachil J, Watson HG |title=Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology |journal=Br. J. Haematol. |volume=145 |issue=1 |pages=24–33 |date=April 2009 |pmid=19222477 |doi=10.1111/j.1365-2141.2009.07600.x |url= |issn=}}</ref><br>
{{Family tree | |p09| | |c09| |s09| |u09| |q09| | |a01| |b01| | |c01| |a01=<div style="float: left; text-align: left; height: 56em; width: 12em; padding:1em;"> '''Treatment:'''<ref name="pmid19222477">{{cite journal |vauthors=Levi M, Toh CH, Thachil J, Watson HG |title=Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology |journal=Br. J. Haematol. |volume=145 |issue=1 |pages=24–33 |date=April 2009 |pmid=19222477 |doi=10.1111/j.1365-2141.2009.07600.x |url= |issn=}}</ref><br>
----
----
❑ The primary treatment of DIC is treatment of the underlying condition <br> ❑ In patients with [[DIC]] and bleeding or at high risk of bleeding and a [[platelet]] count of <50 x 10(9)/l transfusion of [[platelets]] should be considered but non-bleeding patients with [[DIC]], prophylactic [[platelet]] transfusion is not given unless there is a high risk of bleeding. <br> ❑[[Activated partial thromboplastin time]] (aPTT), administration of [[fresh frozen plasma]] (FFP) may be useful in [[DIC]] patients with prolonged [[prothrombin time]] (PT).<br/>❑In patients where [[FFP]] can not be used due to chances of fluid overload,[[factor concentrates]] can be used. <br> ❑ Patients with [[DIC]] with a primary [[hyperfibrinolytic]] state and severe bleeding can be treated with [[lysine]] analogues, such as [[tranexamic acid]], '''1 g every 8 hourly''' is administered. </div> |b01=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Treatment:'''<br>
❑ The primary treatment of DIC is treatment of the underlying condition <br><br/> ❑ In patients with [[DIC]] and bleeding or at high risk of bleeding and a [[platelet]] count of <50 x 10(9)/l transfusion of [[platelets]] should be considered but non-bleeding patients with [[DIC]], prophylactic [[platelet]] transfusion is not given unless there is a high risk of bleeding. <br><br/> ❑ [[Activated partial thromboplastin time]] (aPTT), administration of [[fresh frozen plasma]] (FFP) may be useful in [[DIC]] patients with prolonged [[prothrombin time]] (PT).<br/><br/>❑ In patients where [[FFP]] can not be used due to chances of fluid overload,[[factor concentrates]] can be used. <br><br/> ❑ Patients with [[DIC]] with a primary [[hyper-fibrinolytic]] state and severe bleeding can be treated with [[lysine]] analogues, such as [[Tranexamic acid]], '''1 g every 8 hourly''' is administered. </div> |b01=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑ Admit to [[ICU]] immediately and hematology consultaion is needed <br>❑First-line therapy is treatment of the underlying cause<br/>❑ [[Folate]], [[vitamin K]], [[fresh frozen plasma]] (FFP), [[cryoprecipitate]], [[platelets]], and red blood cell transfusions are given as needed; [[heparin]] can be used if there is any [[thrombi]]  </div>|c01=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Treatment:'''<br>
❑ Admit to [[ICU]] immediately and hematology consultaion is needed. <br><br/>❑ First-line therapy is treatment of the underlying cause.<br/><br/>❑ [[Folate]], [[vitamin K]], [[fresh frozen plasma]] (FFP), [[cryoprecipitate]], [[platelets]], and red blood cell transfusions are given as needed; [[heparin]] can be used if there is any [[thrombi]].<br/><br/> </div>|c01=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑ Immediate hematology/oncology consultation<br>❑Treatment of the underlying cause is done,[[Plasmapheresis]], [[FFP]] are used.<br/>❑ [[Platelets]] should not be given as it will precipitate additional [[thrombus]] formation  </div> |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
❑ Immediate hematology/oncology consultation.<br/><br>❑ Treatment of the underlying cause is done,[[Plasmapheresis]], [[FFP]] are used.<br/><br/>❑ [[Platelets]] should not be given as it will precipitate additional [[thrombus]] formation.<br/><br/> </div> |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑❑  [[Ceftriaxone]] is first-line therapy. [[Vancomycin]] should be added <br> ❑[[Rifampin]] is used as prophylaxis in close contacts of the patients,alternatively  single-dose [[ciprofloxacin]] and IM [[ceftriaxone]] can be administered<br/>❑ [[Dexamethasone]] can reduce neurologic sequelae if given early,even before administering antibiotics<br/>  </div>  <br>  |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
[[Ceftriaxone]] is first-line therapy. [[Vancomycin]] should be added <br><br/> ❑ [[Rifampin]] is used as prophylaxis in close contacts of the patients, alternatively  single-dose [[ciprofloxacin]] and IM [[ceftriaxone]] can be administered.<br/><br/>❑ [[Dexamethasone]] can reduce neurologic sequelae if given early, even before administering [[antibiotics]].<br/><br/>  </div>  <br>  |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑ [[Doxycycline]] is the drug of choice in all nonpregnant patients and children.<br> ❑   Pregnant patients can be treated with [[chloramphenicol]] <br/>  </div>  |s09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<ref name="pmid27406461">{{cite journal |vauthors=Lohani S, Nazir S, Tachamo N, Patel N |title=Disseminated gonococcal infection: an unusual presentation |journal=J Community Hosp Intern Med Perspect |volume=6 |issue=3 |pages=31841 |date=2016 |pmid=27406461 |pmc=4942509 |doi=10.3402/jchimp.v6.31841 |url= |issn=}}</ref><br>
❑ [[Doxycycline]] is the drug of choice in all non-pregnant patients and children.<br/><br> ❑ [[Pregnant]] patients can be treated with [[chloramphenicol]]. <br/><br/>  </div>  |s09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<ref name="pmid27406461">{{cite journal |vauthors=Lohani S, Nazir S, Tachamo N, Patel N |title=Disseminated gonococcal infection: an unusual presentation |journal=J Community Hosp Intern Med Perspect |volume=6 |issue=3 |pages=31841 |date=2016 |pmid=27406461 |pmc=4942509 |doi=10.3402/jchimp.v6.31841 |url= |issn=}}</ref><br>
----
----
❑ Patients with [[Disseminated gonococcal infection]] should be treated for at least 1 week with IV ceftriaxone. <br/>  ❑ Treatment duration should be extended in patients who do not improve adequately <br>  </div> |c09=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Treatment:'''<br>
❑ Patients with [[Disseminated gonococcal infection]] should be treated for at least 1 week with IV ceftriaxone. <br/><br/>  ❑ Treatment duration should be extended in patients who do not improve adequately.<br/><br>  </div> |c09=<div style="float: left; text-align: left; height: 28em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑ Only supportive care, <br>❑Some patients need hospitalization for pain control, kidney [[biopsy]], and/or administration of [[Immunosuppressant|immunosuppressant agents]] or, occasionally, [[IVIG]]<br/>  </div>  |p09=<div style="float: left; text-align: left; height: 30em; width: 12em; padding:1em;"> '''Treatment:'''
❑ Only supportive care.<br/><br>❑ Some patients need hospitalization for [[pain]] control, kidney [[biopsy]], and/or administration of [[Immunosuppressant|immunosuppressant agents]] or, occasionally, [[IVIG]].<br/>  </div>  |p09=<div style="float: left; text-align: left; height: 30em; width: 12em; padding:1em;"> '''Treatment:'''
<br>
<br>
----
----
❑ Initial empiric therapy is [[Vancomycin]] or [[Ampicillin]]/[[Sulbactam]] plus an [[Aminoglycoside]] .<br>❑[[Rifampin]] is added in patients with [[prosthetic valves]]<br> ❑Valve replacement should be considered in selected patients with [[infectious endocarditis]]. <br><br> ❑[[Antimicrobial]] prophylaxis before certain [[dental]] and other procedures.  </div>}}
❑ Initial empiric therapy is [[Vancomycin]] or [[Ampicillin]]/[[Sulbactam]] plus an [[Aminoglycoside]].<br/><br>❑[[Rifampin]] is added in patients with [[prosthetic valves]].<br><br/> ❑ [[Valve]] replacement should be considered in selected patients with [[infectious endocarditis]]. <br><br> ❑ [[Antimicrobial]] prophylaxis before certain [[dental]] and other procedures.  </div>}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
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{{Family tree/end}}
{{Family tree/end}}


If patient presents with Vesiculo-bullous Rash, follow the algoritm below:
If patient presents with [[Vesiculo-bullous]] [[Rash]], follow the algoritm below:


{{Family tree/start}}
{{Family tree/start}}
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{{Family tree | |u09| | | | | |t09| | | | | | | |t09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
{{Family tree | |u09| | | | | |t09| | | | | | | |t09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑  Maintain hydration <br>❑Treat the fever,avoid Aspirin to prevent [[Reye's syndrome]] in children <br/>  ❑Alleviate pain from mouth [[Sore|sores]] <br>  </div> |u09=<div style="float: left; text-align: left; height: 56em; width: 12em; padding:1em;"> '''Treatment:<ref name="pmid25593960">{{cite journal |vauthors=Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A |title=Current concepts in the management of necrotizing fasciitis |journal=Front Surg |volume=1 |issue= |pages=36 |date=2014 |pmid=25593960 |pmc=4286984 |doi=10.3389/fsurg.2014.00036 |url= |issn=}}</ref>'''<br>
❑  Maintain hydration.<br/><br>❑ Treat the fever, avoid [[Aspirin]] to prevent [[Reye's syndrome]] in children.<br/> <br/>  ❑ Alleviate pain from mouth [[Sore|sores]].<br/> <br>  </div> |u09=<div style="float: left; text-align: left; height: 62em; width: 12em; padding:1em;"> '''Treatment:<ref name="pmid25593960">{{cite journal |vauthors=Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A |title=Current concepts in the management of necrotizing fasciitis |journal=Front Surg |volume=1 |issue= |pages=36 |date=2014 |pmid=25593960 |pmc=4286984 |doi=10.3389/fsurg.2014.00036 |url= |issn=}}</ref>'''<br>
----
----
❑Emergency surgical [[debridement]] of the affected tissues is the primary management <br/> ❑ Initial [[antibiotic]] treatment includes [[Ampicillin]] or [[Ampicillin/sulbactam|ampicillin–sulbactam]] combined with metronidazole or clindamycin <br>❑Metronidazole, clindamycin, or carbapenems are used for anarobic coverage. <br/>  ❑[[Ampicillin/sulbactam|Ampicillin–sulbactam]], [[Piperacillin/tazobactam|piperacillin–tazobactam]], ticarcillin–clavulanate acid, third or fourth generation [[cephalosporins]], or [[carbapenems]] are used at a higher dosage if patient was recently admitted to hospital or were treated with [[antibiotics]] <br/>  ❑Antibiotic should be continued for 4–6 weeks and up to 5 days after local signs and symptoms have resolved<br/>  ❑Intravenous [[immunoglobulin]] (IVIG) can be used for neutralizing [[Streptococcal|streptococcal toxins]].  </div>  | | | |}}
❑ Emergency surgical [[debridement]] of the affected tissues is the primary management.<br/><br/> ❑ Initial [[antibiotic]] treatment includes [[Ampicillin]] or [[Ampicillin/Sulbactam|ampicillin–sulbactam]] combined with [[Metronidazole]] or [[Clindamycin]].<br/><br>❑ [[Metronidazole]], clindamycin, or carbapenems are used for anarobic coverage. <br/><br/>  ❑ [[Ampicillin/sulbactam|Ampicillin–sulbactam]], [[Piperacillin/ Tazobactam|piperacillin–tazobactam]], [[Ticarcillin]]–[[Clavulanate acid]], third or fourth generation [[Cephalosporins]], or [[Carbapenems]] are used at a higher dosage if patient was recently admitted to hospital or were treated with [[antibiotics]].<br/> <br/>  ❑ [[Antibiotic]] should be continued for 4–6 weeks and up to 5 days after local signs and symptoms have resolved.<br/><br/>  ❑ Intravenous [[immunoglobulin]] (IVIG) can be used for neutralizing [[Streptococcal|streptococcal toxins]].  </div>  | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
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Patient comes with Erythematous rash, follow the algorithm below:
Patient comes with [[Erythematous]] [[rash]], follow the algorithm below:
{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | | | | A01 | | | |A01=[[Fever]] with [[Erythematous]] rash}}
{{Family tree | | | | | | | A01 | | | |A01=[[Fever]] with [[Erythematous]] rash}}
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{{Family tree | |u09| | | | |t09| | | | | |p09| |q09| | |s09| | | | | | | |p09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Treatement:'''<br>
{{Family tree | |u09| | | | |t09| | | | | |p09| |q09| | |s09| | | | | | | |p09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Treatement:'''<br>
----
----
❑  High dose [[aspirin]]<br>❑Hospitalization with supportive care, <br/>  ❑[[IVIG]] <br/> </div> |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:<ref name="urlClinical Practice Guidelines : Kawasaki disease">{{cite web |url=https://www.rch.org.au/clinicalguide/guideline_index/Kawasaki_disease/ |title=Clinical Practice Guidelines : Kawasaki disease |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>'''<br>
❑  High dose [[aspirin]]<br><br/>❑ Hospitalization with supportive care.<br/><br/>  ❑ [[IVIG]] <br/><br/> </div> |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:<ref name="urlClinical Practice Guidelines : Kawasaki disease">{{cite web |url=https://www.rch.org.au/clinicalguide/guideline_index/Kawasaki_disease/ |title=Clinical Practice Guidelines : Kawasaki disease |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>'''<br>
----
----
❑ [[IVIG]], 2g/kg as a single IV infusion on diagnosis, within the first 10 days of the illness<br>❑ Aspirin is given
❑ [[IVIG]], 2g/kg as a single IV infusion on diagnosis, within the first 10 days of the illness.<br><br/>❑ Aspirin is given
3-5mg/kg as a daily dose until normal echo on follow up(6 months). <br/> </div> |s09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Treatment:'''<br>
3-5mg/kg as a daily dose until normal echo on follow up(6 months). <br/> <br/> </div> |s09=<div style="float: left; text-align: left; height: 32em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑Removal of the infective material <br>❑Administration of IV [[antibiotics]],<br/>  ❑Fluid resuscitation <br/>  ❑[[IVIG]] <br/>Admit to [[ICU]]  ❑  </div> | |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
❑ Removal of the infective material. <br/><br>❑ Administration of IV [[antibiotics]].<br/><br/>  ❑ Fluid resuscitation.<br/><br/>  ❑ [[IVIG]].<br/> <br/>  ❑ Admit to ICU. </div> | |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Treatment:'''<br>
----
----
❑ Treatment includes antistaphylococcal antibiotics<br>❑ Fluid and electrolyte management, and local wound care <br/> </div> |t09=<div style="float: left; text-align: left; height: 38 em; width: 14em; padding:1em;"> '''Treatment:'''<br>
❑ Treatment includes antistaphylococcal [[antibiotics]]<br/><br>❑ Fluid and electrolyte management, and local wound care.<br/> <br/> </div> |t09=<div style="float: left; text-align: left; height: 38 em; width: 14em; padding:1em;"> '''Treatment:'''<br>
----
----
❑  Discontinuation of the offending agent <br/>  ❑Fluid and electrolyte balance<br/>  ❑[[IVIG|Intravenous immune globulin]] (IVIG) may be helpful <br>  ❑ [[Sulfadiazine]] should not be used for wound care, as sulfa is the most common offending agent <br/>  ❑Clean the wound and [[opthalmologic]] consultation if eyes are involved<br/> </div> | | | | | |}}
❑  Discontinuation of the offending agent <br/><br/>  ❑ Fluid and electrolyte balance<br/><br/>  ❑ [[IVIG|Intravenous immune globulin]] (IVIG) may be helpful. <br><br/>  ❑ [[Sulfadiazine]] should not be used for wound care, as sulfa is the most common offending agent.<br/><br/>  ❑ Clean the wound and [[ophthalmologic]] consultation if eyes are involved.<br/> </div> | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
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Latest revision as of 10:02, 11 February 2021


Rash with fever Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords: Approach to febrile rash, Approach to Rash

Overview

A patient with fever may often come with rash.There are several causes for rash in febrile patients.Rash caused by infectious agents may have mild to severe outcome,so it is very important to diagnose the cause and treat accordingly.There can be some non-infectious causes as well.To diagnose efficiently a complete history must be taken which includes history of recent travel, contact with animals, medications, and exposure to forests and other natural environments. Additionally, time of onset of symptoms and morphology, location, distribution of the rash are be helpful in the clinical diagnosis.The most common causes are Dengue hemorrhagic fever, Rocky Mountain spotted fever (RMSF), Scarlet fever, Toxic Epidermal Necrolysis (TEN),Stevens-Johnson Syndrome (SJS), Henoch-Schonlein Purpura (HSP), Kawasaki disease, Lyme disease, Endocarditis, Disseminated gonococcal infection,Autoimmune vasculitis, Systemic lupus erythematosus (SLE),Rheumatoid arthritis,Sjogren’s syndrome, Varicella, Necrotizing fasciitis, Rubella, Measles.Usually,skin rashes are nonspecific and self-limited.If it is caused by viral infections unlike bacterial infections, they do not respond to antibiotics, so treatment usually focuses on relieving symptoms.If it is caused by bacterial infection specific antibiotic is prescribed.The treatment of non-infectious rashes depend on the underlying cause.

Causes

Life Threatening Causes

Life-threatening causes of febrile rashes include conditions that may result in death or permanent disability within 24 hours if left untreated.[1]

Common Causes

Common causes of rash with fever are given below :[1]

Diagnosis

Shown below are 04 algorithms summarizing the diagnosis of Rash with fever in a patient:[2][1]


Abbreviations: BP: Blood pressure, RR=Respiratory rate, HR=Heart Rate, HIV=Human immunodeficiency Virus, EM major=Erythema Multiforme Major, EM minor=Erythema Multiforme Minor, H/O=History of, DIC=disseminated intravascular coagulation, VZV=Varicella zoster virus,SLE=Systemic lupus erythematosus, TTP=Thrombotic Thrombocytopenic Purpura ,RMSF= Rocky Mountain spotted fever, IM=Intramuscular, IVIG= Intravenous Immunoglobulin, IVDU -Intravenous Drug User


 
 
 
 
 
 
 
 
Patient with Fever and Rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Record Vital signs:

❑ Measure the temperature

❑ Record Pulse rate

❑ Record Blood pressure

❑ Record Respiratory rate

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about associated symptoms:

Vomiting

Nausea

Abdominal Pain

Cough

Sore throat

Chest pain

Arthralgia

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about other medical history:

Asplenia

Infection or Inflammation

Sarcoid

Malignancy

Collagen vascular disease

❑ Any recent medications

Valvular heart disease

Chronic liver disease

❑ Solid organ or bone marrow transplantation

Steroid use

Chemotherapy related immune suppression

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about recent Exposure:

❑ Communal living

Tick exposure

❑ Dog exposure

❑ Salt water exposure

Tampon use

IVDU

Trauma and Diabetes Mellitus

❑ Exposure to sexually transmitted disease, including risk factors for infection with human immunodeficiency virus (HIV)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about recent travel history:

❑ International Travel history

❑ Travel in the mid-Atlantic, central, western,

and northeastern parts of the United States(Lyme disease is common)

❑ Travel in wooded areas(Rocky Mountain spotted fever and tick-borne diseases are common)

❑ Recent camping history

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
General Physical Examination:

❑ General appearance-Is the patient toxic? or normal appearance

❑ Look for new-onset heart murmur or nuchal rigidity

Nuchal rigidity

❑ Palpate Lymph nodes for Generalized lymphadenopathy

Conjunctival injection

❑ Look for Nikolsky sign:Sloughing of full-thickness skin with lateral pressure

❑ Look for any lesion on the back, buttocks, or perineum

❑ In diabetic patients check feet

❑ Palpate abdomen for hepatosplenomegaly
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characterize rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Maculopapular rash
 
 
Petechial/Purpuric rash
 
 
Vesiculobullous rash
 
 
 
Erythematous rash
 



Terminolgies used to diagnose Rashes[1]


Term Clinical Features
Lesion Single,Small affected area
Rash An eruption on the skin; more extensive than a single lesion
Macule Well circumscribed area of change without elevation
Papule Solid raised lesion ≤1 cm
Petechia Small red/brown macule ≤1 cm

that does not blanche

Purpura Hemorrhagic area > 3 mm that does not blanch



If a patient present with fever with maculopapular rash then follow the algorithm given below:[2]



 
 
 
 
 
 
Fever with maculopapular rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look at the rash and it's distribution
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Central distribution with fever
 
 
 
 
 
Peripheral distribution with fever
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Viral exanthem
Lyme disease
Still disease
 
 
 
 
 
Look for target lesion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Present
 
 
 
 
 
 
 
 
 
 
 
Absent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stevens-Johnson Syndrome
 
Erythema Multiforme
 
 
 
 
 
 
Lyme disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:

❑ Usually occurs due to drug reaction

❑ Diffusely distributed target lesions including the palms and soles

Mucous membrane may be involved

Toxic appearing patient

Fever

 
 
Characteristics:

❑ Usually autoimmune

❑ May follow Herpes simplex, Mycoplasma, Fungal diseases or may occur due to drug exposure (sulfa drugs, anticonvulsants, antibiotics)
Mucous membrane not involved in EM minor

❑ In EM major significant involvement of mucous membrane

❑ Nonspecific upper respiratory tract infection, moderate fever, general discomfort, cough, sore throat, vomiting, chest pain, diarrhoea may occur before the onset of rash

Rash may be seen in the palms, soles, face, and extensor surfaces and eye involvement in 10%
 
 
 
 
 
Characteristics:

❑ Usually there is a history of travelling to wooden area

Tick-borne illness is caused by Borrelia burgdorferi

❑ A big lesion with dark red border and central clearing known as Erythema migrans

❑ Migratory arthalgia

Atrioventricular Nodal block

Myalgia

Fever

Bells palsy

❑ Confusion

Meningitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Meningococcemia
 
 
 
Rocky Mountain spotted fever
 
 
Syphillis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:

❑ Infection with Neisseria meningitidis

❑ History of living in collge dormitory/millitary/prison

Erythematous and maculopapular that initially begins on wrists and ankles, then spreads and becomes petechial

❑ Ill appearing patient

Fever
 
 
 
 
Characteristics:

❑ Caused by Rickettsia rickettsii

❑ History of travel to wooden areas, primarily in the south-Atlantic region of the United States ❑ Erythematous and maculopapular that initially begins on wrists and ankles, then spreads and becomes petechial

❑ Ill appearing patient, can be in shock

❑ High fever

 
Characteristics:

❑ Caused by Treponema pallidum

❑Secondary syphilis may appear as rough, red, or reddish brown spots on the palms of the hands and the bottoms of the feet]

Non-pruritic

Fever

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


If patient presents with Petechial/Purpuric rash:[2]

 
 
 
 
 
 
Fever with Petechial rash/Perpuric rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Palpate the rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Palpable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-palpable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Endocarditis
 
Henoch-Schonlein purpura
 
Disseminated gonococcal infection
 
Rocky Mountain spotted fever
 
Meningococcemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:[3]



❑ History of IV drug use,Infective Endocarditis, Rheumatic fever

❑ Mostly caused by Staphylococcus and Streptococcus

❑ Look for Janeway lesions which are painless purple or brown erythematous macular lesions, usually affects the palms, soles, and fingers

 
 
Characteristics:

❑ Autoimmune systemic vasculitis that affects the legs, buttocks, and arms and kidneys.

❑ Usually preceded by an infection or drug exposure.

❑ The classic triad comprises of purpura, abdominal pain, and arthritis in the knees, ankles, and elbows.

Pruritic

Nausea

Vomiting

Intussusception

Diarrhoea/Constipation
 
Characteristics:

❑ Caused by Neiserria Gonorrhoea

Rash maybe present in case of disseminated gonococcal infection.

❑ Affects the trunk, limbs, palms and soles, and usually spare the face, scalp and mouth.

 
Characteristics:

❑ Caused by Rickettsia rickettsii

❑ History of travel to wooden areas, primarily in the south-Atlantic region of the United States ❑ Erythematous and maculopapular that initially begins on wrists and ankles, then spreads and becomes petechial

❑ Ill appearing patient, can be in shock

❑ High fever

 
Characteristics:

❑ Infection with Neisseria meningitidis

❑ History of living in collge dormitory/millitary/prison

Erythematous and maculopapular that initially begins on wrists and ankles, then spreads and becomes petechial

❑ Ill appearing patient

Fever

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
DIC
 
 
TTP
 
 
 
 
[[Purpura fulminans]]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:

❑ Very ill patient.

❑ Complication of different serious and life-threatening diseases

❑ Due to uncontrolled activation of clotting factors in the blood vessels, causing clotting of blood in the whole body.
❑ Bleeding in other tissues.

 
 
Characteristics:[4]

❑ Purplish bruises or purpura/petechiae in the mouth

❑ Yellowish color of the skin and sclera

Fatigue

Tachycardia

Shortness of Breath
 
 
 
Characteristics:

❑ Very ill patient

❑ H/O previous infection most commonly by meningococcal or gram-negative organisms, pregnancy, massive trauma, end-stage malignant disease, hepatic failure, snakebites, transfusion reactions, and anything else that may precipitate DICs

Fever

Shock
❑ Rapid subcutaneous hemorrhage

❑ Widespread organ involvement

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

If patient presents with Vesiculo-bullous Rash, follow the algoritm below:[2]

 
 
 
 
 
 
Fever with Vesicobullous rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look at the rash and it's distribution
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diffuse distribution with fever
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Localized distribution with fever
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Varicella
 
Purpura fulminans
 
Disseminated gonococcal disease
 
 
 
 
 
DIC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:[5]

❑ It is caused by varicella-zoster virus (VZV).

Temperature up to 102°F.
Rash is generalized and pruritic,usually starts from chest, back, and face, then spreads over the entire body.

❑ Rash progresses rapidly from macular to papular to vesicular lesions before crusting.

Malaise

 
 
Characteristics:

❑ Very ill patient

❑ H/O previous infection most commonly by meningococcal or gram-negative organisms, pregnancy, massive trauma, end-stage malignant disease, hepatic failure, snakebites, transfusion reactions, and anything else that may precipitate DICs

Fever

Shock

❑ Rapid subcutaneous hemorrhage

❑ Widespread organ involvement
 
Characteristics:

❑ Caused by Neiserria Gonorrhoea

Rash maybe present in case of disseminated gonococcal infection.

❑ Affects the trunk, limbs, palms and soles, and usually spare the face, scalp and mouth.

 
 
 
Characteristics:

❑ Very ill patient.

❑ Complication of different serious and life-threatening diseases

❑ Due to uncontrolled activation of clotting factors in the blood vessels, causing clotting of blood in the whole body

❑ Bleeding in other tissues

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Necrotizing fasciitis
 
 
 
 
 
 
Hand-foot-and-mouth disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:

❑ Very sick patient, may be in septic shock

❑ Rapid spread of cellulitis with purpura/blistering, genitalia may be involved

❑ Affected area may have decreased sensation

 
 
 
 
 
Characteristics:

❑ Mainly seen in young children, caused by enterovirus

❑ Symmetrical vesicles mainly hands, feet and mouth

❑ Can extend to limbs and buttocks

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Patient comes with Erythematous rash, follow the algorithm below:[2]

 
 
 
 
 
 
Fever with Erythematous rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look for Nikolsky sign
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Present
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Absent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Staphylococcal Scalded Skin Syndrome:
 
 
 
 
 
Toxic Epidermal Necrolysis
 
 
 
 
Kawasaki disease
 
Scarlet fever
 
 
Toxic Shock Syndrome
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics:

❑ Mainly seen in young children,usually less than 5 years of age.

❑ Sudden onset of fever.

Erythema of the neck, axilla, and groin, and extreme skin tenderness

Mucous membrane not included

❑ Shallow skin cleavage plane
 
 
 
 
Characteristics:

❑ Caused by drug reaction and most commonly associated with sulfa drugs. Other drugs include anticonvulsants, antivirals, NSAIDs, and allopurinol.

❑ Sudden-onset diffuse erythema with tender skin and sloughing.

Rash starts from the face and around the eyes, then spread to whole body.

❑ Massive skin sloughing in large sheets

❑ Patient is toxic

Myalgia

Mucous membrane is involved.

Immunocompromised patients,HIV patients, patient with SLE,brain tumor are the high risk population.

 
 
 
 
 
Characteristics:

❑ Mainly seen in young children,vasculitis due to autoimmune or infective cause
❑Affects many systems, including the skin, mucous membranes, lymphatics, and blood vessels.

❑ High fever for at least 5 days.

❑ Diffuse erythroderma
Strawberry tongue

❑ Significant cervical lymphadenopathy

Conjunctival injection, peeling of the fingers and toes

❑[ [Oedema]] of the extremities

 
Characteristics:

Strawberry tongue

❑ Tiny red macules or rough papules

❑ Swollen then peeling hands

❑ Evidence of streptococcal infection

 
 
Characteristics:

❑ Associated with tampon use in female,abscesses, nasal packing, surgical wounds, and postpartum conditions

❑ Patient is toxic, in shock, and febrile

❑ Diffuse erythematous rash that eventually leads to desquamation of the hands and feet.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of rash with fever[2][6][7][8][9]

If patient comes it maculopapular rash and fever:

Abbreviations: HIV=Human immunodeficiency Virus, EM major=Erythema Multiforme Major, EM minor=Erythema Multiforme Minor, H/O=History of, DIC=disseminated intravascular coagulation, VZV=Varicella zoster virus,SLE=Systemic lupus erythematosus, TTP=Thrombotic Thrombocytopenic Purpura ,RMSF= Rocky Mountain spotted fever, IM=Intramuscular, IVIG= Intravenous Immunoglobulin


 
 
 
 
 
 
Fever with maculopapular rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stevens-Johnson Syndrome
 
Erythema Multiforme
 
 
 
 
 
 
Lyme disease
 
 
 
Meningococcemia
 
 
 
Rocky Mountain spotted fever
 
Lyme disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment:

❑ Discontinuation of the offending agent

❑ Optimizing fluid and electrolyte levels

❑ Admit to ICU

 
 
Treatment:

❑ Mild cases (EM minor) require only symptomatic support

❑ Give analgesics, cold compressions, topical steroids.

❑ Treatment of the specific cause if it is found and dermatological followup visit should be scheduled.

❑ In Erythema major more aggressive care is needed, start with discontinuation of the causative agent.

Fluid and electrolyte balance, analgesics for pain.

❑ Clean the wounded area, Silver sulfadiazine should not be used.

❑ If oral lesions are present, soothing solution can be used.

Steroid use may give rise to further complications than benefit.
❑ Dermatological and ophthalmologic consultation is needed if eyes are involved.
 
 
 
 
 
Treatment:

Doxycycline is the first-line treatment in non-pregnant adult patients.

Amoxicillin can be used in children.
 
 
 
 
Treatment:

Ceftriaxone is first-line therapy. Vancomycin should be added.

Rifampin is used as prophylaxis in close contacts of the patients, alternatively single-dose ciprofloxacin and IM ceftriaxone can be administered<.br/>
Dexamethasone can reduce neurologic sequelae if given early, even before administering antibiotics.

 
 
 
Treatment:

Doxycycline is the drug of choice in all nonpregnant patients and children.

❑ Pregnant patients can be treated with chloramphenicol

 
Treatment:

Doxycycline is the first-line treatment in nonpregnant adult patients

❑ Children can be treated with amoxicillin.

 


If patient comes with Petechial/Purpuric rash

 
 
 
 
 
 
Fever with Petechial rash/Perpuric rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Endocarditis
 
Henoch-Schonlein purpura
 
Disseminated gonococcal infection
 
Rocky Mountain spotted fever
 
Meningococcemia
 
 
DIC
 
Purpura fulminans
 
TTP
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment:



❑ Initial empiric therapy is Vancomycin or Ampicillin/Sulbactam plus an Aminoglycoside.

Rifampin is added in patients with prosthetic valves.

Valve replacement should be considered in selected patients with infectious endocarditis.

Antimicrobial prophylaxis before certain dental and other procedures.
 
 
Treatment:

❑ Only supportive care.

❑ Some patients need hospitalization for pain control, kidney biopsy, and/or administration of immunosuppressant agents or, occasionally, IVIG.
 
Treatment:[7]

❑ Patients with Disseminated gonococcal infection should be treated for at least 1 week with IV ceftriaxone.

❑ Treatment duration should be extended in patients who do not improve adequately.

 
Treatment:

Doxycycline is the drug of choice in all non-pregnant patients and children.

Pregnant patients can be treated with chloramphenicol.

 
Treatment:

Ceftriaxone is first-line therapy. Vancomycin should be added

Rifampin is used as prophylaxis in close contacts of the patients, alternatively single-dose ciprofloxacin and IM ceftriaxone can be administered.

Dexamethasone can reduce neurologic sequelae if given early, even before administering antibiotics.


 
 
Treatment:[6]

❑ The primary treatment of DIC is treatment of the underlying condition

❑ In patients with DIC and bleeding or at high risk of bleeding and a platelet count of <50 x 10(9)/l transfusion of platelets should be considered but non-bleeding patients with DIC, prophylactic platelet transfusion is not given unless there is a high risk of bleeding.

Activated partial thromboplastin time (aPTT), administration of fresh frozen plasma (FFP) may be useful in DIC patients with prolonged prothrombin time (PT).

❑ In patients where FFP can not be used due to chances of fluid overload,factor concentrates can be used.

❑ Patients with DIC with a primary hyper-fibrinolytic state and severe bleeding can be treated with lysine analogues, such as Tranexamic acid, 1 g every 8 hourly is administered.
 
Treatment:

❑ Admit to ICU immediately and hematology consultaion is needed.

❑ First-line therapy is treatment of the underlying cause.

Folate, vitamin K, fresh frozen plasma (FFP), cryoprecipitate, platelets, and red blood cell transfusions are given as needed; heparin can be used if there is any thrombi.

 
 
Treatment:

❑ Immediate hematology/oncology consultation.

❑ Treatment of the underlying cause is done,Plasmapheresis, FFP are used.

Platelets should not be given as it will precipitate additional thrombus formation.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

If patient presents with Vesiculo-bullous Rash, follow the algoritm below:

 
 
 
 
 
 
Fever with Vesicobullous rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Necrotizing fasciitis
 
 
 
 
 
 
Hand-foot-and-mouth disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment:[8]

❑ Emergency surgical debridement of the affected tissues is the primary management.

❑ Initial antibiotic treatment includes Ampicillin or ampicillin–sulbactam combined with Metronidazole or Clindamycin.

Metronidazole, clindamycin, or carbapenems are used for anarobic coverage.

Ampicillin–sulbactam, piperacillin–tazobactam, TicarcillinClavulanate acid, third or fourth generation Cephalosporins, or Carbapenems are used at a higher dosage if patient was recently admitted to hospital or were treated with antibiotics.

Antibiotic should be continued for 4–6 weeks and up to 5 days after local signs and symptoms have resolved.

❑ Intravenous immunoglobulin (IVIG) can be used for neutralizing streptococcal toxins.
 
 
 
 
 
Treatment:

❑ Maintain hydration.

❑ Treat the fever, avoid Aspirin to prevent Reye's syndrome in children.

❑ Alleviate pain from mouth sores.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Patient comes with Erythematous rash, follow the algorithm below:

 
 
 
 
 
 
Fever with Erythematous rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Staphylococcal Scalded Skin Syndrome:
 
 
 
 
 
Toxic Epidermal Necrolysis
 
 
 
 
Kawasaki disease
 
Scarlet fever
 
 
Toxic Shock Syndrome
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment:

❑ Treatment includes antistaphylococcal antibiotics

❑ Fluid and electrolyte management, and local wound care.

 
 
 
 
Treatment:

❑ Discontinuation of the offending agent

❑ Fluid and electrolyte balance

Intravenous immune globulin (IVIG) may be helpful.

Sulfadiazine should not be used for wound care, as sulfa is the most common offending agent.

❑ Clean the wound and ophthalmologic consultation if eyes are involved.
 
 
 
 
 
Treatement:

❑ High dose aspirin

❑ Hospitalization with supportive care.

IVIG

 
Treatment:[9]

IVIG, 2g/kg as a single IV infusion on diagnosis, within the first 10 days of the illness.

❑ Aspirin is given

3-5mg/kg as a daily dose until normal echo on follow up(6 months).

 
 
Treatment:

❑ Removal of the infective material.

❑ Administration of IV antibiotics.

❑ Fluid resuscitation.

IVIG.

❑ Admit to ICU.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • If patient started any new medication,immediately should stop taking it.
  • If allergic to any known product/medication/food, stop taking it.

Don'ts

  • Don’t use rubbing alcohol on skin
  • Don't clean open wounds with hydrogen peroxide or bleach
  • Don’t use a triple-antibiotic ointment

References

  1. 1.0 1.1 1.2 1.3 Kang JH (September 2015). "Febrile Illness with Skin Rashes". Infect Chemother. 47 (3): 155–66. doi:10.3947/ic.2015.47.3.155. PMC 4607768. PMID 26483989.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Murphy-Lavoie, Heather; LeGros, Tracy (2018). "The Algorithmic Approach to the Unidentified Rash": 1–5. doi:10.1007/978-3-319-75623-3_1.
  3. Gomes, Rafael Tomaz; Tiberto, Larissa Rezende; Bello, Viviane Nardin Monte; Lima, Margarete Aparecida Jacometo; Nai, Gisele Alborghetti; Abreu, Marilda Aparecida Milanez Morgado de (2016). "Dermatologic manifestations of infective endocarditis". Anais Brasileiros de Dermatologia. 91 (5 suppl 1): 92–94. doi:10.1590/abd1806-4841.20164718. ISSN 0365-0596.
  4. "Thrombotic Thrombocytopenic Purpura | NHLBI, NIH".
  5. "Chickenpox | For Healthcare Professionals | Varicella | CDC".
  6. 6.0 6.1 Levi M, Toh CH, Thachil J, Watson HG (April 2009). "Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology". Br. J. Haematol. 145 (1): 24–33. doi:10.1111/j.1365-2141.2009.07600.x. PMID 19222477.
  7. 7.0 7.1 Lohani S, Nazir S, Tachamo N, Patel N (2016). "Disseminated gonococcal infection: an unusual presentation". J Community Hosp Intern Med Perspect. 6 (3): 31841. doi:10.3402/jchimp.v6.31841. PMC 4942509. PMID 27406461.
  8. 8.0 8.1 Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A (2014). "Current concepts in the management of necrotizing fasciitis". Front Surg. 1: 36. doi:10.3389/fsurg.2014.00036. PMC 4286984. PMID 25593960.
  9. 9.0 9.1 "Clinical Practice Guidelines : Kawasaki disease".