Mp Rash Recovered]

8/3/2019 Mp Rash Recovered]

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FEVER

Fever is definedas elevation ofbody temp in

response to apathological

stimulus.

method Celsius

armpit >37.3

oral >37.5

rectal >38 C

ear >38


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Maculopapular rash

Papule is a small, solid mostly elevatedlesion usually of diameter


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Etiological classification

1.Infectious 2.Non infectious1.Infectious

viral: roseola infantum, rubeola, rubella,varicella, erythema infectiosum, EBV,dengue,molluscum contagiosum,echo vs,

coxsackie,adenovs.-COMMONEST &most are limited to Pediatric ageBacteria: scarlet fever, syphilis,disseminated gon.


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Fungal:tinea versicolor

Others: rocky mountain spottedfever,kawasaki disease.

2.Non infectious:

Insect Bitesinfestations: scabies

Drugs

AllergiesContact dermatitis


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Potentially life threatening illness

with MP rash-1.Rubeola2.Kawasaki dis

3.Rocky mountain spotted fever4.Dengue fever5.Erythema multiforme

ACUTE ILLNESS,ASSOCIATEDWITH FEVER and SIGNIFICANTSYSTEMIC SYMTOMS


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Diagnostic approach

1. Proper h/o

2.Past h/o of immunization against

measles,rubella etc and past h/o ofthese illness.

3.Type and Morphological feature ofrash.

4.location(primary site)

5.Systemic manifestations.


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history

Take history of: Onset of the rash: sudden or gradual.

Type of lesion: see Table 35.1.

Distribution: whether central, peripheralor generalized.

Progression: direction of spread, speedof progression.

General well-being of the child,including prodromal


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illness or fever.

Infectious contacts. Drug history: including over-the-counter

preparations, topical treatments and drugs that have

been ceased. Symptoms of the rash: itch, pain,

burning.

Travel history.Contact with pets and other animals.


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Physical examination

Be sure to examine:The entire skin surface:To determine

the true extent of the rash. Type of lesions. Distribution. Evolving lesions.

The mucous membranes for involvementor ulceration.

The conjunctivae for injection orepiscleritis.


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MP RASH FEVER

|ILL LOOKING

YES NO

RECOG CLINICAL APP REC CLN APPEARANCE

YES:ERY MULTIFORME YES:COXSACKIE,FIFTHDISRUBEOLA SCARLETFEVER,VARICELLA

NO:DENGUE NO:DIS GON,EBV,2*SYPKAWASAKI DIS ROSEOLA INFANTUM.RMSF


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MEASLES

Most common viral exanthemas(RNAVS). IP is 10-14 days, droplet infection

prodromal stage: cough coryza,conjuctivitis,fever.-2-3 days 12-24hrs before the appearance ofrash koplik spots will appear on

opposite to the molar as pinpointwhite lesions on a red base)


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Rash: appears 4-5days after the

prodrome. Rashstarts on head(1stbehind ear). Spreadsdownwards totoes.rash disappearsafter 4-5 days in thesame order.

Severely malnourishedchildren may developexfoliation.


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MEASELS RASH


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Fever and rash remains for atleast 10days.

May have anorexia and malaise andlymphadenopathy.

Rash may be atypical in some-immunizedchild,even hemorrhagic.

Complications:otitis media,laryngitispneumonia, encephalitis,SSPE, diarrhea,appendicitis, malnutrition, DIC,acuteglomerulonephritis.

Diagnosis:clinical examinationmeasles specific IgGELISAheamagglunitation inhibition


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Believed to result frm an immunemediated acute hypersensivityreaction on exposure to antigen:

drugs(trimethoprim etc).food(nuts,shell fish)

infections.

Herpetic and M.pneumoniaeinfectionranks among the most common cause.


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ETIOLOGY

Idiopathic (morethan 50 percentof cases)

Radiation therapy

MedicationsPenicillinSulfonamidesPhenytoin

(Dilantin)BarbituratesPhenylbutazone

Infectious causes

Herpes simplexvirusEpstein-Barr virusAdenovirusCoxsackievirus B5

Vaccinia virusMycoplasma

speciesChlamydia speciesSalmonella typhi

Yersinia speciesMycobacterium

tuberculosisHistoplasma

capsulatum


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RASHErythema multiforme begins as a

macular eruption. The dull-redlesions advance from macules thatclear from center with prominence

of characteristic target-shapedlesions. Vesicles and bullae maydevelop in the center of thepapules. In many patients, the

mucous membranes of the mouthand lips are involved.


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The illness is classified as minor or major,depending on severity.Erythema multiforme minor-- bullae andsystemic symptoms are absent. The

eruption is typically confined to theextensor surfaces of extremities andonly rarely involves the mucousmembranes. Recurrent episodes of

erythema multiforme minor usuallyprecede an outbreak of herpes simplexby several days.


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Erythema multiforme major--- most oftenresults from a drug reaction. Mucousmembranes are always involved. Theeruption tends to becomebullous andsystemic symptoms, including fever andprostration, are present. Eating may becomplicated by cheilitis and stomatitis, and

micturition may be difficult because ofbalanitis and vulvitis. Conjunctivitis may besevere and can lead to keratitis andulceration. Lesions may also be found inthe pharynx, larynx and trachea. Rarely,

erythema multiforme major can be life-threatening and can progress to necrotizingtracheobronchitis, meningitis, blindness,sepsis and renal tubular necrosis.1,4,6


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Kawasaki disease

Acute febrile mucocutaneous lymphnode syndrome.

Cause is unknown,assumed of infectiousorigin.

Vasculitis syndrome-necrotisingvasculitis of medium size musculararteries specially the coronary

arteries-Anuresm,dilatation, stenosis >80%-less than 5 years

The important aquired cause.


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DIAGNOSTIC CRITERIA

A. Fever lasting for atleast 5 days.B. Presence of 4 of the 5

1.b/l non purulent conj. injection

2.changes of mucosae oforopharnyx (injected pharynx,injected lips-red,cracked,strawberry tongue)

3.changes of peripheral extremities(edema, erythema, desquamation)4.skin rash (truncal, polymorphous

but non vesicular)


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CONT.5.cervical lymphadenopathy (atleast

1 node >1.5 cm)C. Illness not explained by any otherknown disease.

Rash is generalized, pruritic withraised erythematous plaques.may beeryth MP rash,morbiliform.may be

fleeting and persists for 2-3 days. 20% has coronary arteryanerusym,heart failure,valvular dis.


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CONT.

Persistent high ESR Marked inc platelet:>750,000mmcub

Treatment: IV Ig(2g/kg)

aspirinpulse steroids therapy


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Caused by Rickettsia rickettsii. Transmitted by bite of tick. Rash begins on day 3-4 of high fever. Rashes are MP type on extremities.most

commonly over wrist and ankles. Over next 2 days:becomes generalised and

involve back and abdomen.later becomesconfluent and purpuric.

Notably the rash remains more peripherallydistributed with involvement of the palmand soles.


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Pts have some degree of vasculitis. Fever, headache , myalgia, periorbitaledema, DIC, seizures, shock,

myocarditis and heart failure. Diagnosis:CFT

later PCR

Treatment: doxycycline


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Dengue fever

Acute febrile viral illness presenting withheadache,bone or jt or muscular painrash and leukopenia caused by arthropodvirus.

A biphasic febrile illness. Dengue hemm fever is characterized

by:high grade fever,hgic

phenomenon,hepatomegaly and signs ofcirculatory failure.

May develop dengue shock syndrome.


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Appearance of distinct rashcoincides with biphasic fever.

It is aGeneralized,transient,MP rash

which blanches under pressure. 24-48 hrs after

defervescence a Generalized

MP rash appears which sparesthe palm and soles.


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Diagnosis:raised hematocritthrombocytopenia

positive tourniquet test

Treatment: supportive andsymptomatic


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Caused by Human parvovirus B19.-5thdisease-

Transmitted by respiratory secretionsbefore the rash appears.

IP is 4-14 days. Prodromal illness is minimal. Characteristic lesion occurs in 3

stages. 1st phase:cheeks appearserythematous(slapped cheek)


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2nd

phase:itchy erythematous or MP rashappears on trunk and extensors ofextremities.palms and soles are spared.

3dr phase:rash fades frm thecentre:reticular or lacy pattern.

Rash resolves spontaneously but tend towax and wane can recur with exposure tosunlight,heat, exercise and stress.

Complication:arthritis Treatment: IV Ig therapy inimmunocompromized children.


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Cox sackie vs

Caused by gp A and B-MP rash. Classical with A16 Hand foot and mouth disease. Prodrome:low grade fever,anorexia,mouth

pain,malaise.

Followed with 1-2 days by an oral exanthemaand then a MP rash. Oral lesions begin as small red macules,most

often on palate,uvula,ant tonsil pillar-vesicles-ulcerates.

MP rash may be pruritic and tender.usually ondorsal and lateral aspect of fingers,hands andfeet and may be on buttocks.may ulcerate andform scab.


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Complication:aseptic meningitismyopericarditis.

encephalitis

Treatment:IV Ig ifimmunocompromized or lifethreatening infection.


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Scarlet fever

By gp A streptococcal infection. Associated with pharyngitis. Fever increases abruptly,may peak at

39.6-40 degree celsius.

Rash: genearlized,MP. Skin has sand papery feel on palpation. Sparing of circumoral area-appearance

of palor. Bright erythema of tongue, hypertrophy

of tongue-strawberry tongue.


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Pastias lines:areas ofhyperpigmentationthat do not blanch

with pressureappear in deepcreases.

Miliarysudamina(vesicularlesion) may appearon over abdomen,

hands and feet.


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Causes infectious mononucleosis. More common in older children. Transmission by intimate contact. also by

blood transfusion.

IP is 4-5 wks. To begin with fever,malaise,sore

throat,anoraxia. Later lymphadenopathy and MP rash

appears. MP rash most prominent on trunk and

proximal extremities.


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Ulceration in oralcavity.

Petechiae at theJx of hard and

soft palate. Splenomegaly and

periorbital edema.

Frank jaundice infew.


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Diagnosis: lymphocytosis(large andatypical)

positive paul bunnel test.

demonstration of ant capsid Ag. Treatment: symptomatic

Cst

acyclovir


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Roseola infantum

By herpes simplex VS 6(sixth disease) High fever with pharyngitis.

MP rash after 3-4 days of fever.

Rash: widely disseminated, discrete,small, pinkishmacule on trunk and thenextends to extremities.

Occurrence of rash after 24 hrs of

defervescence rather that the morpappearance of rash is diagnostic.


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By Treponema pallidium. 6-8 wks after primary

lesion.

Generalized cutaneouseruption: brownish maculeor papule. range in sizefm few mm to 1

cm.discrete,symmetrical,particularly over trunkwhere they follow a lineof cleavage..


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Systemic manifestations:malaise,fever,headache.sorethroat,rhinnorhoea,lacrimation andgen lymphadenopathy.


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DisseminatedN.g

By N.gonorrhea. Seen in a child with s/s

of gonninfection:sexually active

or abused. With penile or vaginal

discharge. Skin lesions: wide range.

Small erythematouspapule, petechiae,pustule on a hgic base.usually on trunk.


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Diagnosis: gram stainingculture frm oral or genital sites


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varicella

Early phase. Rash starts as small red macule.

Progress to papule and then

umblicated vesicle on chest.


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Mycoplasma inf

M.pneumoniae. In 15% rash. Classical clinical presentation is achild with malaise, low grade feverand cough..

Persists for 3-4 wks. On X ray diffuse infiltration. Diagnosis: serum cold hemagglutinin.

CFT Rx:erythromycin


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Drug induced

Abrupt onset. Generalized

May be accompanied by systemic

signs: fever,arthralgia,hepatosplenomegaly

DISEASE

IP PRODROME

FEVER

RASH OTHER AGE SEASON

C.P AGENT

COMPLICATI


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ASE ROME ER ON NT LICATIONSmeasles

7-18days

Marked: 2-

4days

high

5-7 days Cough,

coryza,conjunctivitis,Koplik

spots

7 mos. 45years

(rarely

older)

Winter

spring

2 daysbeforesympt

omsthrough firstfewdays

Measles

virus

Pneumonia,death,

otitismedia,

Encephalitis

Roseola

Infantum

6th dis

14-21

days

Marked

3-4days

high

1-2d.widelydistributed smallpinkish

Maculeontrunk,periphery

irritability

6mon-2yrs

any unknown

Human

Herpes

virus

6

no

Scarl

et

1-3

day

Marke

d

Lo

w

2-

7d.gen

pharyn

gitis

>2yrs Winte

r

Onse

t of

Stret

gp A

Outbre

aks,

DISEASE

IP PRODROME

FEVER


C.P AGENT

COMPLICATI


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ONSCoxsacki

e

1-2d

anorexia,

Maliase

Fever

Mouthpain.oral

Exanthema.

Lowgrad

2-7d.MPrash-vesicles-tenderonfingers,hand nfeet.

- any unknownCoxsackie gpA n B

Asepticmeningitis

Encephalitis

Myo-pericarditis

Erythema

infecti

osum5th dis

4-14

day

s

none minimal

2-4d.MPrash islace like

onarms.wax nwane.slappedface

appearance

none Prepuberty

any unknown

Parvo VsB19

no

DISEASE

IP PRODROME

FEVER


C.P AGENT

COMPLICATI


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ONSSec

syphi

lis

6-8wks

- Low

tohigh

Generalizedcutaneou

seruption:brownishmacule orpapule.range insize fm

few mm to1cm.discrete,symmetrical,particularlyover trunkwhere

theyfollow aline ofcleavage

malaise,fever,h

eadache.sorethroat,rhinnorhoea,lacrimation and

genlymphadenopa

thy.

- any unknownT.pal Aseptic

meningitis

Encephalitis

Myo-pericarditis

Druginduc

ed

acute

none Genrash

Fever

Arthral

gia

any any none Lifethreate

ning


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Mp Rash Recovered]