Saturday, February 20, 2010

Child with Fever and Rash- a confusing condition?

Fever plus rash is a common combination seen in children. Often comes in out breaks. Most of the time diagnosis is made on clinical grounds and treated accordingly. Therefore it is important to know the differentials for a child with this problem.


I=7-10d, fever, coryza, cough, conjunctivitis, catarrh, Koplik’s spot.
Rash: 4th day, behind the ear to face and trunk (red, maculopapular)
Cplx: pneumonia, Otitis media, Encephalitis
Ix: raise in measles antibody titre, Immunoflourescence of Nasopharyngeal aspirate
Tx: symptomatic fluid and PCM, no antibiotics unless complicated


I= 10-21d, URTI, catarrh, cervical/suboccipital lymphadenopathy
Rash: erythematous, mainly on trunk
Cplx: Arthralgia, encephalitis (rare in childhood)
Ix: virus culture from stool/nose, rubella antibody titre

Mumps (no rash)

I=4-28d, parotitis (other glands rarely involved)
Cplx: meningitis, pancreatitis, orchitis
Ix: virus isolation from saliva, lymphocytosis, rise of Mumps antibody titre

Varicella (chicken pox)

I=10-21d, fever, rash (itchy): evolves from papules to vesicles, pulstures and scabes
Cplx: conjunctival lesion, encephalitis
Ix: electron microscopy of fluid from vesicles and virus culture, monoclonal antibody

Scarlet fever

I= 1-7d, (URTI) tonsillitis, rash (diffuse, erythematous, mainly on trunk 24-48hr after onset, papular, erythematous on trunk and limbs-looks red, face spared, blances, 3-4 d later rash fade with desquamation on hands, feet.)
Cplx: otitis media, Rh fever, Acute Nephritis
Ix: Throat swab for grp A haemolytic streptococcus, raised ASOT
Tx: penicillin V (250 mg/dose bid–tid PO) for 10 days, or benzathine penicillin G (600,000 IU for ≤60 lb, 1.2 million IU for >60 lb, IM) for compliance. Erythromycin (erythromycin estolate 20–40 mg/kg/24 hr divided bid–qid PO, or erythromycin ethylsuccinate 40 mg/kg/ 24 hr divided bid–qid PO) for 10 days

Other Differential Diagnoses to be considered:

Kawasaki disease (fever, rash, red swollen moth/hand/foot)

Meningococcemia (N. Meningitidis)

Roseola infentum (herpes 6&7)

Erythema infectiosum (parvo virus)

Dengue fever (fever, rash, bleeding, joint pain)

Hand foot mouth disease (coxsacie A)

Ricketsial diseases: Rocky Mountain spotted fever, Mediterranean spotted fever (eschar), scrub typhus (eschar) Dx by immunohistologic demonstration of rickettsiae on skin biopsy. Dec plt and wbc

I(incubation peiod), Ix (investigations), Tx (treatment), Dx (diagnosis) Cplx (complications)