A/Prof Alison Kesson - Fever and a rash in children – current

62 Pages·2011·1.66 MB·English

by  Alison Kesson

Fever and a Rash
Professor Alison M Kesson
Infectious Diseases and
Microbiology
Approach to Diagnosis
• This is not easy !!!
• Rash may or may not be diagnostic
• Will need history, physical exam and
investigations
• HISTORY
– Prior infectious diseases
– Immunisations
– Travel
– Prodromal illness
– Contacts
Approach to Diagnosis
• PHYSICAL EXAM
– General state
– Temperature
– Conjuctiva
– Ears and throat
– Auscultation of chest
– Abdomen – liver and spleen
– Lymph nodes
Types of rashes
• Vesicles and Bullae
• Purpura and ecchymoses
• Macular
• Papules
• Urticaria
• Erthema multifomae
• Erythema nodosum
Vesicles and Bullae
Vescicles
• Result from a disturbance of cohesion of epidermal
cells or components of a basement membrane
zone associated with influx of fluid into or beneath
the site of disturbance.
• Vesicles < 1cm; bullae > 1cm
• Rapidly evolve into erosions, ulcers or crusts.
• Most are benign, others are rapidly progressive
and life threatening.
Vesicular rashes
• VZV
• HSV
• Enterovirus – hand foot and mouth disease
• Impetigo
• Contact dermatitis
• Pemphigus
• Pemphigoid
• Incontinentia pigmenti
• Epidermolysis bullosa
• Burns
• Drugs
• Allergies
Vesicular rashes
• Solitary – lesions of streptococcal blistering
dactylitis
• Localised – staphylococcus bullous impetigo
• Grouped or clustered – herpes simples
virus infection
• Arranged linearly – shingles - Varicella
zoster virus
• Generalised – chickenpox - varicella.
Herpes simplex
Herpes simplex