Assess the clinical syndrome

Riskfactors, geography, season and

associated symptoms

INVESTIGATIONS
 Essential (to be performed in all)
 Blood cultures x 2
 CBC,Platelets, Electrolytes, CRP,Creatinine, LFT,Urine analysis,CxR
Rapid diagnostic tests (to be performed at admission)
 *Malaria card test (RDT)(kit must use HRP/LDHantigen) /Malarial smearsx 3
 #Dengue card tests for NS1antigen, IgM and IgG
 †Typhidot
 Chikungunya test serologis

Rapid tests suggest diagnosis No

Malaria Dengue Typhoid Chikungunya

 Inj.Artesunate  Isotonic fluids Inj. Symptoms
2.4mg/kg  Supportive care Ceftriaxone Treatment
 at admission, then for bleeding, 100mg/kg/da Multivitamin
at 12 h and 24 hr,  electrolyte y
then once a day abnormalities

Empirical treatment
 Inj. Ceftriaxone 100mg/kg/day + Tab. Doxycycline 5mg/kg/day +
 Inj. Azithromycin 10mg/kg/day
 Further work up (as indicated)
 Serology for Scrub typhus (Weil felix, IFA) Dengue (IgM, IgG),
Leptospira
 (IgM, Dot ELISA) WIDAL
 USGabdomen
 Bone Marrow Examination and Cultures
 Viruses :

Enterovirus

Congenital rubella
Adapted from : Prince A. CBC with differential
Infectious diseases. In: and platelet count CMV
Behrman RE, Kliegman RM Petechial or
(eds). Nelson Essentials of purpuric rash Consider : Atypical measles
Pediatrics, 3rd ed.
Philadelphia. WB Saunders Coagulation studies HIV
1998: 317
Blood culture Hemorrhagic fever virus

CSF cytology and Hemorrhagic varicella

culture
Bacteria :

Sepsis (meningococcal,

gonococcal, pneumococcal,

Viruses :
Haemophilus influenzae)

Roseola ( HHV-6 )
Endocarditis
Macular or
Epstein-Barr
Pseudomonas virus
aeruginosa
maculopapular
FEVER AND RASH rash
Adenovirus
Rickettsia

Measles
Rocky Mountain spotted fever
History and Appearance
physical of the rash Rubella
Endemic typhus
examination
Fifth disease (parvovirus)
Ehrlichiosis

Enterovirus
Others :

Hepatitis B virus (papular

Henoch-Schonlein purpura

acrodermatitis)
Vasculitis

HIV
Thrombocytopenia

Dengue virus

Bacteria :

Mycoplasma pneumoniae

Group A Streptococcus (scarlet

fever)
Bacteria :

Diffuse Arcanobacterium hemolyticus

Scarlet fever (Group A
erythroderma
Secondary syphilis
streptococcus)
Leptospirosis
Toxic shock syndrome
Other rashes
Pseudomonas
(Staphylococcus aureus)
Meningococcal infection (early)
Staphylococcal scarlet fever
Salmonella

Lyme disease
Staphylococcal scalded skin
Listeria monocytogenes
Fungi (Candida albicans)
Rickettsia :

Early Rocky Mountain spotted fever

Typhus

Ehrlichiosis
Adapted from : Prince A. Viruses :
Infectious diseases. In:
Behrman RE, Kliegman RM Epstein-Barr virus
(eds). Nelson Essentials of
Pediatrics, 3rd ed. Hepatitis B virus
Philadelphia. WB Saunders
1998: 317 HIV

Enteroviruses

Bacteria :
Urticarial rash
Mycoplasma pneumoniae

Group A streptococcus

Viruses :
Shigella
Consider : Herpes simplex
Vesicular, Meningococcus
bullous, Gram stain and Varicella
Yersinia zoster
pustular rash
culture of the lesion Coxsackie virus A and B
Others :
Tzanck preparation ECHO (enteric cytopathogenic
Parasites
PCR testing human orphan) virus
Insect bites
FEVER Bacteria :
Drug reaction
AND RASH
(continued) Staphylococcal scalded skin syndrome

Viruses :
Staphylococcal bullous impetigo

Epstein-Barr virus
Group A streptococcus impetigo
Consider :
Hepatitis
Others : B
Streptococcal culture
Erythema Bacteria :
Toxic epidermal necrolysis
or antigen detection
nodosum
Group A streptococci
Erythema multiforme (Stevens-Johnson
tests
Tuberculosis
syndrome)
Hepatitis B serology
Yersinia
Rickettsial pox
PPD (tuberculous skin
Cat-scratch disease
test)
Fungi :
Ecthyma gangrenosum
Chest X-ray Pseudomonas aeruginosa

Erythema chronicum migrans Coccidiomycosis

Lyme disease

Distinctive Necrotic eschar Histoplasmosis

Aspergillosis, mucormycosis
rashes
Erysipelas rashes Others : Group A streptococcus

Koplik spots Measles

Sarcoidosis
Erythema marginatum Rheumatic fever
Inflammatory bowel disease

Systemic lupus erythematosus

Behcet disease