Fever and rash

Alan R. Tumbelaka
Pediatric decision-making strategies
Pomeranz, Buzey,Sabnis
WB Saunders Co, Philadelphia,
to accompanied Nelson textbook pediatrics 16th ed.

H and P

History of rash

Presence of pruritus / pain

Appearance related to fever, evolution,
progression and distribution
History of contacts, exposures
History of underlying immune deficiency

Physical examination

Severity of illness, vital signs and height of fever

Tachycardia and tachypnea (indicate sepsis)
Hypotension

Appearance of the rash

Papular
Vesicular
Petechial
Presence of associated enanthemas
Distribution :

Generalized / localized
Symmetric or asymmetric
Centripetal or centrifugal

Petechial
Or purpuric

Fever
and
Rash

History
Physical exams

Macular or
maculopapular
Diffuse
erythroderma

Appearance of
The Rash

Urticarial
rash
Erythema
nodosum
Vesicular, bullous,
Pustular rash

Distinctive
rashes

Petechial
Or purpuric

Complete blood count

With differential count

Platelet count

Consider:

Coagulation studies
Blood culture
Cerebrospinal fluid cytology and culture

Petechial
or purpuric

Viruses

Enteroviruses
Congenital rubella
CMV
Atypical measles
HIV
Hemorrhagic fever

Rickettsia

Others

Bacteria

Sepsis
Endocarditis
P aeruginosa

Rocky Mountain spotted

Epidemic typhus
Ehrlichiosis

Henoch Schonlein
Urticarial at beginning,
later purpuric
Vasculitis
Thrombocytopenia

Petechial
Or purpuric

Fever
and
Rash

History
Physical exams

Macular or
maculopapular
Diffuse
erythroderma

Appearance of
The Rash

Urticarial
rash
Erythema
nodosum
Vesicular, bullous,
Pustular rash

Distinctive
rashes

Macular or
maculopapular

Viruses

Roseola (HHP-6)
EB virus
Adenovirus
Measles
Rubella
Fifth diseases (parvovirus)
Enterovirus
HIV
Dengue virus

Bacteria

Rickettsial

M pneumoniae
Scarlet fever
Syphilis
Leptospirosis
Salmonella
Lyme disease
Early R Mountain sptt
Typhus

Other

Kawasaki

Petechial
Or purpuric

Fever
and
Rash

History
Physical exams

Macular or
maculopapular
Diffuse
erythroderma

Appearance of
The Rash

Urticarial
rash
Erythema
nodosum
Vesicular, bullous,
Pustular rash

Distinctive
rashes

Diffuse erythroderma,
urticarial rashes

Diffuse
erythroderma

Urticarial rashes

Bacteria

Viruses

Streptococcus

Scarlet fever

Staphylococcus

SSSS
Toxic shock

Bacteria

Fungi

Epstein Barr
Hep B
HIV
Enterovirus
M pneumoniae
Shigella
Meningococcus

Others

Parasites
Insect bites
Drug reaction

Petechial
Or purpuric

Fever
and
Rash

History
Physical exams

Macular or
maculopapular
Diffuse
erythroderma

Appearance of
The Rash

Urticarial
rash
Erythema
nodosum
Vesicular, bullous,
Pustular rash

Distinctive
rashes

Erythema nodosum

Consider:

Streptococcal cultur or
Antigen detection test
Hep B serology
Tuberculous test
CXR

Viruses]

Bacteria

Tuberculosis
Yersinia
Streptococcus

Fungi

Epstein Barr
Hep B

Coccidiomycosis
Histoplasma

Others

Sarcoidosis, SLE, Behcet

etc

Petechial
Or purpuric

Fever
and
Rash

History
Physical exams

Macular or
maculopapular
Diffuse
erythroderma

Appearance of
The Rash

Urticarial
rash
Erythema
nodosum
Vesicular,bullous,
Pustular rash

Distinctive
rashes

Vesicular, bullous,
pustular rash

Consider

Gram stain
Cultur of the lession
Tzanck preparation
PCR

Viruses

Bacteria

H simplex
Varicella zoster
Coxsackie A & B
ECHO virus
Staph scald skin syndr
Staph bullous impetigo
Strept A impetigo

Other

TEN
Steven Johnson synd
Rickettsial pox
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