Fever and rash

Dr. Karwan Hawez Sulaiman

MBChB, FICMS, FM
Family Medicine Specialist
College of Medicine
 Outline of the Lecture
1. Objectives.

2. Clinical case.

3. Introduction.

4. Assessment of child with fever.

5. Classification and Rx of child with fever.

 Objectives
1. To know how to assess and classify fever in IMCI
program.
2. To Rx each child according to a specific
classification.
3. To know how to differentiate between simple
and serious causes of fever.
4. To know how to approach to child with rash.
 Clinical Case Approach
Saman Husen Ahmad is 10 months old. He weighs 8.2Kg
+ 75CM. His temperature is 38C. His mother says that
he has a fever 3 days and cough with ST for 2 days
(initial visit).
His RR = 43 breaths/min. The mother feels that the child
was hot for 2 days with rash, red eyes and runny nose
+ difficulty in swallowing and throat congestion.
What is (are) your classification and Rx according to an
IMCI program?
 Introduction
• Normal body temperature is 36.6 up to
37.2C.
• Rectal temperature most consistently
reflects the body’s core temperature;
although in IMCI we depends on the axillary
temperature.
• Fever (by axillary method) is defined as a
body temperature of ≥37.5 and high fever is
≥38.
 Introduction (cont.)
• Viral infections cause most febrile episodes
but serious bacterial infections are present in
10-15% of febrile infants <3-month-old.

• Fever may also be due to UTI, typhoid fever,

kalazar, measles, malaria, or viral hepaitis.
 Introduction (cont.)
• Sudden appearance of rash is a common
presentation in children and is mostly related
to viral causes.
• Other causes of skin rash are bacteria
(staph, strept, meningococcal), syphilis,
rheumatologic diseases, and medications.
• The differential diagnosis is extensive and
includes minor and life-threatening illnesses
 Introduction (cont.)
• Points which are important in rash history
are:

Site, & mode of onset and progression.

Temporal relationship of rash and fever.

Constitutional and respiratory symptoms:

Contact with infectious disease (ill person).

Hx of drug ingestion and immunization hx.

 Introduction (cont.)
 Points which are important in examination are:

 Skin of whole body including palm and feet.

 Nails & Scalp.

 Mucous membrane.

 Oropharynx.

 Conjunctiva & LAP, hepatosplenomegaly.

Macule Papule Vesicle
 Clinical Case Management
Name: Saman Husen Ahmed
Findings:
• Age is 10ms, weight is 8.2Kg and temp is 38C.
• Fever, rash, cough, ST, runny nose, and red eyes for
5 days.
• No general danger sign.
• RR = 43.
1st classification: no pneumonia (cough or cold).
2nd classification: non-streptococcal sorethroat .
 Clinical Case Management (cont.)
3rd and 4th classifications:
• Fever, bacterial infection unlikely.
• Possible Measles.
Rx:
• Soothe the throat and relieve the cough with a safe remedy.
• Give paracetamol for …………………. .
•Send for blood sample and health promotion unit.
• Give vitamin A.
• Follow up in 2 days if fever persists.
• Advice when to return immediately.
Thank You