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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 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.


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 systematic approach is crucial for establishing a timely diagnosis, determining early therapy when appropriate, and considering isolation of the patient if necessary.<br />
Line 165: Line 165:


==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 the the [...] guidelines.
{{familytree/start |summary=PE diagnosis Algorithm.}}
 
=== 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)
<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-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 herpeticumΔ
 
Herpes simplex (disseminated)Δ
 
Varicella (chickenpox)Δ
 
Varicella-zoster (disseminated)Δ
 
=== Purpuric macules, purpuric papules, or purpuric vesicles ===
 
=== Noninfectious ===
"Allergic" vasculitis¶
 
Erythroderma
 
Cholesterol embolization
 
Disseminated intravascular coagulation (purpura fulminans)Δ
 
Drug hypersensitivities
 
Fat embolism
 
Henoch-Schönlein purpura
 
Immune thrombocytopenic purpura
 
Granulomatosis with polyangiitis (Wegener's)
 
=== Bacterial ===
BacteremiaΔ
 
''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){{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | A01 | | | A01= }}
{{familytree | | | | A01 | | | A01= }}
{{familytree | | | | |!| | | | }}
{{familytree | | | | |!| | | | }}
Line 191: Line 504:
{{familytree/end}}
{{familytree/end}}


==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>
*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
*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. 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:
*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:
** – Long-sleeved shirts and pants.
**– Long-sleeved shirts and pants.
** – If possible, keep indoors at sunset.
**– If possible, keep indoors at sunset.
** – Cover water storage containers so that mosquitos cannot get inside to lay eggs.
**– 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.
**– 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.
**– 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.
**– 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==
==Don'ts==


*The content in this section is in bullet points.
*suggest not combining or alternating acetaminophen with ibuprofen.
*we suggest not using external cooling for temperature reduction


==References==
==References==

Revision as of 05:37, 22 February 2021


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 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.

A systematic approach is crucial for establishing a timely diagnosis, determining early therapy when appropriate, and considering isolation of the patient if necessary.

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]

DIAGNOSTIC APPROACH

Characteristics of the rash: Erythema multiforme, Erythema nodosum, Toxic epidermal necrolysis , Urticaria

Physical examination:

Vital signs

●General appearance to assess the severity of illness

●Strict attention to lymph nodes, mucous membranes, conjunctivae, and genitalia

●Meningeal signs and complete neurologic evaluation

●Liver and spleen size

●Joint examination

●Skin examination (t

Laboratory testing: Appropriate laboratory testing includes [5]:

●Nonspecific tests such as 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 therapy

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

●Antigen tests, when appropriate (eg, serum cryptococcal antigen)


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]

Complete Diagnostic Approach

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

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 herpeticumΔ

Herpes simplex (disseminated)Δ

Varicella (chickenpox)Δ

Varicella-zoster (disseminated)Δ

Purpuric macules, purpuric papules, or purpuric vesicles

Noninfectious

"Allergic" vasculitis¶

Erythroderma

Cholesterol embolization

Disseminated intravascular coagulation (purpura fulminans)Δ

Drug hypersensitivities

Fat embolism

Henoch-Schönlein purpura

Immune thrombocytopenic purpura

Granulomatosis with polyangiitis (Wegener's)

Bacterial

BacteremiaΔ

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)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

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

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's[62]

  • 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. 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:
    • – 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

  • suggest not combining or alternating acetaminophen with ibuprofen.
  • we suggest not using external cooling for temperature reduction

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.
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  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).
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