FEVER WITH

RASH
Dr.prof Anurag Chaurasiya
Dr.KS kapoor

Presented by:-
Aditya Gautam
Aditya Singh
Ajay Singh
Akash Singh
OUT LINE :-
• Definition
• Etiology
• Clinical presentation
• Diagnostic approach
• Complication
• Management
Definition of fever
with rash:-
Simultaneous occurrence of fever and a skin
eruption, which can vary in morphology and
distribution
Etiology of fever with rash:-on the basis of
eruption of rash

1) centrally distributed maculopapular rash:-

-measles
- rubella
-epidemic and endemic typhus
-dengue fever
-typhoid fever
-sle
-scrub typhus
-erythema infectiosum
-erythema marginatum
-infectious mononucleosis
-rickettsial spotted fever
 2) Peripheral Eruption:-
- Rockey mountain spotted fever
- chikungunya
- Hand foot and mouth disease
- Erythema multiforme
- Bacterial endocarditis

• 3) Eruption with eschar / Ulcer:-

• - Scrub typhus
• - Anthrax
• 4) Urticaria like Eruptions :-
• - seen in urtricarial vasculitis
5) pustular Eruption:-

-chicken pox disease

-small pox
-Herpes simplex virus
-Rickettsial pox

6)Nodular Eruptions:-
-Bacillary
angiomatosis
-Erythema Nodosum

7)Purpuric Eruption
-Dengue
-Epidemic Typhus
-Endocarditis
-Rockey mountain spotted fever

8)Confluent Desquamative Erythema:-

-Scarlet fever
-kawasaki disease
-drug induced hypersensitivity syndrome
-Steven johnson syndrome
-staphylococcal scalded skin syndrome
Measles :-
• Caused by:-ss RNA virus of family paramyxoviridae
• Incubation period:-8 to 12 days

• Clinical features:-
• (1) from day 1 to day 3 - fever and cough ,coryza, conjunctivitis
• (2) from day 2 to 3 - koplik spot appears
• - seen opposite to second molar as
• white spot with red base
• - pathognomic
• (3) on day 4 rash appears -starts from face spread to trunk and
• then to extremeties
• (4) on day 8 rash disappears
Complication:-
(1) otitis media is mc complication
(2) bronchopneumonia
(3) sub acute sclerosing pan encephalitis

Treatment:-
supportive treatment only
(1) iv / oral fluids
(2) vitamin A to reduce mortality and morbidity

Prevention:-
measles rubella vaccine under National immunization
schedule
Scarlet Fever:-

• Etiology :-group A beta hemolytic streptococci

• Clinical features:-
• (1) fever with rash on day 2
• (2) rash starts from face , spread to trunk, never involves
palm and soles and rash is maculopapular
• (3) sore throat
• (4) tender cervical lymphadenopathy
• (5) strawberry tongue due to intense inflammation and
hypertrophy of papillae
Investigation:-
culture of throat swab is investigation of choice

Treatment:-
pennicillin G for 10 days is treatment of choice
Complication:-
(1) Acute rheumatic fever
(2) psgn
(3) post streptococcal reactive arthritis
 Chicken Pox
• Causative agent:- double standard DNA virus herpes zoster

• Incubation period:-10 to 21 days

• Clinical features:-
• (1) fever
• (2) rash - on first day of fever
• - initially macular rash turns to papular and then vesicular
• - characteristics vesicular rash
• - centripetal distribution
• - pleomorphic rash
• - dew drop in rose petal appearence
 Complications:-
(1) secondary bacterial infection bt S.aureus
(2) meningoencephalitis
(3) cerebellar ataxia
• Diagnosis :-
• (1) based on clinical diagnosis
• (2) tzank smear examination
• (3) Anti IgM antibody detection
• Treatment:-
• Symptomatic treatment
• Acyclovir
• Prevention:-
• (1) vaccination
Kawasaki disease
• Introduction:- Acute, febrile,multisystem disease of children

• Clinical features:-
• (1) non suppurative cervical adenitis
• (2) change in skin and mucous membranes such
• as edema,congested conjunctiva,erythema of
• Oral cavity,lips,palm
• (3) fever for more than 5 days
• (4)desquamation of skin of finger tip

• Complication:-
• (1) vasculitis of coronary artery
• (2) pericarditis, myocarditis, mi, myocardial ischemia
• (3) beadline aneurysm and thromboses may be seen along artey wall
 Diagnosis:-mainly clinical diagnosis

• Treatment:-
• (1) high dose of iv gamma globulin (2gm/kg as a single
infusion over 10 hr) +
• (2)Aspirin (100mg/kg/day for 14 days) followed by 3-5
mg/kg/ day for several weeks
• (3) surgical treatment in patient of giant coronary artery
aneurysm or other complications
Scrub Typhus:-

• Caused by:-orientia tsutsugamushi

• Vector:- mite ( larva of mite k/a chigger)

• Incubation period:- 6 to 21 days

• Clinical features:- fever, malaise, headache, cough
• Myalgia
• Maculopapular rash
• Eschar ( where chigger has feed)

• Complication:-
• Encephalitis
• Interstitial pneumonia
Diagnosis:-
(1) indirect fluorescent antibody
(2) indirect immunoperoxidase
(3) enzyme immunoassay
(4) PCR

• Treatment:-
• (1) Doxycycline (100 mg daily for 7-15 days)
• Or
• (2) Azythromycin (500mg for 3 days)
• Or
• (3) Chloramphenicol (500 mg 4 time daily for 7 -15 days)
Epidemic typhus

• Causative agent:-Rickettsia prowazeki

• Transmission:- feces of infected body louse

• Clinical features:-
• (1) fever
• (2) headache
• (3) rash - on day 5 of fever, purpuric rash, involves palm and soles

• Treatment:-
• Doxycycline for 5. To 7 days and for at least 3 days after patient
becomes afebrile to prevent relapse
Hand foot and mouth disease

• Causative agent:- Coxsakie A16 and Enterovirus 71

• Transmission:- direct contact and usage of infected fomite

• Clinical features:-
• fever+ ulcer or blister in oral cavity
• In palm and soles - papulovesicular lesions are seen

• Complication:-
• does not usually cause complication

• Treatment :-
• symptomatic treatment with isolation in home till all lesions resolved
Chikungunya fever
• Caused by:-SS RNA virus of togaviridae family

• Transmitted by:- (1) Aedes Agepti

• (2)Albopthicus mosquito

• Clinical features:-
• (1) fever - sudden onset
• - associated with chills
• - fever last for 2 to 3 days and may
• reoccur after 3 days so known as
• “SADDLEBACK FEVER ”
• (2) Arthralgia - migratory polyarthralgia
• (3) headache, malaise
• (4) lower back pain
• (5) Rash - maculopapular / petechial rash
• - mostly on trunk, limbs,and may desquamate
Complications:-
(1) Relapse of polyarthralgia
(2) Relapse of polyarthritis
(3) Tenosynovitis

Diagnosis:-
(1) Leukopenia
(2) increase in AST
(3) increase in C- reactive protein
(4) Decrease in platelet count
(5) Rt- pcr

Treatment :-
(1) NSAIDS
(2) sometimes Chloroquine for refractory arthritis
Endemic typhus
• Caused by:-R.Typhi
•
• Transmitted by:-Rat flea

• Incubation period:-8 to 16 days

• Clinical features:-
• (1) fever
• (2) myalgia
• (3) headache
• (4) malaise
• (5) nausea
• (6) Arthralgia
• (7) Rash - initially macular on axilla or inner arm
• - then become maculopapular involves trunk and
• extremities
Complication:-
(1) respiratory failure
(2) hematemesis
(3) cerebral hemorrhage
(4) hemolysis

Diagnosis:-
serological studies

Treatment:-
(1) Doxycycline ( 100 mg twice daily by mouth for 7 to
15 days)
Steven Johnson Syndrome
• Caused by:-

• (1) sulfonamide
• (2) Allopurinol
• (3) Antiepileptic
• (4) beta lactam
• (5) Nevirapine

• Clinical features:-

• (1) Fever > 39°C

• (2) sore throat
• (3) conjunctivitis
• (4) Target like lesion
Diagnosis:-
frozen section skin biopsy

Treatment:-
(1) immediate discontinuation of suspected
drug
(2) fluid management
(3) Atraumatic wound care
(4) infection prevention and treatment
(5) Systemic Glucocorticoid therapy
( Prednisone 1-2 mg /kg )
Rocky mountain spotted fever
• Caused by:- R. Rickettsiae

• Transmitted by:- tick

• Incubation period:- 2-14 days

• Clinical features:-
• Fever
• Headache
• Malaise
• Myalgia
• Nausea
• Vomiting
• Anorexia
• Macular rash - appear first on wrist and ankle
• - then involves extremities and trunk
Complication:-
(1) Non cardiogenic pulmonary oedema
(2) Dysrhythmia
(3) Encephalitis
(4) Renal failure due to Acute tubular necrosis
(5) Massive upper gi hemorrhage

Diagnosis:-

(1) History of exposure to tick infected environment

(2) Indirect immunofluorescence assay
(3) Immunohistological examination of a cutaneous biopsy sample fro
(4) Polymerase chain reaction
Treatment of Rocky mountain
spotted fever:-

(1) Doxycycline is drug of choice

Given( orally/iv 100 mg twice
daily)

(2) in case of allergy to Doxycycline

use Oral tetracycline (500 mg 4
times daily)
 Rickettsial pox
• Caused by:-R. Aakari
• Transmitted by:-mites
• Incubation period:-10 to 17 days

• Clinical features:-
• Fever
• Malaise
• Headache
• Myalgia
• Regional lymphadenopathy
• Chill
• Papule at site of mite feeding
• ↓
• Converted into vesicles
• ↓
Macular rash appear 2 - 6 days after onset
↓
Papule
↓
Vesicles
↓
Crusts

• Diagnosis:-
• 1) Clinical diagnosis
• 2) Serological diagnosis
• 3) Epidemiological diagnosis
• Treatment:-
• Doxycycline is drug of choice