A simplified guide to the most common diseases with fever & rash especially in pediatrics. The data have been trimmed as much as possible and focused on spot visual diagnosis of the disease.

1. By Ahmed Mo’ness
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2. Character of “RASH”
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4. Important Questions
with every “RASH”
Blanching ?
• Yes = infection/dermatological disease
• No = purpera/petechie = blood/vessel disease
Feverish ?
• Yes = mostly systemic infection
• No = mostly local dermatological disease
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5. !! CAUTION !!
Fever + Puperic rash (non blanching) =
Meningococcemia
till proved otherwise
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6. MEASLES
(Rubeola disease)
• Fever (high ~ 40)
• conjunctivitis + cough
• koplik spots (2days before rash) (opposite 2nd
molars)
• rash = Cephalo-caudal (macules + papules)
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10. • Investigations
– measles IgG , IgM
• ttt
– supportive + fluids + Vit.A (important)
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11. RUBELLA
(German Measles)
• prodroma (not common)
• Rash = as measles but not ill looking
• LNs (post auricular, post cervical , sub occipital)
• Forschemier spots (soft palate) (20%)
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12. • inv
– rubella IgG , IgM
• ttt
– supportive
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13. MUMPS
• prodroma
• No rash
• Parotitis / other salivery gland
• complications
= Meningitis/encephalitis, Orchitis/oophritis, Myocarditis,
Pancreatitis, Sensory neural hearing loss
• may present for the first time with one of the complications
(e.g Meningitis) without any preceeding gland swelling
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14. • Invistigations
– mumps IgG , IgM
– serum Amylase (parotitis or pancreatitis )
– CSF culture , CSF PCR
• ttt
– supportive + fluids + isolation
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15. MMR Vaccine
12 month , 18 month , 6 y
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16. Roseola Infantum
(6th Disease)
HIGH Fever 4 days suddenly disappears
then rash begins
(Rainbow after the storm)
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17. • distribution = (trunk then extremities) = T-shirt distribution
• typically occurs in 6- to 12- months child with high
• ttt = supportive
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18. Erythema Infectiosum
(5th Disease)
• Usually NO to Low grade fever
• Rash appears in 2 phases
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19. • Phase I
– Slapped Cheeks
• Phase II
– Lace/Reticular
like rash
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20. • Complications :
– if transmitted to a pregnant in 1st trimester
= fetal anaemia + hydrops fetalis + fetal death
– if affected a patient with haemolytic blood disease =
Aplastic crisis
** Patient is Infectious only before rash !
• Invistigations
– Human Parvovirus B19 IgG, IgM
• ttt
– supportive
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21. Some History
Pre-Vaccination Era
• 1st = Measles
• 2nd = Scarlet
• 3rd = Rubella
• 4th = SSSS (Dukes' disease)
• 5th = Erythema Infectiosum
• 6th = Roseola Infantum
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22. Scarlet Fever
• Fever
• pharyngitis / tonsilitis
• Strawberry tongue + circumoral pallor
• Sandpaper-like skin rash
• Pastia lines
• Desquamation of the palms
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24. • Investigations
– ASO , CBC (leukocytosis) , throat swap
• ttt
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25. Kawasaki Disease
• Fever (high, resistant) at least 5 days with 4 of 5 findings :
– Conjunctivitis
– lips and mouth (fissured lips, strawberry tongue , red
mouth mucosa)
– Cervical LNs (usually unilateral)
– Rash (any form , mostly non-vesicular)
– Hand and foot swelling (later desquamation of fingers and
toes tips)
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28. Herpes Simplex
• Type 1 = skin & mucus membranes
Type 2 = genitalia (Sexually active adults or child
abuse)
• Cold sores (vesicular lesions in nasolabial fold)
Gingivostomatitis (painful mouth ulcers + fever)
Conjunctivitis + corneal ulcers
Meningo-encephalitis (mainly neonates)
Eczema Herpeticum (widespread vesicular skin lesion)
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30. Eczema Herpeticum
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31. • Investigations
– PCR , Culture
• ttt
– mainly supportive + topical lotions
– Acyclovir
• systemic (if sever disease/neonate)
• local (oral/skin/eye preparations)
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32. Chicken Box
• Varicella-Zoster Virus Primary infection
• no prodroma (usually)
• Rash
- itchy
- vesicle + red base
(macule then papule then vesicle / may crust )
- scalp , face , trunk , proximal limbs , palms , soles ,
mucus membranes
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34. • complications
– 2ry bacterial infection = imptigo / cellulitis
– spread of infection -> chest , heart , CNS
– thrombocytopenia
• ttt
– mainly supportive + topical lotions
– Acyclovir
• systemic (if sever disease/neonate)
• local (oral/skin/eye preparations)
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35. Herpes Zoster
• Varicella-Zoster Virus Reactivation
• no prodroma (usually)
• Rash =
- painful
- vesicle on red base
- unilateral side of body = dermatome supplied by
sensory nerve
** regional LNs may be present
** acute stage of the disease = pain only over the affected dermatome
followed later by the rash
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37. • ttt
– mainly supportive + topical lotions
– Acyclovir
• systemic (if sever disease/neonate)
• local (oral/skin/eye preparations)
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38. Impetigo
• Most common bacterial skin infection
• Strept / Staph A. / MRSA
• Bullous
– Thin walled , clear, yellowish Bullae later rupture without crusts.
– May affect face / trunks / extremeties
• Non-Bullous
– More contagious
– Crusts
– Affect Perioral / Perinasal / Extremeties
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Bullous Impetigo

40. 40
Non- Bullous Impetigo

41. • ttt
– Topical +/- Systemic ABs
– Benzathine Penicillin (IM) or Co-trimoxazole (oral 3 days)
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42. Acute Rheumatic Fever
• Jones Criteria
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44. Erythema Multiforme
• Self limited
• Due to infections, Drugs
• Minor form = affect skin only
• Major form = affect skin + MM
• Target lesion = pathognomonic
• Arcuate lesions = atypical form
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45. Target lesion Arcuate lesion
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46. EM vs. SJS vs. TEN
• Erythema multiforme =
– Begin in extremities
– Affect one or more mucus membranes (major form)
– epidermal detachment involves less than 10% TBSA
– Self-limited
• Stevens-Johnson Syndrome
– Begin in face & trunk
– Affect one or more mucus membranes
– epidermal detachment involves more than 10% TBSA
– 5% mortality
• Toxic Epidermal Necrolysis
– As SJS
– Involves more than 30% TBSA
– 40% mortality
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48. Other diseases with fever & rash
• SLE ( Malar rash )
• Hand, Foot & Mouth disease (HFMD)
• Typhoid Fever ( 30% Rose Spots on abdomen)
• IMN (10% any form of rash – mainly Morbilliform)
• Lyme Disease (Erythema Migrans)
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49. NUMBERS
 Incubation Period
 Fever timing to rash
 Infectivity period
+ Mode of infection
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50. • Measles
* IP 1-2 weeks
* Fever (high) 4 days then Rash
* Infectious from fever to 4 days after rash
* droplet
• Rubella
* IP 2-3 weeks
* Fever (low) 5-10 days then Rash
* Infectious from fever to 4 days after rash
* droplet
• MUMPS
* IP 2-3 weeks
* Infectious 9 days before to 9 days after Parotitis
* droplet
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51. • Chicken Pox (or varicella)
* IP 2-3 weeks
* Fever (low/absent) with Rash
* Infectious 2 days before rash till crusting
* droplet or vesicle discharge contact or indirect with objects
soiled with vesicle discharge
• Roseola Infantum / Sixth diseas / HHV 6
* IP 1-2 weeks
* Infectious only before symptoms (rash/fever)
* droplet
• Erythema Infectiosum HPV B19 (5th disease)
* IP 1-3 weeks
* Infectious only before rash !
* droplet or vertical transmission (mother to fetus)
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52. • HSV
* IP 2-12 days
* Fever with rash
* Infectious up to 7 weeks after rash !
* droplet
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53. THANKS
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