Fever and rash resident survival guide (pediatrics): Difference between revisions

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|[[File:Siren.gif|30px|link=Fever and rash resident survival guide (pediatrics)]]||<br>||<br>
|[[Fever and rash resident survival guide (pediatrics)|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{CMG}} {{AE}} {{EAM}}
{{CMG}} {{AE}} {{EAM}}
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======{{SK}}======
======{{SK}}======


======Fever :======
======Fever:======
Frenzy
Frenzy,[[Temperature]], Feverishness, [[Heat]], [[Fermentation|Ferment]], [[Pyrexia]],
 
[[Temperature]]
 
Feverishness
 
[[Heat]]
 
[[Fermentation|Ferment]]
 
[[Pyrexia]]
 
Excitement
 
[[Agitation]]
 
[[Febrile]]


[[Feverish]]  
Excitement, [[Agitation]], [[Febrile]], [[Feverish]], Furor, [[Sweat]], [[Ecstasy]], Febricity, [[Hyperthermia]].
 
Furor
 
[[Sweat]]
 
[[Ecstasy]]
 
Febricity
 
[[Hyperthermia]]


======Rush:======
======Rush:======
Reckless
Reckless, Impetuous, Impulsive, Hasty, Overhasty, Foolhardy, Incautious, [[Precipitate]], Precipitous, [[Premature]], [[Carelessness|Careless]], Heedless, Thoughtless.
 
Impetuous
 
Impulsive
 
Hasty
 
Overhasty
 
Foolhardy
 
Incautious
 
[[Precipitate]]
 
Precipitous
 
[[Premature]]  
 
[[Carelessness|Careless]]
 
Heedless
 
Thoughtless
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==Overview==
==Overview==
Fever with an accompanying rash is a common symptom constellation in patients presenting to clinicians' offices and emergency departments. Skin manifestations may provide the only early clue to an underlying infection, may be the hallmark of contagious disease, and/or may be an early sign of a life-threatening infection or serious noninfectious disorder. The differential diagnosis of fever and rash is extremely broad, but this symptom complex provides an opportunity for the diligent clinician to establish a probable etiology through a careful history and physical examination.
[[Fever]] with [[rash]] is a common symptom redundancy in patients presenting to clinicians' offices and [[Emergency|emergenc]]<nowiki/>y departments. [[Skin Disease|Skin]] manifestations may provide the only early clue to an underlying [[infection]], may be the hallmark of [[contagious]] disease, and/or may be an early sign of a life-threatening infection or serious noninfectious disorder. The differential diagnosis of [[fever]] and [[rash]] is extremely broad, but this symptom complex show an fortuity for the exacting clinician to start a probable [[etiology]] through a careful [[History and Physical examination|history]] and [[physical examination]].


A systematic approach is crucial for establishing a timely diagnosis, determining early therapy when appropriate, and considering isolation of the patient if necessary.<br />
A [[Systematics|systematic]] method is crucial for starting a timely [[diagnosis]], determining early [[therapy]] when appropriate, and considering [[Isolation transformer|isolation]] of the patient if necessary. The [[treatment]] must to be belonging to euch cause specifeclly.
 
and the most important part is the  advice that  patient have to be aware of [[fever]] and rush diseases, to avoid the severity of the [[fever]] and rush side effect.<br />


==Causes==
==Causes==
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The diagnostic approach to the child patient with fever and rash should focus on the appearance of the rash and the detailed epidemiologic history<ref name="pmid11486283">{{cite journal| author=O'Brien D, Tobin S, Brown GV, Torresi J| title=Fever in returned travelers: review of hospital admissions for a 3-year period. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 5 | pages= 603-9 | pmid=11486283 | doi=10.1086/322602 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11486283  }}</ref><ref name="pmid146393752">{{cite journal| author=Lupi O, Tyring SK| title=Tropical dermatology: viral tropical diseases. | journal=J Am Acad Dermatol | year= 2003 | volume= 49 | issue= 6 | pages= 979-1000; quiz 1000-2 | pmid=14639375 | doi=10.1016/s0190-9622(03)02727-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14639375  }}</ref><ref name="pmid10453260">{{cite journal| author=Suh KN, Kozarsky PE, Keystone JS| title=Evaluation of fever in the returned traveler. | journal=Med Clin North Am | year= 1999 | volume= 83 | issue= 4 | pages= 997-1017 | pmid=10453260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10453260  }}</ref>
The diagnostic approach to the child patient with fever and rash should focus on the appearance of the rash and the detailed epidemiologic history<ref name="pmid11486283">{{cite journal| author=O'Brien D, Tobin S, Brown GV, Torresi J| title=Fever in returned travelers: review of hospital admissions for a 3-year period. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 5 | pages= 603-9 | pmid=11486283 | doi=10.1086/322602 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11486283  }}</ref><ref name="pmid146393752">{{cite journal| author=Lupi O, Tyring SK| title=Tropical dermatology: viral tropical diseases. | journal=J Am Acad Dermatol | year= 2003 | volume= 49 | issue= 6 | pages= 979-1000; quiz 1000-2 | pmid=14639375 | doi=10.1016/s0190-9622(03)02727-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14639375  }}</ref><ref name="pmid10453260">{{cite journal| author=Suh KN, Kozarsky PE, Keystone JS| title=Evaluation of fever in the returned traveler. | journal=Med Clin North Am | year= 1999 | volume= 83 | issue= 4 | pages= 997-1017 | pmid=10453260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10453260  }}</ref>


DIAGNOSTIC APPROACH


Characteristics of the rash: Erythema multiforme, Erythema nodosum, Toxic epidermal necrolysis , Urticaria
[[Seasonal allergy|Season]]<ref name="pmid16177685">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Vibrio illnesses after Hurricane Katrina--multiple states, August-September 2005. | journal=MMWR Morb Mortal Wkly Rep | year= 2005 | volume= 54 | issue= 37 | pages= 928-31 | pmid=16177685 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16177685  }}</ref><ref name="pmid758155">{{cite journal| author=Blake PA, Merson MH, Weaver RE, Hollis DG, Heublein PC| title=Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. | journal=N Engl J Med | year= 1979 | volume= 300 | issue= 1 | pages= 1-5 | pmid=758155 | doi=10.1056/NEJM197901043000101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=758155  }}</ref>
 
Geography
 
[[Incubation period]]
 
[[Exposure and response|Exposure]] history<ref name="pmid2051013">{{cite journal| author=Craven RB, Barnes AM| title=Plague and tularemia. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 165-75 | pmid=2051013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051013  }}</ref><ref name="pmid20510122">{{cite journal| author=Fox JG, Lipman NS| title=Infections transmitted by large and small laboratory animals. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 131-63 | pmid=2051012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051012  }}</ref><ref name="pmid2051011">{{cite journal| author=Goldstein EJ| title=Household pets and human infections. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 117-30 | pmid=2051011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051011  }}</ref><ref name="pmid14727806">{{cite journal| author=Hankenson FC, Johnston NA, Weigler BJ, Di Giacomo RF| title=Zoonoses of occupational health importance in contemporary laboratory animal research. | journal=Comp Med | year= 2003 | volume= 53 | issue= 6 | pages= 579-601 | pmid=14727806 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727806  }}</ref><ref name="pmid9887159">{{cite journal| author=Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ| title=Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 2 | pages= 85-92 | pmid=9887159 | doi=10.1056/NEJM199901143400202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9887159  }}</ref>
 
[[Arthropods|Arthropod]] exposures<ref name="pmid8147546">{{cite journal| author=Fishbein DB, Dawson JE, Robinson LE| title=Human ehrlichiosis in the United States, 1985 to 1990. | journal=Ann Intern Med | year= 1994 | volume= 120 | issue= 9 | pages= 736-43 | pmid=8147546 | doi=10.7326/0003-4819-120-9-199405010-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8147546  }}</ref><ref name="pmid18452807">{{cite journal| author=Masters EJ, Grigery CN, Masters RW| title=STARI, or Masters disease: Lone Star tick-vectored Lyme-like illness. | journal=Infect Dis Clin North Am | year= 2008 | volume= 22 | issue= 2 | pages= 361-76, viii | pmid=18452807 | doi=10.1016/j.idc.2007.12.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452807  }}</ref><ref name="pmid3565971">{{cite journal| author=Mackowiak PA, LeMaistre CF| title=Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. | journal=Ann Intern Med | year= 1987 | volume= 106 | issue= 5 | pages= 728-33 | pmid=3565971 | doi=10.7326/0003-4819-106-5-728 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3565971  }}</ref><ref name="pmid8604172">{{cite journal| author=Bakken JS, Krueth J, Wilson-Nordskog C, Tilden RL, Asanovich K, Dumler JS| title=Clinical and laboratory characteristics of human granulocytic ehrlichiosis. | journal=JAMA | year= 1996 | volume= 275 | issue= 3 | pages= 199-205 | pmid=8604172 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8604172  }}</ref><ref name="pmid9233663">{{cite journal| author=Dumler JS| title=Is human granulocytic ehrlichiosis a new Lyme disease? Review and comparison of clinical, laboratory, epidemiological, and some biological features. | journal=Clin Infect Dis | year= 1997 | volume= 25 Suppl 1 | issue=  | pages= S43-7 | pmid=9233663 | doi=10.1086/516164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9233663  }}</ref>
 
[[Medication]] history<ref name="pmid128641">{{cite journal| author=Arndt KA, Jick H| title=Rates of cutaneous reactions to drugs. A report from the Boston Collaborative Drug Surveillance Program. | journal=JAMA | year= 1976 | volume= 235 | issue= 9 | pages= 918-23 | pmid=128641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=128641  }}</ref>
 
[[Immunization]] history<ref name="pmid20170376">{{cite journal| author=Weinberg A, Lazar AA, Zerbe GO, Hayward AR, Chan IS, Vessey R | display-authors=etal| title=Influence of age and nature of primary infection on varicella-zoster virus-specific cell-mediated immune responses. | journal=J Infect Dis | year= 2010 | volume= 201 | issue= 7 | pages= 1024-30 | pmid=20170376 | doi=10.1086/651199 | pmc=3136368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20170376  }}</ref><ref name="pmid3033012">{{cite journal| author=Hayward AR, Herberger M| title=Lymphocyte responses to varicella zoster virus in the elderly. | journal=J Clin Immunol | year= 1987 | volume= 7 | issue= 2 | pages= 174-8 | pmid=3033012 | doi=10.1007/BF00916011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3033012  }}</ref><ref name="pmid6244336">{{cite journal| author=Arvin AM, Pollard RB, Rasmussen LE, Merigan TC| title=Cellular and humoral immunity in the pathogenesis of recurrent herpes viral infections in patients with lymphoma. | journal=J Clin Invest | year= 1980 | volume= 65 | issue= 4 | pages= 869-78 | pmid=6244336 | doi=10.1172/JCI109739 | pmc=434474 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6244336  }}</ref><ref name="pmid6277260">{{cite journal| author=Burke BL, Steele RW, Beard OW, Wood JS, Cain TD, Marmer DJ| title=Immune responses to varicella-zoster in the aged. | journal=Arch Intern Med | year= 1982 | volume= 142 | issue= 2 | pages= 291-3 | pmid=6277260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6277260  }}</ref>
 
[[Sexual activities|Sexual]] history<ref name="pmid9142802">{{cite journal| author=Vanhems P, Allard R, Cooper DA, Perrin L, Vizzard J, Hirschel B | display-authors=etal| title=Acute human immunodeficiency virus type 1 disease as a mononucleosis-like illness: is the diagnosis too restrictive? | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 5 | pages= 965-70 | pmid=9142802 | doi=10.1093/clinids/24.5.965 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9142802  }}</ref><ref name="pmid1743707">{{cite journal| author=de Jong MD, Hulsebosch HJ, Lange JM| title=Clinical, virological and immunological features of primary HIV-1 infection. | journal=Genitourin Med | year= 1991 | volume= 67 | issue= 5 | pages= 367-73 | pmid=1743707 | doi=10.1136/sti.67.5.367 | pmc=1194734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1743707  }}</ref><ref name="pmidPMID 3928202">{{cite journal| author=Koss PG| title=Disseminated gonococcal infection. The tenosynovitis-dermatitis and suppurative arthritis syndromes. | journal=Cleve Clin Q | year= 1985 | volume= 52 | issue= 2 | pages= 161-73 | pmid=PMID 3928202 | doi=10.3949/ccjm.52.2.161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3928202  }}</ref>
 
[[Immunocompetence]] of the host<ref name="pmid114477142">{{cite journal| author=Lopez FA, Sanders CV| title=Dermatologic infections in the immunocompromised (non-HIV) host. | journal=Infect Dis Clin North Am | year= 2001 | volume= 15 | issue= 2 | pages= 671-702, xi | pmid=11447714 | doi=10.1016/s0891-5520(05)70164-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11447714  }}</ref><ref name="pmid11447714">{{cite journal| author=Lopez FA, Sanders CV| title=Dermatologic infections in the immunocompromised (non-HIV) host. | journal=Infect Dis Clin North Am | year= 2001 | volume= 15 | issue= 2 | pages= 671-702, xi | pmid=11447714 | doi=10.1016/s0891-5520(05)70164-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11447714  }}</ref>
 
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01= [[Differential diagnosis]] of [[fever and rash]] based on the accompanying symptoms}}
{{Family tree | |,|-|-|-|-|v|-|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|v|-|^|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | }}
{{Family tree | B01 | | | B02 | | | | | | | | B03 | | | | | | | | B04 | | B05 | | B06 | | B07 | | B08 | | |B01=[[Arthritis]]/[[arthralgia]]|B02=[[Desquamation]]|B03=Lymphadenopathy|B04=Enanthems|B05=Ulcerative/vesicular stomatitis|B06=Palm-soul involvement|B07=Rash predominantly on extremities|B08=Pulmonary infiltrations}}
{{Family tree | |!| | | | |!| | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | |!| | | |!| | | |!| | | |!| | | |!| | | }}
{{Family tree | B01 | | | B02 | | B03 | | B04 | | B05 | | B06 | | B07 | | B08 | | B09 | | B10 | | B11 | | |B01=|B02=|B03=Generalized|B04=Hilar|B05=Cervical|B06=Inguinal|B07=|B08=|B09=|B10=|B11=}}
{{Family tree/end}}
 
 
 
Differential diagnosis of fever and rash based upon accompanying signs:
 
===[[Arthritis]] or [[arthralgia]]===
[[Acute meningococcemia]]
 
[[Allergic purpura]]
 
Disseminated gonoccal
 
[[Erythema marginatum]]([[acute rheumatic fever]])
 
[[hepatitis B virus]], [[prodromal]] phase.
 
[[lyme disease]]
 
[[Parvovirus B19|parvovirus]] [[Parvovirus B19|B19]]
 
[[Reiter's syndrome|reiter's syndrom]]
 
[[Rocky Mountain spotted fever|rocky mountain spotted fever]]
 
[[roseola]] (especially in adults)
 
[[rubella]]
 
[[serum sickness]]
 
stills disease
 
[[systemic lupus erythematous]] <br />
===[[Desquamation]]===
''Arcanobacterium haemolyticum'' infection
 
[[Drug hypersensitivity]]
 
Graft-versus-host reaction
 
[[Kawasaki syndrome]]
 
[[Measles]]
 
[[Rocky Mountain spotted fever]]
 
[[Scarlet fever]]
 
Staphylococcal scalded-skin syndrome
 
[[Stevens-Johnson syndrome]]
 
[[Toxic epidermal necrolysis]]
 
[[Toxic shock syndrome]]
 
von Zumbusch pustular psoriasis
 
===[[Lymphadenopathy]]===
 
====[[Cervical]]====
[[Kawasaki syndrome]]
 
[[Rubella]]
 
[[Scarlet fever]]
 
====Generalized====
[[Infectious mononucleosis]]
 
[[Secondary syphilis]]
 
[[Serum sickness]]
 
[[Sarcoidosis]]
 
[[Systemic lupus erythematosus]]
 
[[Toxoplasmosis]]
 
====[[Hilar]]====
Atypical [[measles]]
 
[[Sarcoidosis]]
 
====Local====
[[Cat-scratch disease]]


Physical examination:
[[Tularemia]]


Vital signs
====[[Meningitis]]====
[[Acute meningococcemia]]


●General appearance to assess the severity of illness
[[Cryptococcosis]]


●Strict attention to lymph nodes, mucous membranes, conjunctivae, and genitalia
[[Enterovirus]] (Coxsackieviruses, echoviruses)


●Meningeal signs and complete neurologic evaluation
[[Leptospirosis]]


●Liver and spleen size
[[Lyme disease]]


●Joint examination
[[Rocky Mountain spotted fever]]


●Skin examination (t
[[Secondary syphilis]]


Laboratory testing:  Appropriate laboratory testing includes [5]:
===Mucosal membrane lesions (enanthems)===
[[Herpes simplex]]


●Nonspecific tests such as complete blood count and urinalysis
[[Infectious mononucleosis]] (palatal petechiae)


●Blood cultures (including specific media and isolation methods for bacterial, mycobacterial, and fungal organisms) should be inoculated prior to beginning antimicrobial therapy
[[Measles]] (Koplick's spots)= Strawberry tongue,Atypical measles,Kawasaki disease,Scarlet fever,Toxic shock syndrome


●Serologic tests, when appropriate (eg, for ''Coccidioides immitis'', hepatitis B, ''Toxoplasma gondii'', ''Borrelia burgdorferi'', ''Treponema pallidum'', dengue virus, and HIV)
[[Varicella zoster]]


●Antigen tests, when appropriate (eg, serum cryptococcal antigen)
===Ulcerative or vesicular stomatitis===
[[Hand-foot-mouth disease]]


[[Herpes simplex]]


Season<ref name="pmid16177685">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Vibrio illnesses after Hurricane Katrina--multiple states, August-September 2005. | journal=MMWR Morb Mortal Wkly Rep | year= 2005 | volume= 54 | issue= 37 | pages= 928-31 | pmid=16177685 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16177685  }}</ref><ref name="pmid758155">{{cite journal| author=Blake PA, Merson MH, Weaver RE, Hollis DG, Heublein PC| title=Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. | journal=N Engl J Med | year= 1979 | volume= 300 | issue= 1 | pages= 1-5 | pmid=758155 | doi=10.1056/NEJM197901043000101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=758155  }}</ref>
[[Histoplasmosis]]


Geography
[[Inflammatory bowel disease]]
 
[[Secondary syphilis]]
 
[[Systemic lupus erythematosus]]
 
===Palm-sole involvement===
[[Acute meningococcemia]]
 
Atypical [[measles]]
 
[[Dengue]]
 
[[Drug rash]]
 
[[Erythema multiforme]]
 
[[Hand-foot-mouth disease]]
 
[[Kawasaki syndrome]]
 
[[Measles]]
 
[[Rocky Mountain spotted fever]]
 
[[Secondary syphilis]]
 
''[[Staphylococcus aureus]]'' endocarditis
 
===Rash predominantly on extremities===
[[Allergic purpura]]
 
[[Brucellosis]]
 
[[Disseminated gonococcal infection]]
 
[[Ecthyma gangrenosum]]
 
[[Erythema nodosum]]
 
[[Sporotrichosis]] (fever rare)
<br />
 
===[[Pulmonary]] infiltrate===
Atypical measles
 
[[Coccidioidomycosis]]
 
[[Cryptococcosis]]
 
[[Fat embolism]]


Incubation period
[[Histoplasmosis]]


Exposure history<ref name="pmid2051013">{{cite journal| author=Craven RB, Barnes AM| title=Plague and tularemia. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 165-75 | pmid=2051013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051013  }}</ref><ref name="pmid20510122">{{cite journal| author=Fox JG, Lipman NS| title=Infections transmitted by large and small laboratory animals. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 131-63 | pmid=2051012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051012  }}</ref><ref name="pmid2051011">{{cite journal| author=Goldstein EJ| title=Household pets and human infections. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 117-30 | pmid=2051011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051011  }}</ref><ref name="pmid14727806">{{cite journal| author=Hankenson FC, Johnston NA, Weigler BJ, Di Giacomo RF| title=Zoonoses of occupational health importance in contemporary laboratory animal research. | journal=Comp Med | year= 2003 | volume= 53 | issue= 6 | pages= 579-601 | pmid=14727806 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727806  }}</ref><ref name="pmid9887159">{{cite journal| author=Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ| title=Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 2 | pages= 85-92 | pmid=9887159 | doi=10.1056/NEJM199901143400202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9887159  }}</ref>
''[[Mycoplasma pneumoniae]]''


Arthropod exposures<ref name="pmid8147546">{{cite journal| author=Fishbein DB, Dawson JE, Robinson LE| title=Human ehrlichiosis in the United States, 1985 to 1990. | journal=Ann Intern Med | year= 1994 | volume= 120 | issue= 9 | pages= 736-43 | pmid=8147546 | doi=10.7326/0003-4819-120-9-199405010-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8147546  }}</ref><ref name="pmid18452807">{{cite journal| author=Masters EJ, Grigery CN, Masters RW| title=STARI, or Masters disease: Lone Star tick-vectored Lyme-like illness. | journal=Infect Dis Clin North Am | year= 2008 | volume= 22 | issue= 2 | pages= 361-76, viii | pmid=18452807 | doi=10.1016/j.idc.2007.12.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452807  }}</ref><ref name="pmid3565971">{{cite journal| author=Mackowiak PA, LeMaistre CF| title=Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. | journal=Ann Intern Med | year= 1987 | volume= 106 | issue= 5 | pages= 728-33 | pmid=3565971 | doi=10.7326/0003-4819-106-5-728 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3565971  }}</ref><ref name="pmid8604172">{{cite journal| author=Bakken JS, Krueth J, Wilson-Nordskog C, Tilden RL, Asanovich K, Dumler JS| title=Clinical and laboratory characteristics of human granulocytic ehrlichiosis. | journal=JAMA | year= 1996 | volume= 275 | issue= 3 | pages= 199-205 | pmid=8604172 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8604172  }}</ref><ref name="pmid9233663">{{cite journal| author=Dumler JS| title=Is human granulocytic ehrlichiosis a new Lyme disease? Review and comparison of clinical, laboratory, epidemiological, and some biological features. | journal=Clin Infect Dis | year= 1997 | volume= 25 Suppl 1 | issue=  | pages= S43-7 | pmid=9233663 | doi=10.1086/516164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9233663  }}</ref>
North American [[blastomycosis]]


Medication history<ref name="pmid128641">{{cite journal| author=Arndt KA, Jick H| title=Rates of cutaneous reactions to drugs. A report from the Boston Collaborative Drug Surveillance Program. | journal=JAMA | year= 1976 | volume= 235 | issue= 9 | pages= 918-23 | pmid=128641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=128641  }}</ref>
[[Psittacosis]]


Immunization history<ref name="pmid20170376">{{cite journal| author=Weinberg A, Lazar AA, Zerbe GO, Hayward AR, Chan IS, Vessey R | display-authors=etal| title=Influence of age and nature of primary infection on varicella-zoster virus-specific cell-mediated immune responses. | journal=J Infect Dis | year= 2010 | volume= 201 | issue= 7 | pages= 1024-30 | pmid=20170376 | doi=10.1086/651199 | pmc=3136368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20170376  }}</ref><ref name="pmid3033012">{{cite journal| author=Hayward AR, Herberger M| title=Lymphocyte responses to varicella zoster virus in the elderly. | journal=J Clin Immunol | year= 1987 | volume= 7 | issue= 2 | pages= 174-8 | pmid=3033012 | doi=10.1007/BF00916011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3033012  }}</ref><ref name="pmid6244336">{{cite journal| author=Arvin AM, Pollard RB, Rasmussen LE, Merigan TC| title=Cellular and humoral immunity in the pathogenesis of recurrent herpes viral infections in patients with lymphoma. | journal=J Clin Invest | year= 1980 | volume= 65 | issue= 4 | pages= 869-78 | pmid=6244336 | doi=10.1172/JCI109739 | pmc=434474 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6244336  }}</ref><ref name="pmid6277260">{{cite journal| author=Burke BL, Steele RW, Beard OW, Wood JS, Cain TD, Marmer DJ| title=Immune responses to varicella-zoster in the aged. | journal=Arch Intern Med | year= 1982 | volume= 142 | issue= 2 | pages= 291-3 | pmid=6277260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6277260  }}</ref>
[[Rocky Mountain spotted fever]]


Sexual history<ref name="pmid9142802">{{cite journal| author=Vanhems P, Allard R, Cooper DA, Perrin L, Vizzard J, Hirschel B | display-authors=etal| title=Acute human immunodeficiency virus type 1 disease as a mononucleosis-like illness: is the diagnosis too restrictive? | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 5 | pages= 965-70 | pmid=9142802 | doi=10.1093/clinids/24.5.965 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9142802  }}</ref><ref name="pmid1743707">{{cite journal| author=de Jong MD, Hulsebosch HJ, Lange JM| title=Clinical, virological and immunological features of primary HIV-1 infection. | journal=Genitourin Med | year= 1991 | volume= 67 | issue= 5 | pages= 367-73 | pmid=1743707 | doi=10.1136/sti.67.5.367 | pmc=1194734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1743707  }}</ref><ref name="pmidPMID 3928202">{{cite journal| author=Koss PG| title=Disseminated gonococcal infection. The tenosynovitis-dermatitis and suppurative arthritis syndromes. | journal=Cleve Clin Q | year= 1985 | volume= 52 | issue= 2 | pages= 161-73 | pmid=PMID 3928202 | doi=10.3949/ccjm.52.2.161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3928202  }}</ref>
[[Sarcoidosis]]


Immunocompetence of the host<ref name="pmid114477142">{{cite journal| author=Lopez FA, Sanders CV| title=Dermatologic infections in the immunocompromised (non-HIV) host. | journal=Infect Dis Clin North Am | year= 2001 | volume= 15 | issue= 2 | pages= 671-702, xi | pmid=11447714 | doi=10.1016/s0891-5520(05)70164-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11447714  }}</ref><ref name="pmid11447714">{{cite journal| author=Lopez FA, Sanders CV| title=Dermatologic infections in the immunocompromised (non-HIV) host. | journal=Infect Dis Clin North Am | year= 2001 | volume= 15 | issue= 2 | pages= 671-702, xi | pmid=11447714 | doi=10.1016/s0891-5520(05)70164-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11447714  }}</ref>
[[Varicella zoster]]


==Complete Diagnostic Approach==
==Complete Diagnostic Approach==
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
Shown below is an algorithm summarizing the diagnosis of fever and rush according to ...., Inc. and/or its affiliatesin three categories:
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | A01 | | | A01= }}
{{familytree | | | | |!| | | | }}
{{familytree | | | | B01 | | | B01= }}
{{familytree | | |,|-|^|-|.| | }}
{{familytree | | C01 | | C02 | C01= | C02= }}


{{familytree/end}}
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01=Complete diagnostic aproach}}
{{Family tree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|.| | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | A02 | | A03 | |A01=Characteristics of the rash |A02=Physical examination |A03=Laboratory testing }}
{{Family tree | | | |,|-|-|-|-|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|-|-|-|-|.| | | | | |!| | | |!| | | | }}
{{Family tree | | | A01 | | | | | | A02 | | | | | | A03 | | | | | | A04 | | | | A05 | | A06 |-| A07 | |A01=• Macules<br>• Papules<br>• Nodules<br>• Plaques |A02=• Vesicles<br>• Pustules<br>• Bullae|A03=• Purpuric papules<br>• Purpuric macules<br>• Purpuric vesicles |A04=Widespread erythema with or without edema followed by desquamation |A05=• Vital signs<br>• General appearance<br>• Strict attention to lymph nodes, mucous membranes, genitalia and conjuctiva<br>• Evaluate liver and spleen size<br>• Joint examination<br>• Skin examination|A06=Non-specific testing |A07=• Complete blood count<br>• Urianalysis }}
{{Family tree | |,|-|^|-|.| | | |,|-|^|-|.| | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | | | |!| | | | | | }}
{{Family tree | A01 | | A02 | | A03 | | A04 | | A05 | | A06 | | A07 | | A08 | | | | | | A10 |-| A11 | |A01=Non-infectious |A02=Infectious |A03=Non-infectious |A04=Infectious |A05=Non-infectious |A06=Infectious |A07=Non-infectious |A08=Infectious |A10=Blood culture |A11=• Bacteria<br>• Mycobacteria<br>• Fungal}}
{{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | |!| | | | | | | | | | | | | | | }}
{{Family tree | A01 | | |!| | | A03 | | |!| | | A05 | | |!| | | A07 | | |!| | | | | | | A10 |-| A11 | |A01=|A03=|A05=|A07=|A10=Serology test|A11=• Coccidioides immitis<br>• Hepatitis B<br>• Toxoplasma Gondii<br>• Borrelia Burgdorferi<br>• Treponema Pallidum<br>• Dengue virus<br>• HIV}}
{{Family tree | |,|-|-|-|+|-|-|-|.| | | |!| | | | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | |!| | | | | | }}
{{Family tree | A01 | | A02 | | A03 | | |!| | | | | A04 | | A05 | | A06 | | A07 | | | | A08 |-| A09 | | | |A01=Bacterial|A02=Viral|A03=Fungal|A04=Bacterial|A05=Viral|A06=Bacterial|A07=Viral|A08=Antigen test|A09=Criptococcal antigen }}
{{Family tree | | | | | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{Family tree | | | | | | | | | A01 | | A02 | | A03 | | | | | | | | | | | | | | | | | | A04 |-| A05 | | |A01=Bacterial|A02=Viral|A03=Fungal|A04=Fluorescent antibody or PCR or viral culture|A05=• Varicella zoster<br>• herpes virus}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 |-| A02 | |A01=Darkfield microscopy or fluorescent antibody |A02=Syphilis }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 |-| A02 | |A01=Immunofluorescent |A02=Rikettsia (Rocky mountain spotted fever) }}
{{Family tree/end}}


===''1.Characteristics of the [[rash]]'':===
===[[Macules]], [[papules]], [[nodules]], or [[plaques]]===
===Noninfectious===
[[Erythema multiforme]]
[[Systemic lupus erythematosus]]
[[Dermatomyositis]]
Drug hypersensitivities
[[Gianotti-Crosti syndrome]]
[[Inflammatory bowel disease]]
[[Pityriasis rosea]] (fever rare)
[[Sarcoidosis]]
[[Serum sickness]]
[[Sweet syndrome]] ([[acute febrile neutrophilic dermatosis]])
[[Still's disease]] ([[juvenile idiopathic arthritis]])
===[[Bacterial]]===
''[[Arcanobacterium haemolyticum]]''
''[[Bacillus anthracis]]''
''[[Bartonella bacilliformis]]''
''[[Bartonella henselae]]'' ([[cat scratch disease]])
''[[Bartonella quintana]]'' ([[trench fever]])
''[[Borrelia burgdorferi]]'' ([[Lyme disease]])
''[[Borrelia]]'' spp ([[relapsing fever]])
''[[Brucellosis|Brucella]]'' spp ([[brucellosis]])
''[[Calymmatobacterium granulomatis]]'' ([[donovanosis]])
''[[Chlamydia psittaci]]'' ([[psittacosis]])
[[Ehrlichiosis]]
''[[Ehrlichia]] chafeensis'' (HME)
Human granulocytic erlichiosis
''[[Erysipelothrix rhusiopathiae]]'' ([[erysipeloid]])
''[[Francisella tularensis]]'' ([[tularemia]])
''[[Listeria monocytogenes]]''
''[[Leptospira]]'' spp ([[leptospirosis]])
''[[Mycobacterium leprae]]''
''[[Mycobacterium marinum]]''
''[[Mycobacterium tuberculosis]]''
''[[Mycoplasma pneumoniae]]''
''[[Neisseria gonorrhoeae]]'' ([[gonorrhea]])
''[[Neisseria meningitidis]]'' ([[meningococcemia]])
''[[Pseudomonas aeruginosa]]''
''[[Rickettsial|Rickettsia]] akari'' ([[rickettsialpox]])
''[[Rickettsial|Rickettsia]] prowazekii'' ([[epidemic]]/louse-borne typhus)
''[[Rickettsial|Rickettsia]] rickettsii'' (RMSF-early lesions)
''[[Rickettsial|Rickettsia]] orientalis''/''tsutsugamushi'' ([[scrub typhus]])
''[[Rickettsial|Rickettsia]] typhi'' (endemic/murine typhus)
''[[Salmonella]] typhi'' ([[typhoid fever]])
''[[Spirillum]] minor'' ([[rat-bite fever]])<br />
===[[Fungal]]===
''[[Blastomyces dermatitidis]]''
''[[Candida]]'' spp
''[[Coccidioides immitis]]''
''[[Cryptococcus neoformans]]''
''[[Histoplasma capsulatum]]''
Other disseminated deep fungal infections in [[immunocompromised]] patients<br />
===[[Viral]]===
[[Adenovirus]]
[[Arbovirus]]
Atypical [[measles]]
[[Chikungunya]] virus
[[Colorado tick fever]]
Coxsackieviruses A and B
[[Cytomegalovirus]], primary infection
[[Dengue virus]]
[[Epstein-Barr virus]], primary infection
Echoviruses
[[Hepatitis B]] ([[urticaria]])
[[Human herpesvirus 6]] ([[exanthem subitum]])
[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] ([[Human Immunodeficiency Virus (HIV)|HIV-1]])
[[Kawasaki syndrome]] (presumed viral)
[[Molluscum contagiosum]]
[[Orf]]
[[Parvovirus B19]] ([[erythema infectiosum]] [<nowiki/>[[fifth disease]]])
[[Rubella]] ([[German measles]])
[[Rubeola]] ([[measles]])
[[Varicella]] ([[chickenpox]])
[[Varicella-zoster]] ([[Disseminated disease|disseminated]])
Viral hemorrhagic fevers (many)
[[West nile virus|West Nile virus]]
[[Zika virus]]
===[[Vesicles]], bullae, or [[pustules]]===
===Noninfectious===
[[Erythema multiforme]] bullosum
[[Toxic epidermal necrolysis]]
[[Dermatitis]] from plants
Drug [[hypersensitivities]]
===[[Bacterial]]===
''[[Bacillus anthracis]]''
''Ehrlichia canis''
''[[Listeria monocytogenes]]''
''[[Mycoplasma pneumoniae]]''
''[[Neisseria gonorrhoeae]]''
''[[Neisseria meningitidis]]''
''[[Pseudomonas aeruginosa]]''
''[[Rickettsiae|Rickettsia]] akari''
''[[Rickettsia rickettsii]]''
''[[Staphylococcus aureus]]'' (TSS, SSSS)
''[[Streptococcus]]'' group A
''[[Treponema pallidum]]'' (secondary syphilis)
''[[Vibrio vulnificus]]''
===[[Fungal]]===
''[[Histoplasma capsulatum]]''
===[[Viral]]===
[[Colorado tick fever]]
[[Coxsackie virus|Coxsackie]] A5, 9, 10, 16, B2, 7
Echoviruses
[[Eczema herpeticum]]
[[Herpes simplex]] ([[Disseminated intravascular coagulation|disseminated]])
[[Varicella]] ([[chickenpox]])
[[Varicella-zoster virus|Varicella-zoster]] (disseminated)
===[[Purpuric]] [[macules]], [[purpuric]] [[papules]], or [[purpuric]] [[vesicles]]===
===Noninfectious===
"Allergic" [[vasculitis]]
[[Erythroderma]]
[[Cholesterol embolization]]
[[Disseminated intravascular coagulation]] ([[purpura fulminans]])
Drug [[hypersensitivities]]
[[Fat embolism]]
[[Henoch-Schönlein purpura]]
[[Immune thrombocytopenic purpura]]
[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis CT|Wegener's]])
===[[Bacterial]]===
[[Bacteremia]]
''[[Borrelia]]'' spp
''[[Clostridium]]'' spp
[[Infective endocarditis]] (many species)
''[[Haemophilus influenzae]]'' type B
''[[Neisseria gonorrhoeae]]'' (disseminated gonococcal infection)
''[[Neisseria meningitidis]]'' (acute or chronic meningococcemia)
''[[Pseudomonas]] aeruginosa''
''[[Rickettsia prowazekii]]''
''[[Rickettsia rickettsii]]''
''Spirillum minor''
''[[Staphylococcus aureus]]'' (bacteremia)
''[[Streptobacillus moniliformis]]''
''Streptococcus'' group A (streptococcal toxic shock syndrome, scarlet fever)
''[[Streptococcus pneumoniae]]'' (asplenic patient)
''[[Vibrio vulnificus]]''
''[[Yersinia pestis]]''
===[[Viral]]===
[[Adenovirus]] (rare)
Atypical measles
[[Chikungunya]] virus
[[Colorado tick fever]]
[[Congenital cytomegalovirus infecttion|Congenital cytomegalovirus]]
[[Coxsackie virus|Coxsackie]] A and B (rare, types A-9, B2-5)
[[Dengue fever]]
[[Epstein-Barr virus]] (rare)
Echoviruses (rare, types 3, 4, 9)
[[Rubella]]
[[Varicella-zoster virus]]
[[West nile virus|West Nile virus]]
[[Yellow fever]]
===Widespread [[erythema]] with or without [[edema]] followed by [[desquamation]]===
===Noninfectious===
[[Erythroderma]]
Drug [[hypersensitivities]]
Graft-versus-host reaction
[[Stevens-Johnson syndrome]]
[[Toxic epidermal necrolysis]]
von Zumbusch pustular psoriasis
===[[Bacterial]]===
''[[Streptococcus Group A|Streptococcus]]'' group A (scarlet fever, streptococcal toxic shock syndrome)
''Stapylococcus'' aureus (TSS, SSSS)
===Viral===
[[Kawasaki syndrome]] (presumed viral)
<br />
====''2.[[Physical examination]]''====
*[[Vital signs]]
*General appearance to assess the severity of illness
*Strict attention to [[lymph nodes]], [[mucous membranes]], [[Conjunctiva|conjunctiv]]<nowiki/>ae, and [[genitalia]]
*[[Meningeal signs]] and complete [[Neurology|neurologic]] evaluation
*[[Liver]] and [[spleen]] size
*[[Joint]] examination
*[[Skin]] examination
===''3.Laboratory testing''===
*Nonspecific tests like: [[complete blood count]] and [[urinalysis]]
*[[Blood cultures]] (including specific media and isolation methods for [[bacterial]], [[mycobacterial]], and [[fungal]] organisms) should be inoculated prior to beginning [[Antimicrobial drug|antimicrobial]] therapy
*[[Serologic]] tests, when appropriate (eg, for ''[[Coccidioides immitis]]'', [[hepatitis B]], ''[[Toxoplasma gondii]]'', ''[[Borrelia burgdorferi]]'', ''[[Treponema pallidum]]'', [[dengue virus]], and [[HIV]])
*[[Antigen detection test|Antigen]] tests, when appropriate (eg, serum [[Cryptococcal infection|cryptococcal]] [[Antigen presenting cells|antigen]])
*[[herpes simplex virus]] and [[varicella-zoster virus]] can be diagnosed with direct [[fluorescent antibody]] or [[polymerase chain reaction]] ([[PCR]]) assays.  [[Viral culture]] can also be performed
*In suspected cases of [[syphilis]], can be evaluated with [[Darkfield microscope|darkfield]] microscopy or direct [[fluorescent antibody]] testing
*in suspected cases of [[Rocky Mountain spotted fever]], direct [[immunofluorescent]] demonstration of [[rickettsial]] organisms is diagnostic
<br />
==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
Shown below is an algorithm summarizing the treatment of fever and rush disease according the the [...] guidelines.
{{familytree/start |summary=PE diagnosis Algorithm.}}
 
{{familytree | | | | | | | | A01 |A01= }}  
Treatment of [[fever]] depending on the cause of the [[symptoms]], in severe cases, a child might sometimes need to stay in the [[hospital]].<br /> patient of fever can take [[acetaminophen]] and [[ibuprofen]], if patient have [[Itchy skin|itchy]] [[viral]] '''rash''', you can try applying a cool [[Compressed fluid|compress]] or [[calamine lotion]] to the affected area.
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
 
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
<br />
{{familytree | | | |!| | | | | | | | | |!| }}
 
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
{{Family tree/start}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | | | | | | | A01 | | | A01= Child with fever and rush }}
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
{{familytree | | |,|-|-|-|-|^|-|-|-|-|.| | }}
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
{{familytree | | C01 | | | | | | | | C02 | C01= Non-Infectious| C02= Infectious}}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
{{familytree | | |!| | | | | |,|-|-|-|+|-|-|-|.| | }}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | A01 | | | | A02 | | A03 | | A04 | | | A01= Treat every case according to the cause of disease | A02= Bacterial| A03= Viral| A04= Fungal}}
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
{{familytree | | | | | | | | |!| | | |!| | | |!| | | | | | | | }}
{{familytree/end}}
{{familytree | | | | | | | | A01 | | A02 | | A03 | | | A01= Antibiotic and antihistaminic | A02=• Rest<br>• Antipiretics<br>• Plenty of oral fluids| A03= Antifungals according to the microorganism}}
{{familytree/end}}<br />[[Antibiotics]] can  get rid of the infection, but they will not treat the rash, so we use the antibiotic in:
 
*[[cellulitis]] and similar [[skin]] [[infections]].
*[[Streptococcus|strep]] [[infections]].
*A viral [[rash]] becomes infected, especially if a child scratches it a lot. So a child might need [[antibiotics]].
 
<br />


==Do's==
==Do's<ref name="urlwww.infectiousdiseaseadvisor.com">{{cite web |url=https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/fever-and-rash/ |title=www.infectiousdiseaseadvisor.com |format= |work= |accessdate=}}</ref>==


*The content in this section is in bullet points.<ref name="urlwww.infectiousdiseaseadvisor.com">{{cite web |url=https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/fever-and-rash/ |title=www.infectiousdiseaseadvisor.com |format= |work= |accessdate=}}</ref>
*Cough etiquette, contact precautions, and hand hygiene are easy and cost-effective measures in reducing the spread of [[infectious]] agents causing [[fever]] and [[rash]].
*Prevention of diseases causing fever and rash is difficult. Cough etiquette, contact precautions, and hand hygiene are easy and cost-effective measures in reducing the spread of infectious agents causing fever and rash. Avoiding unnecessary drug prescriptions prevents drug-related adverse events
*For [[measles]], [[mumps]], [[rubella]] ([[MMR]]) prevention can be achieved by [[vaccination]] (two doses in childhood). In adolescents and adults, if none confirmatory immunization documentation exists, they need to receive two doses of MMR, at least 4-week apart.(Vaccines have been accepted in most national immunization programs)
*For measles, mumps, rubella (MMR) prevention can be achieved by vaccination (two doses in childhood). In adolescents and adults, if none confirmatory immunization documentation exists, they need to receive two doses of MMR, at least 4-week apart. MMR is contraindicated in pregnancy, HIV with CD4 lymphocyte < 200 cells/mm3, or immune compromised patients.  Prevention of varicella and meningococcemia can also be achieved by vaccination. Both vaccines have been accepted in most national immunization programs. There are variations across the globe depending on the epidemiology of the disease (e.g., meningococcal disease), health budget, and authority decisions (e.g., varicella vaccine is not on the immunization program of France or the United Kingdom).  For meningococcal disease, chemoprophylaxis can also be useful. Among household contacts, the incidence of transmission of meningococcus is approximately 5%; therefore, it is recommended that household contacts of bacteriologically confirmed cases receive rifampin (adults: 600 mg bid for a total of 4 doses; children older than 1 month: 10 mg/kg; children younger than 1 month: 5 mg/kg). These contacts should be advised to watch for fever, rash, sore throat, or any symptoms of meningitis. Intimate, non-household contacts who have had mucosal exposure to the patient’s oral secretions should also receive prophylaxis.  Health-care workers are not at an increased risk for the disease and do not require prophylaxis unless they have had direct mucosal contact with patient secretions (i.e., mouth-to-mouth resuscitation, endotracheal intubation, or nasotracheal suctioning). Ciprofloxacin (500 mg by mouth; adults only) or ceftriaxone (250 mg IM for adults or 125 mg IM for children) are single dose alternatives. With the increasing vector borne diseases (e.g., Zika, chinkungunya, dengue, yellow fever) efforts to prevent mosquito bites are cornerstone. Some of the recommended measures in persons living or traveling to endemic areas are:
*Prevention of [[varicella]] and [[meningococcemia]] can also be achieved by [[vaccination]]. (vaccines have been accepted in most national immunization programs).
** – Long-sleeved shirts and pants.
*For [[Meningococcal Disease|meningococcal]] disease, [[chemoprophylaxis]] can also be useful. Among household contacts, the incidence of transmission of meningococcus is approximately 5%; therefore, it is recommended that household contacts of bacteriologically confirmed cases receive [[rifampin]] (adults: 600 mg bid for a total of 4 doses; children older than 1 month: 10 mg/kg; children younger than 1 month: 5 mg/kg). These contacts should be advised to watch for [[fever]], [[rash]], [[sore throat]], or any symptoms of [[meningitis]]. Intimate, non-household contacts who have had mucosal exposure to the patient’s oral secretions should also receive prophylaxis.  Health-care workers are not at an increased risk for the disease and do not require prophylaxis unless they have had direct mucosal contact with patient secretions (i.e., mouth-to-mouth resuscitation, endotracheal intubation, or nasotracheal suctioning). [[Ciprofloxacin]] (500 mg by mouth; adults only) or [[ceftriaxone]] (250 mg IM for adults or 125 mg IM for children) are single dose alternatives.
** – If possible, keep indoors at sunset.
*With the increasing vector borne diseases (e.g., [[Zika virus infection|Zika]], [[chinkungunya]], [[Dengue fever|dengue]], [[yellow fever]]) efforts to prevent mosquito bites are cornerstone. Some of the recommended measures in persons living or traveling to endemic areas are:
** – Cover water storage containers so that mosquitos cannot get inside to lay eggs.
*Long-sleeved shirts and pants.
** – Discard or empty regularly any items that hold water like tires, buckets, pools, birdbaths, flowerpot saucers, or trash containers.
*If possible, keep indoors at sunset.
** – Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.
*Cover water storage containers so that mosquitos cannot get inside to lay eggs.
** – Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET (≥20%), picardin, IR3535, oil of lemon eucalyptus, or para-menthane-diol.  For men who live in or have traveled to an area with Zika, and have a pregnant partner they either have to use condoms correctly from start to finish, every time they have vaginal, anal, and oral sex, or do not have sex during pregnancy.  Women who had Zika virus disease should wait at least 8 weeks after exposure to attempt conception and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception.
*Discard or empty regularly any items that hold water like tires, buckets, pools, birdbaths, flowerpot saucers, or trash containers.
*Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.
*Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET (≥20%), picardin, IR3535, oil of lemon eucalyptus, or para-menthane-diol.  For men who live in or have traveled to an area with [[Zika virus infection|Zika]], and have a pregnant partner they either have to use [[condoms]] correctly from start to finish, every time they have [[vaginal]], [[anal]], and [[oral]] sex, or do not have sex during pregnancy.  Women who had [[Zika virus disease]] should wait at least 8 weeks after exposure to attempt conception and men with [[Zika virus disease]] should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to [[Zika virus]] but without clinical illness consistent with [[Zika virus disease]] should wait at least 8 weeks after exposure to attempt conception.


==Don'ts==
==Don'ts==


*The content in this section is in bullet points.
*Suggest not combining or alternating [[acetaminophen]] with [[ibuprofen]].
*Suggest not using external cooling for [[temperature]] reduction.
*Suggest not to clean the rush area to avoid the [[secondary infection]] by [[chemical]] products.
*Avoiding unnecessary drug prescriptions prevents [[Drug-induced|drug]]-related adverse events.
*[[MMR]] is contraindicated in [[pregnancy]], [[HIV]] with [[CD4+ lymphocytes|CD4]] lymphocyte < 200 cells/mm3, or [[immune]]<nowiki/>compromised patients.
*There are variations across the globe depending on the [[epidemiology]] of the disease (e.g., [[meningococcal disease]]), health budget, and authority decisions (e.g., [[varicella vaccine]] is not on the immunization program of France or the United Kingdom).


==References==
==References==
Line 213: Line 709:
[[Category:Resident survival guide]]
[[Category:Resident survival guide]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]

Latest revision as of 10:36, 7 March 2021
Resident
Survival
Guide

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

Synonyms and keywords:
Fever:

Frenzy,Temperature, Feverishness, Heat, Ferment, Pyrexia,

Excitement, Agitation, Febrile, Feverish, Furor, Sweat, Ecstasy, Febricity, Hyperthermia.

Rush:

Reckless, Impetuous, Impulsive, Hasty, Overhasty, Foolhardy, Incautious, Precipitate, Precipitous, Premature, Careless, Heedless, Thoughtless.

Fever and rash resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Fever with rash is a common symptom redundancy in patients presenting to clinicians' offices and emergency departments. Skin manifestations may provide the only early clue to an underlying infection, may be the hallmark of contagious disease, and/or may be an early sign of a life-threatening infection or serious noninfectious disorder. The differential diagnosis of fever and rash is extremely broad, but this symptom complex show an fortuity for the exacting clinician to start a probable etiology through a careful history and physical examination.

A systematic method is crucial for starting a timely diagnosis, determining early therapy when appropriate, and considering isolation of the patient if necessary. The treatment must to be belonging to euch cause specifeclly.

and the most important part is the advice that patient have to be aware of fever and rush diseases, to avoid the severity of the fever and rush side effect.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes[20]

FIRE: Focused Initial Rapid Evaluation

The diagnostic approach to the child patient with fever and rash should focus on the appearance of the rash and the detailed epidemiologic history[37][38][39]


Season[40][41]

Geography

Incubation period

Exposure history[42][43][44][45][46]

Arthropod exposures[47][48][49][50][51]

Medication history[52]

Immunization history[53][54][55][56]

Sexual history[57][58][59]

Immunocompetence of the host[60][61]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Differential diagnosis of fever and rash based on the accompanying symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Arthritis/arthralgia
 
 
Desquamation
 
 
 
 
 
 
 
Lymphadenopathy
 
 
 
 
 
 
 
Enanthems
 
Ulcerative/vesicular stomatitis
 
Palm-soul involvement
 
Rash predominantly on extremities
 
Pulmonary infiltrations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Generalized
 
Hilar
 
Cervical
 
Inguinal
 
 
 
 
 
 
 


Differential diagnosis of fever and rash based upon accompanying signs:

Arthritis or arthralgia

Acute meningococcemia

Allergic purpura

Disseminated gonoccal

Erythema marginatum(acute rheumatic fever)

hepatitis B virus, prodromal phase.

lyme disease

parvovirus B19

reiter's syndrom

rocky mountain spotted fever

roseola (especially in adults)

rubella

serum sickness

stills disease

systemic lupus erythematous

Desquamation

Arcanobacterium haemolyticum infection

Drug hypersensitivity

Graft-versus-host reaction

Kawasaki syndrome

Measles

Rocky Mountain spotted fever

Scarlet fever

Staphylococcal scalded-skin syndrome

Stevens-Johnson syndrome

Toxic epidermal necrolysis

Toxic shock syndrome

von Zumbusch pustular psoriasis

Lymphadenopathy

Cervical

Kawasaki syndrome

Rubella

Scarlet fever

Generalized

Infectious mononucleosis

Secondary syphilis

Serum sickness

Sarcoidosis

Systemic lupus erythematosus

Toxoplasmosis

Hilar

Atypical measles

Sarcoidosis

Local

Cat-scratch disease

Tularemia

Meningitis

Acute meningococcemia

Cryptococcosis

Enterovirus (Coxsackieviruses, echoviruses)

Leptospirosis

Lyme disease

Rocky Mountain spotted fever

Secondary syphilis

Mucosal membrane lesions (enanthems)

Herpes simplex

Infectious mononucleosis (palatal petechiae)

Measles (Koplick's spots)= Strawberry tongue,Atypical measles,Kawasaki disease,Scarlet fever,Toxic shock syndrome

Varicella zoster

Ulcerative or vesicular stomatitis

Hand-foot-mouth disease

Herpes simplex

Histoplasmosis

Inflammatory bowel disease

Secondary syphilis

Systemic lupus erythematosus

Palm-sole involvement

Acute meningococcemia

Atypical measles

Dengue

Drug rash

Erythema multiforme

Hand-foot-mouth disease

Kawasaki syndrome

Measles

Rocky Mountain spotted fever

Secondary syphilis

Staphylococcus aureus endocarditis

Rash predominantly on extremities

Allergic purpura

Brucellosis

Disseminated gonococcal infection

Ecthyma gangrenosum

Erythema nodosum

Sporotrichosis (fever rare)

Pulmonary infiltrate

Atypical measles

Coccidioidomycosis

Cryptococcosis

Fat embolism

Histoplasmosis

Mycoplasma pneumoniae

North American blastomycosis

Psittacosis

Rocky Mountain spotted fever

Sarcoidosis

Varicella zoster

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of fever and rush according to ...., Inc. and/or its affiliatesin three categories:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complete diagnostic aproach
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characteristics of the rash
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination
 
Laboratory testing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Macules
• Papules
• Nodules
• Plaques
 
 
 
 
 
• Vesicles
• Pustules
• Bullae
 
 
 
 
 
• Purpuric papules
• Purpuric macules
• Purpuric vesicles
 
 
 
 
 
Widespread erythema with or without edema followed by desquamation
 
 
 
• Vital signs
• General appearance
• Strict attention to lymph nodes, mucous membranes, genitalia and conjuctiva
• Evaluate liver and spleen size
• Joint examination
• Skin examination
 
Non-specific testing
 
• Complete blood count
• Urianalysis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-infectious
 
Infectious
 
Non-infectious
 
Infectious
 
Non-infectious
 
Infectious
 
Non-infectious
 
Infectious
 
 
 
 
 
Blood culture
 
• Bacteria
• Mycobacteria
• Fungal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Serology test
 
• Coccidioides immitis
• Hepatitis B
• Toxoplasma Gondii
• Borrelia Burgdorferi
• Treponema Pallidum
• Dengue virus
• HIV
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bacterial
 
Viral
 
Fungal
 
 
 
 
 
 
 
 
Bacterial
 
Viral
 
Bacterial
 
Viral
 
 
 
Antigen test
 
Criptococcal antigen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bacterial
 
Viral
 
Fungal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fluorescent antibody or PCR or viral culture
 
• Varicella zoster
• herpes virus
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Darkfield microscopy or fluorescent antibody
 
Syphilis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Immunofluorescent
 
Rikettsia (Rocky mountain spotted fever)
 
 

1.Characteristics of the rash:

Macules, papules, nodules, or plaques

Noninfectious

Erythema multiforme

Systemic lupus erythematosus

Dermatomyositis

Drug hypersensitivities

Gianotti-Crosti syndrome

Inflammatory bowel disease

Pityriasis rosea (fever rare)

Sarcoidosis

Serum sickness

Sweet syndrome (acute febrile neutrophilic dermatosis)

Still's disease (juvenile idiopathic arthritis)

Bacterial

Arcanobacterium haemolyticum

Bacillus anthracis

Bartonella bacilliformis

Bartonella henselae (cat scratch disease)

Bartonella quintana (trench fever)

Borrelia burgdorferi (Lyme disease)

Borrelia spp (relapsing fever)

Brucella spp (brucellosis)

Calymmatobacterium granulomatis (donovanosis)

Chlamydia psittaci (psittacosis)

Ehrlichiosis

Ehrlichia chafeensis (HME)

Human granulocytic erlichiosis

Erysipelothrix rhusiopathiae (erysipeloid)

Francisella tularensis (tularemia)

Listeria monocytogenes

Leptospira spp (leptospirosis)

Mycobacterium leprae

Mycobacterium marinum

Mycobacterium tuberculosis

Mycoplasma pneumoniae

Neisseria gonorrhoeae (gonorrhea)

Neisseria meningitidis (meningococcemia)

Pseudomonas aeruginosa

Rickettsia akari (rickettsialpox)

Rickettsia prowazekii (epidemic/louse-borne typhus)

Rickettsia rickettsii (RMSF-early lesions)

Rickettsia orientalis/tsutsugamushi (scrub typhus)

Rickettsia typhi (endemic/murine typhus)

Salmonella typhi (typhoid fever)

Spirillum minor (rat-bite fever)

Fungal

Blastomyces dermatitidis

Candida spp

Coccidioides immitis

Cryptococcus neoformans

Histoplasma capsulatum

Other disseminated deep fungal infections in immunocompromised patients

Viral

Adenovirus

Arbovirus

Atypical measles

Chikungunya virus

Colorado tick fever

Coxsackieviruses A and B

Cytomegalovirus, primary infection

Dengue virus

Epstein-Barr virus, primary infection

Echoviruses

Hepatitis B (urticaria)

Human herpesvirus 6 (exanthem subitum)

Human immunodeficiency virus (HIV-1)

Kawasaki syndrome (presumed viral)

Molluscum contagiosum

Orf

Parvovirus B19 (erythema infectiosum [fifth disease])

Rubella (German measles)

Rubeola (measles)

Varicella (chickenpox)

Varicella-zoster (disseminated)

Viral hemorrhagic fevers (many)

West Nile virus

Zika virus

Vesicles, bullae, or pustules

Noninfectious

Erythema multiforme bullosum

Toxic epidermal necrolysis

Dermatitis from plants

Drug hypersensitivities

Bacterial

Bacillus anthracis

Ehrlichia canis

Listeria monocytogenes

Mycoplasma pneumoniae

Neisseria gonorrhoeae

Neisseria meningitidis

Pseudomonas aeruginosa

Rickettsia akari

Rickettsia rickettsii

Staphylococcus aureus (TSS, SSSS)

Streptococcus group A

Treponema pallidum (secondary syphilis)

Vibrio vulnificus

Fungal

Histoplasma capsulatum

Viral

Colorado tick fever

Coxsackie A5, 9, 10, 16, B2, 7

Echoviruses

Eczema herpeticum

Herpes simplex (disseminated)

Varicella (chickenpox)

Varicella-zoster (disseminated)

Purpuric macules, purpuric papules, or purpuric vesicles

Noninfectious

"Allergic" vasculitis

Erythroderma

Cholesterol embolization

Disseminated intravascular coagulation (purpura fulminans)

Drug hypersensitivities

Fat embolism

Henoch-Schönlein purpura

Immune thrombocytopenic purpura

Granulomatosis with polyangiitis (Wegener's)

Bacterial

Bacteremia

Borrelia spp

Clostridium spp

Infective endocarditis (many species)

Haemophilus influenzae type B

Neisseria gonorrhoeae (disseminated gonococcal infection)

Neisseria meningitidis (acute or chronic meningococcemia)

Pseudomonas aeruginosa

Rickettsia prowazekii

Rickettsia rickettsii

Spirillum minor

Staphylococcus aureus (bacteremia)

Streptobacillus moniliformis

Streptococcus group A (streptococcal toxic shock syndrome, scarlet fever)

Streptococcus pneumoniae (asplenic patient)

Vibrio vulnificus

Yersinia pestis

Viral

Adenovirus (rare)

Atypical measles

Chikungunya virus

Colorado tick fever

Congenital cytomegalovirus

Coxsackie A and B (rare, types A-9, B2-5)

Dengue fever

Epstein-Barr virus (rare)

Echoviruses (rare, types 3, 4, 9)

Rubella

Varicella-zoster virus

West Nile virus

Yellow fever

Widespread erythema with or without edema followed by desquamation

Noninfectious

Erythroderma

Drug hypersensitivities

Graft-versus-host reaction

Stevens-Johnson syndrome

Toxic epidermal necrolysis

von Zumbusch pustular psoriasis

Bacterial

Streptococcus group A (scarlet fever, streptococcal toxic shock syndrome)

Stapylococcus aureus (TSS, SSSS)

Viral

Kawasaki syndrome (presumed viral)


2.Physical examination

  • General appearance to assess the severity of illness

3.Laboratory testing


Treatment

Shown below is an algorithm summarizing the treatment of fever and rush disease according the the [...] guidelines.

Treatment of fever depending on the cause of the symptoms, in severe cases, a child might sometimes need to stay in the hospital.
patient of fever can take acetaminophen and ibuprofen, if patient have itchy viral rash, you can try applying a cool compress or calamine lotion to the affected area.


 
 
 
 
 
 
Child with fever and rush
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-Infectious
 
 
 
 
 
 
 
Infectious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat every case according to the cause of disease
 
 
 
Bacterial
 
Viral
 
Fungal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Antibiotic and antihistaminic
 
• Rest
• Antipiretics
• Plenty of oral fluids
 
Antifungals according to the microorganism
 
 


Antibiotics can get rid of the infection, but they will not treat the rash, so we use the antibiotic in:


Do's[62]

  • Cough etiquette, contact precautions, and hand hygiene are easy and cost-effective measures in reducing the spread of infectious agents causing fever and rash.
  • For measles, mumps, rubella (MMR) prevention can be achieved by vaccination (two doses in childhood). In adolescents and adults, if none confirmatory immunization documentation exists, they need to receive two doses of MMR, at least 4-week apart.(Vaccines have been accepted in most national immunization programs)
  • Prevention of varicella and meningococcemia can also be achieved by vaccination. (vaccines have been accepted in most national immunization programs).
  • For meningococcal disease, chemoprophylaxis can also be useful. Among household contacts, the incidence of transmission of meningococcus is approximately 5%; therefore, it is recommended that household contacts of bacteriologically confirmed cases receive rifampin (adults: 600 mg bid for a total of 4 doses; children older than 1 month: 10 mg/kg; children younger than 1 month: 5 mg/kg). These contacts should be advised to watch for fever, rash, sore throat, or any symptoms of meningitis. Intimate, non-household contacts who have had mucosal exposure to the patient’s oral secretions should also receive prophylaxis. Health-care workers are not at an increased risk for the disease and do not require prophylaxis unless they have had direct mucosal contact with patient secretions (i.e., mouth-to-mouth resuscitation, endotracheal intubation, or nasotracheal suctioning). Ciprofloxacin (500 mg by mouth; adults only) or ceftriaxone (250 mg IM for adults or 125 mg IM for children) are single dose alternatives.
  • With the increasing vector borne diseases (e.g., Zika, chinkungunya, dengue, yellow fever) efforts to prevent mosquito bites are cornerstone. Some of the recommended measures in persons living or traveling to endemic areas are:
  • Long-sleeved shirts and pants.
  • If possible, keep indoors at sunset.
  • Cover water storage containers so that mosquitos cannot get inside to lay eggs.
  • Discard or empty regularly any items that hold water like tires, buckets, pools, birdbaths, flowerpot saucers, or trash containers.
  • Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.
  • Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET (≥20%), picardin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. For men who live in or have traveled to an area with Zika, and have a pregnant partner they either have to use condoms correctly from start to finish, every time they have vaginal, anal, and oral sex, or do not have sex during pregnancy. Women who had Zika virus disease should wait at least 8 weeks after exposure to attempt conception and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception.

Don'ts

References

  1. ↑ Ferguson LE, Hormann MD, Parks DK, Yetman RJ (2002). "Neisseria meningitidis: presentation, treatment, and prevention". J Pediatr Health Care. 16 (3): 119–24. PMID 12015670.
  2. ↑ Toews WH, Bass JW (1974). "Skin manifestations of meningococcal infection; an immediate indicator of prognosis". Am J Dis Child. 127 (2): 173–6. doi:10.1001/archpedi.1974.02110210023003. PMID 4204016 PMID 4204016 Check |pmid= value (help).
  3. ↑ Durack DT, Lukes AS, Bright DK (1994). "New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service". Am J Med. 96 (3): 200–9. doi:10.1016/0002-9343(94)90143-0. PMID 8154507.
  4. ↑ Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ; et al. (2015). "Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association". Circulation. 132 (15): 1435–86. doi:10.1161/CIR.0000000000000296. PMID 26373316.
  5. ↑ Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A; et al. (2015). "Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011". J Am Coll Cardiol. 65 (19): 2070–6. doi:10.1016/j.jacc.2015.03.518. PMID 25975469.
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  22. ↑ Grose C (1981). "Variation on a theme by Fenner: the pathogenesis of chickenpox". Pediatrics. 68 (5): 735–7. PMID 6273782.
  23. ↑ Ozaki T, Ichikawa T, Matsui Y, Nagai T, Asano Y, Yamanishi K; et al. (1984). "Viremic phase in nonimmunocompromised children with varicella". J Pediatr. 104 (1): 85–7. doi:10.1016/s0022-3476(84)80596-x. PMID 6317835 PMID 6317835 Check |pmid= value (help).
  24. ↑ Nguyen QT, Sifer C, Schneider V, Allaume X, Servant A, Bernaudin F; et al. (1999). "Novel human erythrovirus associated with transient aplastic anemia". J Clin Microbiol. 37 (8): 2483–7. doi:10.1128/JCM.37.8.2483-2487.1999. PMC 85263. PMID 10405389.
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  30. ↑ Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC; et al. (2004). "Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association". Circulation. 110 (17): 2747–71. doi:10.1161/01.CIR.0000145143.19711.78. PMID 15505111.
  31. ↑ Adler JL, Mostow SR, Mellin H, Janney JH, Joseph JM (1970). "Epidemiologic investigation of hand, foot, and mouth disease. Infection caused by coxsackievirus A 16 in Baltimore, June through September 1968". Am J Dis Child. 120 (4): 309–14. doi:10.1001/archpedi.1970.02100090083005. PMID 5493828 PMID 5493828 Check |pmid= value (help).
  32. ↑ Adler JL, Mostow SR, Mellin H, Janney JH, Joseph JM (1970). "Epidemiologic investigation of hand, foot, and mouth disease. Infection caused by coxsackievirus A 16 in Baltimore, June through September 1968". Am J Dis Child. 120 (4): 309–14. doi:10.1001/archpedi.1970.02100090083005. PMID 5493828 PMID 5493828 Check |pmid= value (help).
  33. ↑ Anagnostopoulos I, Hummel M, Kreschel C, Stein H (1995). "Morphology, immunophenotype, and distribution of latently and/or productively Epstein-Barr virus-infected cells in acute infectious mononucleosis: implications for the interindividual infection route of Epstein-Barr virus". Blood. 85 (3): 744–50. PMID 7530505.
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  60. ↑ Lopez FA, Sanders CV (2001). "Dermatologic infections in the immunocompromised (non-HIV) host". Infect Dis Clin North Am. 15 (2): 671–702, xi. doi:10.1016/s0891-5520(05)70164-1. PMID 11447714.
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  62. ↑ "www.infectiousdiseaseadvisor.com".
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