Fever and rash in children: Difference between revisions

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{{SI}}                                                                  
{{Fever and rash in children}}
{{SI}}                                                              
{{CMG}} {{AE}} {{Ifeoma Anaya}}
{{CMG}} {{AE}} {{Ifeoma Anaya}}


{{SK}} Fever and rash in kids
{{SK}} [[Fever]] and [[rash]] in kids


==Overview==
==Overview==
Fever and skin rash are very common symptoms seen in pediatric populations both in clinic and hospital settings. Disease states associated with these symptoms are varied and can range from benign to extremely severe illness requiring prompt intervention in the emergency room or even ICU. Therefore, a vast knowledge of these disease states is very important as oftentimes, diagnosis is mainly clinical.
[[Fever]] and [[rash]] are [[symptoms]] encountered frequently in [[pediatrics]]. [[Disease states]] associated with these [[symptoms]] are varied. [[Febrile]] [[rashes]] can be classified based on [[morphology]], [[distribution of spread]], [[pattern]] of occurrence and cause. [[Fever]] results when [[exogenous]] ([[micro-organisms]]) and [[endogenous]] [[Pyrogen|pyrogens]] interact with the Organum Vasculosum of the Lamina Terminalis (OVLT) causing a rise in [[body temperature]] as a result of an increase in the [[hypothalamic]] [[set point]]. [[Fever]] and [[rash]] in kids are caused by [[infectious]] ([[bacterial]], [[viral]], [[fungal]], and [[protozoan]]) and non-[[infectious]] ([[drug]]-related [[Eruption|eruptions]] and [[Immune-mediated disease|immune-mediated]]) causes. [[Patients]] of all [[age]] groups may develop [[diseases]] that present with [[fever]] and [[rash]]. Common [[risk factors]] for the [[development]] of [[diseases]] that present with [[fever]] and [[rash]] include contact with [[Illness|ill]] individuals, poor/depressed [[immunity]], lack of [[vaccination]], very [[Young adult|young]] [[age]], and poor [[hand washing]] habits. The [[symptoms]] of [[diseases]] associated with [[fever]] and [[rash]] usually develop in the first few days from contact. The stages/phases of most [[infectious]] [[Process (anatomy)|processes]] include the [[incubation period]], [[prodromal]] [[Phase (matter)|phase]], [[illness]], decline, and [[convalescence]]. Rapid [[clinical]] [[diagnosis]] is necessary in severe cases to begin immediate [[empiric therapy]] while awaiting the test results. [[Triaging]] kids who present with [[fever]] and [[rash]] into three groups on basis of early [[symptoms and signs]] is essential for making prompt [[diagnosis]] and administering possible treatment regimen. Effective measures for [[primary prevention]] of [[fever]] and [[rash]] in [[children]] may include [[vaccination]], [[coughing]], and [[sneezing]] into [[elbows]] or [[tissue]], [[hand washing]], avoiding contact with [[Illness|ill]] individuals, [[Prevention|preventing]] exposure to [[tick bites]].


==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
==Classification==
==Classification==
Febrile rashes can be classified based on morphology (maculopapular, pustular, vesicular, etc); based on distribution of spread (systemic and localized); based on pattern of occurrence (acute and chronic); based on causation (infectious and non-infectious) <ref name="pmid26483989">{{cite journal| author=Kang JH| title=Febrile Illness with Skin Rashes. | journal=Infect Chemother | year= 2015 | volume= 47 | issue= 3 | pages= 155-66 | pmid=26483989 | doi=10.3947/ic.2015.47.3.155 | pmc=4607768 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26483989  }} </ref>.


{{Family tree/start}}
*[[Febrile]] [[rashes]] can be classified based on:
{{Family tree||||||||||||||A01||||||||||||||A01=Febrile Rash}}
**[[Morphology]] ([[maculopapular]], [[Pustular rash|pustular]], [[vesicular]] etc)
{{Family tree||||||||||||,|-|-|^|-|-|-|-|-|-|-|.|||||}}
**[[Distribution of spread]] ([[systemic]] and [[Localized disease|localized]])
{{Family tree|||||||||||B01||||||||||B02||||||B01=Infectious|B02=Non-infectious}}
**[[Pattern]] of occurrence ([[acute]] and [[chronic]])
{{Family tree||||||||,|-|-|+|-|-|-|-|-|.|||||||||||}}
**Cause ([[infectious]] and [[non-infectious]])<ref name="pmid26483989">{{cite journal| author=Kang JH| title=Febrile Illness with Skin Rashes. | journal=Infect Chemother | year= 2015 | volume= 47 | issue= 3 | pages= 155-66 | pmid=26483989 | doi=10.3947/ic.2015.47.3.155 | pmc=4607768 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26483989  }} </ref>
{{Family tree||||||C01|||C02|||C03|||||||||||||||C01=Viral|C02=Bacterial|C03=Fungal}}
*Types of [[rashes]] found among [[pediatric]] [[patients]] include the following:<ref name="pmid26483989" />
{{Family tree||||||||||||||||||||||||||||}}
**[[Macules]]
{{Family tree||||||||||||||||||||||||||||}}
**[[Papules]]
{{Family tree||||||||||||||||||||||||||||}}
**[[Nodules]]
{{Family tree||||||||||||||||||||||||||||}}
**[[Pustules]]
{{Family tree||||||||||||||||||||||||||||}}
**[[Vesicles]]
{{Family tree||||||||||||||||||||||||||||}}
**[[Bullae]]
{{Family tree/end}}
**[[Petechiae]]
**[[Purpura]]
**[[Ecchymoses]]
*Classification of [[febrile]] [[rashes]] based on [[rash]] [[morphology]] is as follows:<ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-1</ref><ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-2</ref><ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-3</ref><ref>https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-4</ref>
 
{| class="wikitable"
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever + Rash Morphology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
|-
| align="center" style="background:#DCDCDC;" + |Non-[[blanching]] [[lesions]] ([[Petechiae]], [[Purpura]] and [[Ecchymoses]])
|a. [[Meningococcemia]]
b. [[Rocky Mountain Spotted Fever]] ([[Rocky Mountain spotted fever|RMSF]])
 
c. [[Hemolytic Uremic Syndrome]] ([[Hemolytic-uremic syndrome|HUS]])
 
d. [[Henoch-Schonlein Purpura]] ([[HSP]])
|-
| align="center" style="background:#DCDCDC;" + |[[Blanching]] [[rash]]
|a. [[Kawasaki disease]]
b. [[Juvenile Rheumatoid Arthritis]]
 
c. [[Juvenile (organism)|Juvenile]] [[Dermatomyositis]]
|-
| align="center" style="background:#DCDCDC;" + |[[Vesicular]] or [[bullous]] [[lesions]]
|a. [[Erythema multiforme]]
b. [[Stevens-Johnson Syndrome]] ([[Stevens-Johnson syndrome|SJS]]) and [[Toxic Epidermal Necrolysis]] ([[Toxic epidermal necrolysis|TEN]])
 
c. [[Staphylococcal scalded skin syndrome|Staphylococcal Scalded Skin Syndrome]] ([[SSSS]])
 
d. [[Disseminated gonococcal infection|Disseminated]] [[gonococcal]] [[disease]] in [[Adolescent|adolescents]]
 
e. [[Herpes simplex virus|HSV]] I & II
|-
| align="center" style="background:#DCDCDC;" + |[[Umbilicated lesions|Umbilicated]] [[papules]] and [[pustules]]
|a. [[Molluscum contagiosum]]
b. [[Varicella]]/[[Chickenpox]]
|-
| align="center" style="background:#DCDCDC;" + |Sandpaper [[rash]]
|a. [[Scarlet fever]]
|-
| align="center" style="background:#DCDCDC;" + |[[Viral]] [[syndromes]](mostly [[maculopapular]])
|a. [[Measles]] ([[Rubeola]])
b. [[Rubella]] ([[German measles]])
 
c. [[Erythema infectiosum]] ([[Parvovirus B19|Parvovirus]] B19)
 
d. [[Herpangina]] ([[Coxsackie]])
 
e. [[Hand-foot-and-mouth disease]] ([[Coxsackie]])
 
f. [[Roseola infantum]] ([[Human herpesvirus 6|Human Herpes Virus types 6]] or 7)
|-
| align="center" style="background:#DCDCDC;" + |Limited to certain [[Geographical pole|geographical]] [[Area|areas]]
|a. [[Babesiosis]]
b. [[Blastomycosis]]
 
c. [[Coccidiodomycosis]]
 
d. [[Histoplasmosis]]
 
e. [[Lyme disease]]
 
f. [[Relapsing fever]]
 
g. [[Colorado tick fever|Colorado Tick Fever]]
|}


==Pathophysiology==
==Pathophysiology==
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
 
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*When core [[Body temperature|body temperatures]] vary outside normal ranges, [[Thermoregulation|thermoregulatory]] responses are triggered.<ref name="pmid22772856">{{cite journal| author=Schortgen F| title=Fever in sepsis. | journal=Minerva Anestesiol | year= 2012 | volume= 78 | issue= 11 | pages= 1254-64 | pmid=22772856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22772856  }} </ref>
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*It is understood that [[infectious]] [[Process (anatomy)|processes]] accounts for up to 74% of [[fever]] in [[Hospital|hospitalized]] [[patients]], the remainder being caused by [[malignancy]], [[ischemia]] and [[drug]]-related reactions.<ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*[[Fever]] results when [[exogenous]] ([[micro-organisms]]) and [[endogenous]] [[Pyrogen|pyrogens]] interact with the Organum Vasculosum of the Lamina Terminalis (OVLT) causing a rise in [[body temperature]] as a result of an increase in the [[hypothalamic]] [[set point]].
*This rise in the [[hypothalamic]] [[set point]] is due to an increased production of [[Prostaglandin E2]] ([[PGE2]]) by [[endothelial cells]] of the [[vascular]] OVLT located in the [[preoptic area]] of the [[anterior hypothalamus]]. It lacks the [[Blood brain barrier|Blood-Brain-Barrier (BBB)]] thus easily accessible to [[Pyrogen|pyrogens]]. This resultant increased production of [[PGE2]] results in raised [[body temperature]].<ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref>
*[[Lipopolysaccharide]] (LPS) on [[gram negative bacteria]] is a common [[exogenous]] [[pyrogen]] which stimulates the production of [[endogenous]] [[cytokines]] such as [[IL-1|IL]]-1, [[IL-6]] an<nowiki/>d [[Tumor necrosis factor-alpha|TNF]]-α via the [[Toll-like receptor]] (TL<nowiki/>Rs) [[cascade]].<ref name="pmid27411542">{{cite journal| author=Walter EJ, Hanna-Jumma S, Carraretto M, Forni L| title=The pathophysiological basis and consequences of fever. | journal=Crit Care | year= 2016 | volume= 20 | issue= 1 | pages= 200 | pmid=27411542 | doi=10.1186/s13054-016-1375-5 | pmc=4944485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27411542  }} </ref><ref name="pmid22772856">{{cite journal| author=Schortgen F| title=Fever in sepsis. | journal=Minerva Anestesiol | year= 2012 | volume= 78 | issue= 11 | pages= 1254-64 | pmid=22772856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22772856  }} </ref>
*[[PGE2]] production can also be stimulated via the [[vagus nerve]] by [[inflammatory processes]] and directly by [[microbial]] [[Product (biology)|products]] through [[TLR10|TLRs]].<ref name="pmid22772856">{{cite journal| author=Schortgen F| title=Fever in sepsis. | journal=Minerva Anestesiol | year= 2012 | volume= 78 | issue= 11 | pages= 1254-64 | pmid=22772856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22772856  }} </ref>
*[[Skin]] [[lesions]] ([[rash]]) could be primarily [[vascular]] or from [[infection]] spread to [[tissues]] (e.g. [[skin]]).<ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>
*The first step in the formation of a [[skin]] [[lesion]]/[[rash]] is the presence of the [[micro-organism]] in the [[vascular]] [[endothelium]].<ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>
*A [[macule]] forms from sustained [[local]] [[dilation]] of subpapilary [[dermal]] [[blood vessels]].
*[[Edema]] with [[Infiltration (medical)|infiltration]] of [[Cells (biology)|cells]] turns a [[macule]] to [[papule]].
*Primary [[epidermal]] involvement results in [[vesicles]], [[ulcers]], [[Scab|scabs]], and secondary [[Epidermis (skin)|epidermal]] changes can lead to [[desquamation]] and [[pigment]] changes.<ref name="pmid5342519">{{cite journal| author=Mims CA| title=Pathogenesis of rashes in virus diseases. | journal=Bacteriol Rev | year= 1966 | volume= 30 | issue= 4 | pages= 739-60 | pmid=5342519 | doi= | pmc=441013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5342519  }} </ref>
 
==Causes==
==Causes==
* Infectious
**Viral
***Roseola infantum (Exanthem subitum)
***Rubella
***Rubeola (Measles)
***Erythema infectiosum (Parvovirus B19)
***Varicella (Chickenpox)
***Herpangina
***Hand-foot-and-mouth disease
**Bacterial
***Meningococcemia
***Rocky Mountain Spotted Fever
***Hemolytic Uremic Syndrome
***Scarlet Fever
***Staphylococcal Scalded Skin Syndrome (SSSS)
***Henoch-schὅnlein purpura
Disease name] may be caused by [cause1], [cause2], or [cause3].


OR
*Common causes of [[fever]] and [[rash]] in kids may include:
 
{| class="wikitable"
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Causative Organism
|-
| align="center" style="background:#DCDCDC;" + |[[Viral]]
|[[Measles]]
[[German Measles]]
 
[[Erythema infectiosum]]
 
[[Roseola infantum]]
 
[[Herpangina]]


Common causes of [disease] include [cause1], [cause2], and [cause3].
[[Hand-foot-and-mouth disease]]


OR
[[Molluscum contagiosum]]


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
[[Chickenpox]]
|[[Rubeola]]
[[Rubella]]


OR
[[Parvovirus B19]]


The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
[[Human herpesvirus 6|Human Herpes Virus]] 6 & 7


==Differentiating [disease name] from other Diseases==
[[Coxsackie virus|Coxsackievirus]]


For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].
[[Coxsackie virus]]
 
[[Poxvirus]]
 
[[Varicella Zoster]] virus
|-
| rowspan="8" align="center" style="background:#DCDCDC;" + |[[Bacterial]]
|[[Meningococcemia]]<br />
|[[Neisseria meningitidis]]
[[Hemophilus influenzae]]
 
[[Streptococcus pneumoniae|Streptococcus pneumoniae<br />]]
|-
|[[RMSF]]
|[[Rickettsia rickettsii]]
|-
|[[Hemolytic-uremic syndrome|HUS]]
|[[Enterohemorrhagic escherichica coli|Enterohemorrhagic E.coli]] ([[EHEC]])
|-
|[[Scarlet Fever]]
|[[Streptococcus pyogenes]] (Group A [[Streptococci]], GAS)
|-
|[[Disseminated gonococcal infection|Disseminated gonococcal]] [[disease]] in [[Adolescent|adolescents]]
|[[Neisseria gonorrhoeae|Neisseria gonorrhoea]]
|-
|[[SSSS]]
 
[[Toxic shock syndrome|TSS]]
|[[Staphylococcus aureus]]
|-
|[[Lyme disease]]
|[[Borrelia burgdorferi]]
|-
|[[Relapsing fever]]
|[[Borrelia recurrentis]]
|-
| align="center" style="background:#DCDCDC;" + |[[Protozoan]]
|[[Babesiosis]]
|[[Babesia microti]]
|-
| align="center" style="background:#DCDCDC;" + |[[Fungal]]
|[[Histoplasmosis]]
[[Blastomycosis]]
 
[[Coccidiodomycosis]]
 
[[Paracoccidiodomycosis]]
|[[Histoplasma capsulatum]]
[[Blastomyces dermatitidis]]
 
[[Coccidioides immitis]]
 
[[Paracoccidioides brasiliensis]]
|}
 
 
{| class="wikitable"                                                                                               
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Non-Infectious
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
|-
| align="center" style="background:#DCDCDC;" + |[[Immune-mediated disease|Immune-mediated]]/[[Autoimmune]]
|[[Kawasaki Disease]]
[[Henoch-Schonlein Purpura]]
 
[[Juvenile Rheumatoid Arthritis]]
 
[[Juvenile (organism)|Juvenile]] [[Dermatomyositis]]
|-
| align="center" style="background:#DCDCDC;" + |[[Drug]]-related [[Eruption|eruptions]]
|[[Erythema multiforme]]
[[SJS]]
 
[[Toxic epidermal necrolysis|TEN]]
|}


==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
===Age===
===Age===
*Patients of all age groups may develop [disease name].
*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
===Gender===
*[Disease name] affects men and women equally.
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===
*There is no racial predilection for [disease name].
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].


==Risk Factors==
*[[Patients]] of all [[age]] [[Group (sociology)|groups]] may develop [[diseases]] that present with [[fever]] and [[rash]].
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].


== Natural History, Complications and Prognosis==
===Race===
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


== Diagnosis ==
*There is no [[racial]] predilection to [[diseases]] that present with [[fever]] and [[rash]].
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
=== Symptoms ===
*[Disease name] is usually asymptomatic.
*Symptoms of [disease name] may include the following:
:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]
=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]


=== Laboratory Findings ===
===Gender===
*There are no specific laboratory findings associated with [disease name].


*A  [positive/negative] [test name] is diagnostic of [disease name].
*No known gender predilection.
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Electrocardiogram===
There are no ECG findings associated with [disease name].


OR
*Most [[children]] become susceptible to some of the [[diseases]] from 6 months of [[age]] when [[maternal]] [[antibodies]] begin to wane.<ref name="pmid25462439">{{cite journal| author=Tesini BL, Epstein LG, Caserta MT| title=Clinical impact of primary infection with roseoloviruses. | journal=Curr Opin Virol | year= 2014 | volume= 9 | issue=  | pages= 91-6 | pmid=25462439 | doi=10.1016/j.coviro.2014.09.013 | pmc=4267952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462439  }} </ref>


An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
==Risk Factors==


===X-ray===
*Common [[risk factors]] for the [[development]] of [[diseases]] that present with [[fever]] and [[rash]] include:
There are no x-ray findings associated with [disease name].
**Contact with [[Illness|ill]] individuals
**Poor/depressed [[immunity]]
**Lack of [[vaccination]]
**Very young [[age]] (6 months-12 months)
**Poor [[hand washing]] habits


OR
==Natural History, Complications, and Prognosis==


An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Natural History===


OR
*The [[symptoms]] of [[diseases]] associated with [[fever]] and [[rash]] usually develop in the first few days from contact. The stages/phases of most [[infectious]] [[Process (anatomy)|processes]] include the:
**[[Incubation period]] is defined as the period between [[Exposure (photography)|exposure]] to an [[infection]] and the [[appearance]] of the first [[symptoms]].
**[[Prodromal]] [[Phase (matter)|phase]] is defined as the [[period]] of early [[symptoms]] of a [[disease]].
**[[Illness]] is defined as [[appearance]] of characteristic [[symptoms]] of the [[disease]].
**Decline phase
**[[Convalescence]] phase


There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Complications===


===Echocardiography or Ultrasound===
*Common [[complications]] of [[diseases]] presenting with [[fever]] and [[rash]] include:
There are no echocardiography/ultrasound  findings associated with [disease name].
**[[Febrile seizure]]
**[[Rhabdomyolysis]]
**[[Shock]] ([[septic]] or [[hypovolemic]])
**[[Disseminated Intravascular Coagulation]] (in [[Meningococcemia]])
**[[Reye syndrome]] (especially in [[children]] that have been given [[aspirin]]).


OR
===Prognosis===


Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Prognosis]] is generally excellent for [[viral]] [[syndromes]]. Prompt [[diagnosis]], [[treatment]], and close follow-up of [[patients]] presenting with other [[causes]] of [[fever]] and [[rash]] also result in a good [[prognosis]].


OR
==Diagnosis==


There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*Rapid [[clinical]] [[diagnosis]] is necessary in severe cases to begin immediate [[empiric therapy]] while awaiting test results.


===CT scan===
===Symptoms===
There are no CT scan findings associated with [disease name].


OR
*Besides [[fever]] and [[rash]], additional [[symptoms]] may include:
**[[Cough]]
**[[Sore throat]]
**[[Runny nose]]
**[[Red eyes]] ([[conjunctivitis]])
**[[Irritability]]
*The above additional [[symptoms]] are usually seen in the [[prodromal]] [[Phase (matter)|phase]] of most [[infectious diseases]]. Other [[symptoms]] are:
**Recent [[upper respiratory tract infections]] or [[diarrheal]] [[illness]]
**[[Ear pain]]
**[[Pruritus]] (which could be severe in [[drug]] related [[rashes]])
**[[Poor appetite]]
**[[Headaches]]
**[[Diarrhea]]
**[[Pallor]]
**[[Pains]] in certain [[body]] [[Area|areas]] ([[arthritis]])
*Important details in the history include:
**Onset and progression of [[symptoms]]
**[[Site]] of the [[rash]] ([[central]] or peripheral)
**Relation with the season(s)
**Travel history
**[[Tick bites|Tick bite]](s)
**Contact with an [[Illness|ill]] [[person]] or animal
**[[Medication]] history (most especially [[sulfonamides]], [[NSAIDs]] and [[anticonvulsants]])
**[[Exposure]] to [[Forest plot|forest]] or other [[natural environment]]
**Also important to evaluate the [[immune]] status of the [[patient]]


[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Physical Examination===


OR
*Findings on [[examination]] include:
**[[Illness]] severity
**Type of [[rash]], its [[Location parameter|location]], and [[Distribution constant|distribution]]
**[[Lymphadenopathy]]
**[[Conjunctival]], [[oral]] and [[genital]] changes
**[[Nuchal rigidity]] (especially in older kids)
**[[Nikolsky's sign]]
**[[Area|Areas]] of [[tenderness]] (e.g. at the [[joints]])
**[[Hepatomegaly]]
**[[splenomegaly]]
**[[Hypotension]]
**[[Tachycardia]]


There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Laboratory Findings===


===MRI===
*[[Laboratory]] findings needed to support [[diagnosis]] or determine [[illness]] severity of some [[diseases]] are as follows:
There are no MRI findings associated with [disease name].
**[[Complete blood count]] with differentials which might reveal:
***[[anemia]]
***[[thrombocytopenia]]
***[[elevated white blood cell count]]
**[[Factor analysis|Factor]] assays show low [[coagulation factors]] in severe [[Meningococcemia]] with [[Disseminated Intravascular Coagulation]] ([[Disseminated intravascular coagulation|DIC]])
**[[Serum]] chemistries: [[Electrolyte imbalance|Electrolyte imbalance]] in ([[HUS]], [[Meningococcemia]])
**Labs to isolate offending [[organisms]] in [[Infectious disease|infectious diseases]] for targeted [[antibiotics]] regimen are:
***[[Nasal]]/[[throat]] [[Swabbing|swab]] for [[rapid strep test]] and/or [[Culture collection|culture]]
***[[Blood cultures]]
***[[Stool culture|Stool]] and [[Urine culture|urine]] [[microscopy]]/[[Culture medium|culture]]/[[Sensitivity (tests)|sensitivity]]
***[[Cerebrospinal fluid]] ([[CSF]]) [[analysis]]
***[[Antibody]] and [[Polymerase chain reaction|PCR]] assays- [[Rocky Mountain spotted fever|RMSF]]<ref name="pmid25092818">{{cite journal| author=McQuiston JH, Wiedeman C, Singleton J, Carpenter LR, McElroy K, Mosites E | display-authors=etal| title=Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain Spotted Fever. | journal=Am J Trop Med Hyg | year= 2014 | volume= 91 | issue= 4 | pages= 767-70 | pmid=25092818 | doi=10.4269/ajtmh.14-0123 | pmc=4183402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25092818  }} </ref>
***[[Skin biopsy]] of [[lesions]] in [[HSP]] show [[leukocytoclastic vasculitis]]
***[[Immunofluorescence assay|Immunofluorescence]]
*[[Immunohistochemistry]] for diagnosing [[Systemic]] [[mycoses]] ([[fungal infections]] related to certain [[Geographical isolation|geographical]] [[Area|areas]]).<ref name="pmid8645463">{{cite journal| author=Jensen HE, Schønheyder HC, Hotchi M, Kaufman L| title=Diagnosis of systemic mycoses by specific immunohistochemical tests. | journal=APMIS | year= 1996 | volume= 104 | issue= 4 | pages= 241-58 | pmid=8645463 | doi=10.1111/j.1699-0463.1996.tb00714.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8645463  }} </ref>
*The [[viral]] [[syndromes]], [[varicella]], [[molluscum contagiosum]], [[lyme disease]], [[immune-mediated disease|immune-mediated]] [[vasculitis]] and [[drug]]-related [[Eruption|eruptions]] rely heavily on a good [[History and Physical examination|history]] and [[physical examination]] findings to make a [[diagnosis]].
*Peripheral thick and thin [[blood smear]] shows [[Babesia microti]].<ref name="pmid26629450">{{cite journal| author=Parija SC, Kp D, Venugopal H| title=Diagnosis and management of human babesiosis. | journal=Trop Parasitol | year= 2015 | volume= 5 | issue= 2 | pages= 88-93 | pmid=26629450 | doi=10.4103/2229-5070.162489 | pmc=4557163 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629450  }} </ref>


OR
===X-ray===


[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[X-rays]] might be useful in managing severely [[Illness|ill]] individuals to look for [[complications]] but not routinely needed to make [[diagnosis]].


OR
===Echocardiography or Ultrasound===
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].


OR
*There are no [[echocardiography]] findings associated with [[fever]] and [[rash]] but can be used to [[Monitor role|monitor]] for [[coronary aneurysm]] in a [[patient]] with [[kawasaki disease]].


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
==Treatment==
===Medical therapy===


=== Other Diagnostic Studies ===
*[[Triaging]] kids who present with [[fever]] and [[rash]] into three groups based on early [[symptoms and signs]] is essential for making prompt [[diagnosis]] and administering possible treatment regimen. These groups are:
*[Disease name] may also be diagnosed using [diagnostic study name].
**[[Children]] presenting with severe [[illness]] necessitating immediate [[Intervention (counseling)|intervention]]. This is especially true for the non-[[blanching]] [[lesions]].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
**[[Children]] presenting with [[viral]] [[syndromes]] which are easily recognized and require [[symptomatic]] [[treatment]] and reassurance.
**[[Children]] presenting [[undifferentiated]] [[rashes]] which could be [[benign]] or an unusual presentation of severe [[illness]].
*The '''first group''' is usually managed in the [[hospital]] with:
**[[Intravenous fluids|Intravenous fluid]] [[therapy]] with/without [[Vasopressors|vasopressor]]
**Initiation of [[empirical]] [[antibiotics]] while awaiting [[Culture collection|culture]] results.
**Third generation [[Cephalosporins|cephalosporin]] is first line [[drug]] for [[meningococcemia]].
**[[Doxycycline]] is drug of choice for [[Rocky Mountain spotted fever|RMSF]].
**[[Treatment]] for [[Hemolytic-uremic syndrome|HUS]] is supportive with a [[consultation]] to [[Nephrologist]] to manage [[renal failure]].
*The '''second group''' as earlier mentioned is managed conservatively with measures like:
**[[Antipyretics]]
**[[Fluid]] [[therapy]]
**[[antihistamines]] to soothe the [[patient]]
**Reassurance to care-givers
**Most recover without any [[complications]]
**Majority of [[children]] in this [[Group (sociology)|group]] have [[benign]] [[viral]] [[illness]] that resolves spontaneously.
**Others may have unusual presentations of serious [[illness]] and would require close monitoring with further evaluation and easy access to care. Maybe sometimes needful to admit.
*In general, most [[bacterial diseases]] are treated with the appropriate [[antibiotics]], [[Antifungal drug|antifungal]] therapy for diseases of [[fungal]] origin, [[viral]] [[syndromes]] tend to resolve spontaneously with [[symptomatic]] [[treatment]], [[drug]] related eruption require cessation of offending [[drug]] with adequate [[treatment]] of [[symptoms]], and [[fluid]] [[therapy]].


== Treatment ==
===Prevention===
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
=== Prevention ===
*There are no primary preventive measures available for [disease name].
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].


*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
*Effective measures for [[primary prevention]] of [[fever]] and [[rash]] in [[children]] may include:
**[[Vaccinations|Vaccination]] done in a timely manner can [[Prevention|prevent]] occurrence of many [[childhood]] [[illnesses]] presenting with [[fever]] and [[rash]] such as the [[viral]] [[syndromes]].<ref name="pmid18803578">{{cite journal| author=Fölster-Holst R, Kreth HW| title=Viral exanthems in childhood--infectious (direct) exanthems. Part 1: Classic exanthems. | journal=J Dtsch Dermatol Ges | year= 2009 | volume= 7 | issue= 4 | pages= 309-16 | pmid=18803578 | doi=10.1111/j.1610-0387.2008.06868.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18803578  }} </ref>
**Frequently and thoroughly [[washing]] [[hands]] with [[soap]] and [[water]].
**[[Sneeze]] and [[cough]] into [[elbows]] and/or [[tissues]] (which should be thrown away).
**Avoid contact with [[infected]] individuals and contaminated surfaces.
**Wearing clothes to cover upper and [[lower limbs]] to [[Prevention|prevent]] [[tick bites]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Pick One of 28 Approved]]


{{WS}}
[[Category:Up-To-Date]]
{{WH}}
[[Category:Primary care]]
[[Category:Pediatrics]]

Latest revision as of 21:10, 24 February 2021

Fever and rash in children Microchapters

Overview

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Natural History, Complications, and Prognosis

Diagnosis

Treatment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[2]

Synonyms and keywords: Fever and rash in kids

Overview

Fever and rash are symptoms encountered frequently in pediatrics. Disease states associated with these symptoms are varied. Febrile rashes can be classified based on morphology, distribution of spread, pattern of occurrence and cause. Fever results when exogenous (micro-organisms) and endogenous pyrogens interact with the Organum Vasculosum of the Lamina Terminalis (OVLT) causing a rise in body temperature as a result of an increase in the hypothalamic set point. Fever and rash in kids are caused by infectious (bacterial, viral, fungal, and protozoan) and non-infectious (drug-related eruptions and immune-mediated) causes. Patients of all age groups may develop diseases that present with fever and rash. Common risk factors for the development of diseases that present with fever and rash include contact with ill individuals, poor/depressed immunity, lack of vaccination, very young age, and poor hand washing habits. The symptoms of diseases associated with fever and rash usually develop in the first few days from contact. The stages/phases of most infectious processes include the incubation period, prodromal phase, illness, decline, and convalescence. Rapid clinical diagnosis is necessary in severe cases to begin immediate empiric therapy while awaiting the test results. Triaging kids who present with fever and rash into three groups on basis of early symptoms and signs is essential for making prompt diagnosis and administering possible treatment regimen. Effective measures for primary prevention of fever and rash in children may include vaccination, coughing, and sneezing into elbows or tissue, hand washing, avoiding contact with ill individuals, preventing exposure to tick bites.

Classification

Fever + Rash Morphology Disease
Non-blanching lesions (Petechiae, Purpura and Ecchymoses) a. Meningococcemia

b. Rocky Mountain Spotted Fever (RMSF)

c. Hemolytic Uremic Syndrome (HUS)

d. Henoch-Schonlein Purpura (HSP)

Blanching rash a. Kawasaki disease

b. Juvenile Rheumatoid Arthritis

c. Juvenile Dermatomyositis

Vesicular or bullous lesions a. Erythema multiforme

b. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

c. Staphylococcal Scalded Skin Syndrome (SSSS)

d. Disseminated gonococcal disease in adolescents

e. HSV I & II

Umbilicated papules and pustules a. Molluscum contagiosum

b. Varicella/Chickenpox

Sandpaper rash a. Scarlet fever
Viral syndromes(mostly maculopapular) a. Measles (Rubeola)

b. Rubella (German measles)

c. Erythema infectiosum (Parvovirus B19)

d. Herpangina (Coxsackie)

e. Hand-foot-and-mouth disease (Coxsackie)

f. Roseola infantum (Human Herpes Virus types 6 or 7)

Limited to certain geographical areas a. Babesiosis

b. Blastomycosis

c. Coccidiodomycosis

d. Histoplasmosis

e. Lyme disease

f. Relapsing fever

g. Colorado Tick Fever

Pathophysiology

Causes

  • Common causes of fever and rash in kids may include:
Infectious Disease Causative Organism
Viral Measles

German Measles

Erythema infectiosum

Roseola infantum

Herpangina

Hand-foot-and-mouth disease

Molluscum contagiosum

Chickenpox

Rubeola

Rubella

Parvovirus B19

Human Herpes Virus 6 & 7

Coxsackievirus

Coxsackie virus

Poxvirus

Varicella Zoster virus

Bacterial Meningococcemia
Neisseria meningitidis

Hemophilus influenzae

Streptococcus pneumoniae

RMSF Rickettsia rickettsii
HUS Enterohemorrhagic E.coli (EHEC)
Scarlet Fever Streptococcus pyogenes (Group A Streptococci, GAS)
Disseminated gonococcal disease in adolescents Neisseria gonorrhoea
SSSS

TSS

Staphylococcus aureus
Lyme disease Borrelia burgdorferi
Relapsing fever Borrelia recurrentis
Protozoan Babesiosis Babesia microti
Fungal Histoplasmosis

Blastomycosis

Coccidiodomycosis

Paracoccidiodomycosis

Histoplasma capsulatum

Blastomyces dermatitidis

Coccidioides immitis

Paracoccidioides brasiliensis


Non-Infectious Disease
Immune-mediated/Autoimmune Kawasaki Disease

Henoch-Schonlein Purpura

Juvenile Rheumatoid Arthritis

Juvenile Dermatomyositis

Drug-related eruptions Erythema multiforme

SJS

TEN

Epidemiology and Demographics

Age

Race

Gender

  • No known gender predilection.

Risk Factors

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

X-ray

Echocardiography or Ultrasound

Treatment

Medical therapy

Prevention

References

  1. 1.0 1.1 Kang JH (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. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-1
  3. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-2
  4. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-3
  5. https://www.consultant360.com/articles/rashes-and-fever-children-sorting-out-potentially-dangerous-part-4
  6. 6.0 6.1 6.2 Schortgen F (2012). "Fever in sepsis". Minerva Anestesiol. 78 (11): 1254–64. PMID 22772856.
  7. 7.0 7.1 7.2 Walter EJ, Hanna-Jumma S, Carraretto M, Forni L (2016). "The pathophysiological basis and consequences of fever". Crit Care. 20 (1): 200. doi:10.1186/s13054-016-1375-5. PMC 4944485. PMID 27411542.
  8. 8.0 8.1 8.2 Mims CA (1966). "Pathogenesis of rashes in virus diseases". Bacteriol Rev. 30 (4): 739–60. PMC 441013. PMID 5342519.
  9. Tesini BL, Epstein LG, Caserta MT (2014). "Clinical impact of primary infection with roseoloviruses". Curr Opin Virol. 9: 91–6. doi:10.1016/j.coviro.2014.09.013. PMC 4267952. PMID 25462439.
  10. McQuiston JH, Wiedeman C, Singleton J, Carpenter LR, McElroy K, Mosites E; et al. (2014). "Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain Spotted Fever". Am J Trop Med Hyg. 91 (4): 767–70. doi:10.4269/ajtmh.14-0123. PMC 4183402. PMID 25092818.
  11. Jensen HE, Schønheyder HC, Hotchi M, Kaufman L (1996). "Diagnosis of systemic mycoses by specific immunohistochemical tests". APMIS. 104 (4): 241–58. doi:10.1111/j.1699-0463.1996.tb00714.x. PMID 8645463.
  12. Parija SC, Kp D, Venugopal H (2015). "Diagnosis and management of human babesiosis". Trop Parasitol. 5 (2): 88–93. doi:10.4103/2229-5070.162489. PMC 4557163. PMID 26629450.
  13. Fölster-Holst R, Kreth HW (2009). "Viral exanthems in childhood--infectious (direct) exanthems. Part 1: Classic exanthems". J Dtsch Dermatol Ges. 7 (4): 309–16. doi:10.1111/j.1610-0387.2008.06868.x. PMID 18803578.