MEASLES

RULE IN RULE OUT

Presence of fever Measles is a serious Absence of Koplik spots Represent the
infection characterized enanthem and are the
by high fever, an pathognomonic sign of
enanthem, cough, measles appearing 1-4
coryza, conjunctivitis, days prior to the onset
and a prominent of rash. They have been
exanthem reported in 50-70% of
measles cases but
probably occur in the
great majority

Kawasaki syndrome can

cause many of the same
findings as measles but
lacks discrete intraoral
lesions and a severe
prodromal cough
Onset of rash at 3rd Symptoms increase in Cephalad progression of The rash begins on the
febrile day intensity for 2-4 days rash, with sparing of the forehead (around the
until the 1st day of the face, soles, and palms hairline), behind the
rash. ears, and on the upper
neck, as a red
maculopapular
eruption. It then
spreads downward to
the torso and
extremities, reaching
the palms and soles in
up t 50% of cases.
Maculopapular rash The rash begins on the Acquired measles
forehead (around the vaccine
hairline), behind the
ears, and on the upper
neck, as a red
maculopapular eruption
Presence of In more severe cases, No known exposure to Patients are infectious
lymphadenopathies generalized people with measles from 3 days before up
lymphadenopathy may to 4-6 days after the
be present, with onset of rash,
cervical and occipital approximately 90% of
lymph nodes especially exposed susceptible
prominent individuals experience
measles. Face-to-face
contact is not
necessary, because
 viable virus may be
suspended in air for as
long as 1 hour after the
patient with the source
case leaves a room.
Absence of coryza, After an incubation
cough, and period of 8-12 days, the
conjunctivitis prodromal phase begins
with a mild fever
followed by the onset
of conjunctivitis with
photophobia, coryza,
and a prominent cough
Persistence of With the onset of rash,
symptoms despite symptoms begin to
appearance of rash subside
Thrombocytosis, and Laboratory findings in
leukocytosis with the acute phase include
elevations of reduction in the total
neutrophils WBC, with lymphocytes
decreased more than
neutrophils. In addition,
characteristic
thrombocytosis of
Kawasaki syndrome is
absent in measles.

INFECTIOUS MONONUCLEOSIS
RULE IN RULE OUT
Presence of fever, It is characterized by No known contact with Among children,
malaise, sore throat, systemic somatic patients with EBV transmission may occur
and lymphadenopathy complaints consisting infection or with by exchange of saliva
primarily of fatigue, manifestations thereof from child to child, such
malaise, fever, sore as occurs between
throat, and generalized children in out-of-home
lymphadenopathy. childcare.

Lymphadenopathy EBV is shed in oral

occurs most commonly secretions consistently
in the anterior and for more than 6 months
posterior cervical nodes after acute infection
and the submandibular and then intermittently
lymph nodes, and less for life
commonly in the
axillary and inguinal
lymph nodes.
 Patients may complain
of malaise, fatigue,
acute or prolonged
fever (>1 week),
headaches, sore throat,
nausea, abdominal
pain, and myalgia.

Primary infection in
adolescents and adults
manifests in 30-50% of
cases as the classic
triad of fatigue,
pharyngitis, and
generalized
lymphadenopathy.
Primary infection in
children may be
clinically silent.
Residence in a Infection with EBV in Patient is 5 years old The syndrome may be
developing country developing countries seen at all ages but is
and among socio- rarely apparent in
economically children younger than 4
disadvantaged years of age, when
populations of most EBV infections are
developed countries asumptomatic
usually occurs during
infancy and early
childhood.
Hyperemic tonsils The sore throat is often No organomegaly Classic physical
accompanied by examination findings
moderate to severe are generalized
pharyngitis with marked lymphadenopathy (90%
tonsillar enlargement, of cases), splenomegaly
occasionally with (50% of cases), and
exudates. hepatomegaly (10% of
cases)
Palatal petechiae at the
junction of the hard and
soft palate are
frequently seen. The
pharyngitis resembles
that caused by
streptococcalinfection.
Presence of Rashes are usually Neutrophilic In >90% of cases there
maculopapular rash maculopapular and predominance is leukocytosis of 10,000
 have been reported in to 20,000 cells/uL, of
3-15% of patients. The which at least two
rash has the thirds are lymphocytes
appearance of atopic
dermatitis and may
appear on the
extremities and
buttocks.
Presence of In >90% of cases there
leukocytosis is leukocytosis of 10,000
to 20,000 cells/uL, of
which at least two
thirds are lymphocytes

ERYTHEMA INFECCTIOSUM
RULE IN RULE OUT
Patient is 5 years old Clinically apparent No known exposure to Transmission of B19 is
infections, such as the infected individuals by respiratory route,
rash illness of erythema presumably via large-
infectiosum are most droplet spread from
prevalent in school-age nasopharyngeal viral
children (70% of cases shedding. The
occur in patients transmission rate is 15-
between 5 and 15 years 30% among susceptible
of age) household contacts,
and mothers are more
commonly infected
than fathers
Presence of fever The prodromal phase is Absence of the The hallmark of
mild and consists of low progression of rash erythema infectiosum is
grade fever in 15-30% the characteristic rash,
of cases. which occurs in 3 stages
that are not always
Upon presence of rash, distinguishable.
affected children are
afebrile and do not The initial stage is an
appear ill. erythematous facial
flushing often described
as a “slapped cheek”
appearance. The rash
spreads rapidly or
concurrently to the
trunk and proximal
extremities as a diffuse
macular erythema in
the second stage.
 Central clearing of
macular lesions occurs
promptly, giving the
rash a lacy, reticulated
appearance.
Presence of rash The initial stage is an
erythematous facial
flushing often described
as a “slapped cheek”
appearance. The rash
spreads rapidly or
concurrently to the
trunk and proximal
extremities as a diffuse
macular erythema in
the second stage.
Central clearing of
macular lesions occurs
promptly, giving the
rash a lacy, reticulated
appearance. The rash
ends to be more
prominent on the
extensor surface,
sparing the palm and
soles.