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Dr(Mrs) M.S.Panapitiya Consultant Paediatrician

Fever & rashes. Dr(Mrs) M.S.Panapitiya Consultant Paediatrician. why. Viral exanthum Serious illness. Main features. Well child / ill child Erythematous / haemorrhagic rash. Diagnostic clues. Association with fever Distribution Morphology. Classfication of rashes.

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Dr(Mrs) M.S.Panapitiya Consultant Paediatrician

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  1. Fever & rashes Dr(Mrs) M.S.Panapitiya Consultant Paediatrician

  2. why • Viral exanthum • Serious illness

  3. Main features • Well child / ill child • Erythematous / haemorrhagic rash

  4. Diagnostic clues • Association with fever • Distribution • Morphology

  5. Classfication of rashes • Mobiliform rashes • Scarlantiform rashes

  6. Mobilliform rash

  7. Scarlatiniform rash • Has the pattern of scarlet fever • has innumerable small red papules • Patients with other conditions such as Kawasaki disease viral infections drug reaction

  8. Aetiology • VIRAL INFECTIONS • BACTERIAL INFECTIONS • NONINFECTIVE

  9. Viral infections Chicken pox Hand foot mouth disease Measles Rubella Fifth disease Sixth disease Dengue fever

  10. Fifth Disease Erythemainfectiousum Parvovirus B19 The preceding four exanthems were 1. Measles 2. Scarlet fever 3. Rubella 4. Atypical Scarlet fever ( Filatov-Dukes disease) 6. Roseolainfantum (sixth disease)

  11. Fifth Disease Benign, self-limited exanthematous illness of childhood. • The prodromal phase • low-grade fever • headache • mild upper respiratory • tract infection

  12. Fifth Disease Characteristic rash occurs in three stages erythematous facial flushing "slapped-cheek" appearance.

  13. 2. Spreads rapidly to the trunk and proximal extremities as a diffuse macular erythema

  14. Central clearing of macular lesions occurs giving the rash a lacy, reticulated appearance.

  15. Fifth Disease Palms and soles are spared, more prominent on extensor surfaces rash resolves spontaneously without desquamation

  16. Roseolainfantum Exanthemsubitum Sixth disease Human herpes virus 6 (HHV-6)

  17. Roseolainfantum Primary HHV-6 infection occurs early in life. Peak acquisition of primary HHV-6 infection, from 6-15 m of age By 3-5 yr, 80-100% of children are seropositive

  18. Roseolainfantum • The prodromal period • usually asymptomatic but may • include • mild upper respiratory tract signs • mild conjunctival redness • cervical or, less frequently, occipital • lymphadenopathy • mild palpebral edema.

  19. Roseolainfantum Clinical illness 101-106°F with an average of 103°F irritable and anorexic Seizures may occur in 5-10% of children Infrequently abdominal pain, vomiting, and diarrhea. Fever persists for 3-5 days, and then typically resolves rather abruptly (crisis)

  20. Roseolainfantum A rash appears within 12-24 hr of fever resolution Begins as discrete, small (2-5 mm), slightly raised pink lesions on the trunk and spreads to the neck, face, and proximal extremities Not pruritic, and no vesicles or pustules remain discrete but occasionally may become almost confluent. After 1-3 days, the rash fades.

  21. Measles (rubeola)

  22. Measles Measles has three clinical stages Incubation stage 10-12 days Prodromal stage 2- 4 days Disease stage 6-10 days

  23. Measles prodromal phase • characterized by • low-grade to moderate fever • conjunctivitis • coryza • dry cough • red mottling on the hard & soft palate • Koplik spots

  24. Measles Koplik spots The pathognomonic sign of measles, appear by 2-3 days Grayish white dots, usually as small as grains of sand Opposite the lower molars They appear and disappear rapidly, usually within 12-18 hr.

  25. Measles EXANTHEMATOUS PHASE The temperature rises abruptly as the rash appears neck, behind the ears, along the hairline, and on the posterior parts of the cheek

  26. Measles Lesions macular, maculopapularconfluent,haemorrhagic Spreads rapidly over the entire face, neck, upper arms, and upper part of the chest within the first 24 hr

  27. Measles • Mx • admit • iv fluids • vit A • antiotics • NUTRITION

  28. Measles • Complictions pneumonia diarrhoea malnutrition blindness encephalitis death

  29. RUBELLA (German or three-day measles) The incubation period is 14-21 days The prodromal phase of mild catarrhal symptoms is shorter than that of measles and may go unnoticed Two thirds of infections are subclinical.

  30. RUBELLA most characteristic sign retroauricular, posterior cervical, and occipital An enanthem appears in 20% of patients just before the onset of the skin rash. discrete rose-colored spots on the soft palate (Forchheimer spots) Lymphadenopathy.

  31. Rubella Exanthem It begins on the face and spreads quickly. Discrete maculopapules are present in large numbers Spread rapidly over the entire body, usually within 24 hr. May be confluent The eruption usually clears by the third day. Rubella without a rash has been described.

  32. Vesicular exanthum CHICKEN POX Hand foot and mouth disease

  33. Hand foot and mouth disease Coxsackievirus A Coxsackie B viruses Enterovirus 71

  34. Hand foot and mouth disease It is usually a mild illness, with or without low-grade fever. The oropharynx is inflamed and contains scattered vesicles on the tongue, buccal mucosa, posterior pharynx, palate, gingiva, and/or lips. These may ulcerate, leaving 4-8 mm shallow lesions with surrounding erythema.

  35. Hand, foot, and mouth disease Develop the rash on the palms of the hands, soles of the feet, maybe on buttocks. Rash is not itchy, Starts out as small, flat, red dots turn into bumps or blisters(3-7mm)

  36. Hand, foot, and mouth disease They are generally more common on the extensor surfaces Vesicles resolve in about 1 week

  37. Mx Symptomatic No specific therapy

  38. CHICKEN POX Vricella-Zoster Virus Patients are contagious 24-48 hr before the rash appears and until vesicles are crusted, usually 3-7 days after onset of rash

  39. CHICKEN POX Prodromal phase 24- 48 hr before the rash malaise, headache, anorexia fever - variable - resolves 2-4 days after the onset of the rash

  40. CHICKEN POX • The rash often appears first • on the scalp, face, or trunk. • It can then spread over the • entire body. Ulcerative lesions involving the oropharynx are common

  41. CHICKEN POX Vricella-Zoster Virus The initial exanthem • The initial exanthem • Intensely pruritic • Erythematousmacules • Papular stage • Blisters on a pink base • Dry brown crusts • New waves of blisters often spring up as the illness progresses

  42. CHICKEN POX Vricella-Zoster Virus Varicella is a more serious disease with higher rates of complications and deaths among infants, adults, and immunocompromised patients.

  43. Newborn with varicella Newborns have particularly high mortality around the time of delivery. Maternal varicella one week before or 2 days after birth frequently results in the newborn developing severe varicella

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