Rash with fever resident survival guide: Difference between revisions

Jump to navigation Jump to search
Line 205: Line 205:
{{Family tree | | | |C03| | | | | | | | | | | | | | | |C04| | | | | | | | | | | | | | |C03= Palpable|C04=Non-palpable}}
{{Family tree | | | |C03| | | | | | | | | | | | | | | |C04| | | | | | | | | | | | | | |C03= Palpable|C04=Non-palpable}}
{{Family tree | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree | |,|-|-|-|+|-|-|-|-|v|-|-|-|v|-|-|-|.| | | | |!| | | | | | | | | |}}
{{Family tree | |,|-|-|-|+|-|-|-|v|-|-|-|-|v|-|-|-|.| | | | |!| | | | | | | | | |}}
{{Family tree | |!| | | |!| | | | |!| | | |!| | | |!| | | | |!| | | | | | | | | | | |}}
{{Family tree | |!| | | |!| | | |!| | | | |!| | | |!| | | | |!| | | | | | | | | | | |}}
{{Family tree | |p09| |c09| |k09| |j09| |u09| | | | | | | | |!| | | | | | |p09=Endocarditis|c09=Henoch-Schonlein purpura|k09=Disseminated
{{Family tree | |p09| |c09| |k09| |j09| |u09| | | |!| | | | | | |p09=Endocarditis|c09=Henoch-Schonlein purpura|k09=Disseminated
gonococcal infection|j09=Rocky Mountain spotted fever|u09=Meningococcemia}}
gonococcal infection|j09=Rocky Mountain spotted fever|u09=Meningococcemia}}
{{Family tree | |!| | | | |!| | | | |!| | | |!| | |!| | | | |!| | || | | | | | | | | | | | | |}}
{{Family tree | |!| | | | |!| | | |!| | | | |!| | |!| | | | |!| | || | | | | | | | | | | | | |}}
{{Family tree | |p09| | |c09| |s09| |u09| |q09| | | | | | | |!| | |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
{{Family tree | |p09| | |c09| |s09| |u09| |q09| | |!| | |q09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
----
----
❑  Infection with [[Neisseria meningitidis]] <br>❑ History of living in collge dormitory/millitary/prison ❑[[Erythematous]] and [[maculopapular]] that initially begins on wrists and ankles, then spreads and becomes [[petechial]]<br/> ❑Ill appearing patient<br/> ❑ [[Fever]]  <br>  |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
❑  Infection with [[Neisseria meningitidis]] <br>❑ History of living in collge dormitory/millitary/prison ❑[[Erythematous]] and [[maculopapular]] that initially begins on wrists and ankles, then spreads and becomes [[petechial]]<br/> ❑Ill appearing patient<br/> ❑ [[Fever]]  <br>  |u09=<div style="float: left; text-align: left; height: 24em; width: 12em; padding:1em;"> '''Characteristics:'''<br>
Line 222: Line 222:
----
----
❑ History of IV drug use,Infective Endocarditis, rheumatic fever, <br>❑ Mostly caused by Staphylococcus and Streptococcus<br> ❑Look for Janeway lesions which are painless purple or brown erythematous macular lesions, usually affects the palms, soles, and fingers <br>  </div>}}}}
❑ History of IV drug use,Infective Endocarditis, rheumatic fever, <br>❑ Mostly caused by Staphylococcus and Streptococcus<br> ❑Look for Janeway lesions which are painless purple or brown erythematous macular lesions, usually affects the palms, soles, and fingers <br>  </div>}}}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree/end}}
{{Family tree/end}}

Revision as of 22:59, 19 August 2020


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:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

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][2]

Diagnosis

Shown below are 04 algorithms summarizing the diagnosis of Rash with fever in a patient:[3][1]

 
 
 
 
 
 
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
Arthralgias
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 fever (RMSF) and other tick-borne illnesses.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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:



 
 
 
 
 
 
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 as a result of 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

}}
 
 
 
 
 
 
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:[4]



❑ 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
❑Diarrhea/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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

  • The content in this section is in bullet points.

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. "Evaluating the Febrile Patient with a Rash - American Family Physician".
  3. Murphy-Lavoie, Heather; LeGros, Tracy (2018). "The Algorithmic Approach to the Unidentified Rash": 1–5. doi:10.1007/978-3-319-75623-3_1.
  4. 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.