Fever and Rash

DJATNIKA SETIABUDI
Tropical Medicine Block/System
Medical Faculty
Padjadjaran University

Introduction

Common problem in clinic

Wide range of severity :

self limited disease life-threatening

Wrong 1st suspicion fatal outcome

Knowledge of differential diagnosis !!!

Differential Diagnosis

(1)

1.

Past history of infectious disease and

immunization

2.

Type of pro-dromal period

3.

Feature of the rash

4.

Presence of pathognomic or other

diagnostic signs

5.

Laboratory diagnostic tests

Differential Diagnosis

(2)

Feature of the rash :

Category:
- macular or maculo-papular
- papulo-vesicular
- petechial or purpuric

Character : discrete or confluent

Distribution

Duration

The appearance associated with fever?

MORBILLI
(Measles; Rubeola)
Acute infection, contagious, caused by morbilli
Virus ( Famili Paramyxoviridae)
3 stadia : Prodromal
Erupstion
Convalescens
Endemic in developing countries
Effective imunization program
cases decreasing
prone to older age group

Pathology

Lesion particularly at :
- Skin
- Mucous membranes :
respiratory : nasopharyng, bronchi
digestive : oral cavity, intestine
- Conjungtiva
Serous exudate,
mononuclear cell predominant

Clinical manifestations
Incubation period : 10 12 days
Stadium prodromal :
- Coryza, Cough, Conjungtivitis
- Koplik spots
- Fever
Stadium eruption :
- High fever : 40 40,50C
- Typical rash: maculopapular eritromatosus
Head truncus extremities
Stadium convalescens:
- rash : hyperpigmentation macule/squama
- sign and symptoms resolve

Diagnosis

Anamnesis :
- symptoms
- history : - contact
- imunization

Clinical signs: typical

Laboratorium :
- leukopenia,
- relative lymphocytosis

Complication
Pneumonia / Bronchopneumonia ; Otitis media

CNS : - meningoensefalitis
- Subacute Sclerosing Pan Encephalitis
Persisten diarrhea
protein lossing enteropathy
Exaserbation of TBC
Keratoconjunctivitis blindness
Secondary bacterial infection of skin
Myocarditis
Noma

Prognosis

Particularly good prognosis

CFR decreased

Mortality caused by complication

Treatment

Symptomatic

Supportive

Vitamin A :
Unicef/WHO reccomendation

Management of complication

Prevention
Active immunization:

Measles vaccine
when ? 9 months old
booster: 15 months --> MMR
Passive immunization

RUBELLA (German Measles)

Acute infection, contagious, caused by rubela

virus (family Togaviridae)
prodromal sign : + / Rash : short periode 3 days
Typical sign: lymphadenopathy
post auricular suboccipital
posterior colli
Problems in pregnant women
Congenital rubella Syndrome

Clinical Manifestation

Incubation period : 18 + 3 days

Mild prodromal sign:

- mild fever
- adolescent : more severe

Rash : maculopapular
face sentrifugal to
neck trunk extremities
24 hours all of body
resolve in 3rd day

Congenital rubella Syndrome

Depend on gestational age

Abortus
Stillbirth
Congenital anomaly

gravida 1 4 weeks : 61%

5 8 weeks : 26 %
9 12 weeks : 8%

Congenital rubella Syndrome

Opthalmologic : cataract Micropthalmia

Glaukoma - chorioretinitis

Cardiac : Septal Defect PDA

Neurologic : Meningoencephalitis
Microcephaly mental Retardation

Auditoric : sensorineural deafness

Exanthem subitum
( Roseola infantum )

Acute infection caused by Human Herpes

Virus 6 ( some HHV 7 )

Mostly in infant

Sporadic ( sometimes epidemic)

Typical feature :
- Severity of clinical sign unproportionally with
degree of fever
- Simultaniously resolve of rash and clinical sign

Clinical Manifestation
Incubation period : 7 17 days ( + 10 days )
Most common in 6 18 months old
Fever
- abruptly high ; 39,4 41,20C
- Duration: 1 5 days ( mostly 3 4 days )
- Convulsion can occur
Mild clinical sign :
- mild pharyngitis and coryza
Rash : not specific
macule / maculopapular ; rose colour :
chest > exremities and neck face
Appear while temperature has return to normal
Disappear on 1 2 days with normal skin

Prognosis

Particularly good prognosis

Bad prognosis :
- hyperpyrexia with persistent convulsion

Treatment

Symptomatic

Supportive

Prevention : ?

SCARLET FEVER (SCARLATINA)

Grup A beta-hemolytic Streptococcus

pyrogenic toxin (erytrogenic toxin)

Clinical manifestation :
- Incubation period : 1 7 days (mean : 3 days)
- Acute symptoms:
high fever headache vomiting- chills
- Signs: severe pharyngitis
hyperemis edema eksudate- dysphagia
- Circum oral pallor dan Pastia lines
- white strawbey tongue desquamation
red strawberry tongue

Typical rash:
- Reddish macule / papule
blanching on pressure
- Firstly on axilla, groin and neck
24 hours all of body
- Severe disease : miliaria sudamina
- Petechiae can occur
- Desquamation occur from end of 1stweek
to 6th week of disease

Diagnosis
History and physical examination

Pharyngeal swab : bacterial culture

Serologic : ASTO/ ASLO/ ASO

Complete blood count : leukositosis
CRP increased or (+) : not specific

Complication
Local spread / per continuitatum:
- Sinusitis Otitis media - Mastoiditis
- Retro / para parapharyngeal absces
- Bronchopneumonia
- Servical adenitis

Hematogenic spread:
- Meningitis Osteomyelitis
Arthritis (septic)

Non-suppurative (late) complication:

- Acute rhematic fever
- Acute Glomerulonephritis

Treatment
Antibiotics :

Penicillin group
Allergy to penicillin :
Erythromycin lincomycin
Clindamycin- Cephadroxil

Symptomatic

Supportive

Management of Complication