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Djatnika Setiabudi
Diagnosis
- Accurate anamnesis
- Physical examination
- Supporting examination
Etiologic Agents
Infectious Diseases
Virus
Classic viral exanthema:
Measles, Rubella, Varicella Zoster
Virus (VZV)
Parvovirus, Roseola (HHV 6 and
HHV 7)
Others: HSV, EBV, HBV, Enterovirus, Dengue
Bacteria
Scarlet fever, meningococcemia, typhoid fever
Staphylococcal infection (sepsis, toxic shock
Etiologic Agents
Mycoplasma
Rickettsia
Noninfectious Diseases
Allergic: food, drugs, toxin, serum
sickness
Demographic data
Appearance of rash
History of exposure
History of health before
History of disease in the family
Other complaint
Physical Examination
Characteristic of rash
Macule, papule, maculo-papule
Vesicle, pustule, bulla
Petechiae or purpura
With enanthema
Mouth: Hand-foot-mouth disease?
Others
Arthritis, eye disorders, cardiac
disorders
Hepatomegaly, splenomegaly,
Diffential Diagnosis of Fever
and Rash
Viruses Bacteria Other
Anamnesis
* Symptoms
* History: contact, immunization
Clinical signs
* Typical
Laboratory examination
* Leukopenia
* Relative lymphocytosis
Clinical Manifestations of
Morbilli
Rash distribution
from head to lower
extremities
Measl
Koplick’s
spots
es
Conjunctivi
Morbilli
Complications
Acute otitis media (10–15%)
Pneumonia interstitialis (50–75% with
radiologic abnormalities)
Myocarditis and pericarditis
Encephalitis (1/1,000 cases) 7–10 days after
rash appearance
(1/3 dead, 1/3 physical defect, 1/3 recover )
Subacute sclerosing panencephalitis (SSPE)
(0,2–2 /100,000 morbilli, mean incubation 7
years)
CFR almost 100% after 6–9 months
Complications
Persistent diarrhea
Exaserbation of TBC
Keratoconjunctivitis blindness
Secondary bacterial infection of skin
Noma
Rubella (German Measles)
Clinical manifestation
Incubation period: 1–7 days
(mean: 3 days)
Acute symptoms: high fever—
headache— vomiting—chills
Signs: severe pharyngitis
hyperemia— edema— exudate—
dysphagia
Sometimes abdominal pain
Scarlet Fever - Scarlatina
Typical rash
Erythroderma diffuse (red sandpaper)
Reddish macule/papule blanching on
pressure
Firstly
on axilla, groin, and neck 24
hours all of
body
Petechiae can occur
Rash at chin and forehead (confluence):
Scarlet Fever - Scarlatina
Tongue: white thick membrane
(white strawberry tongue)
Other complaint
• Weakness, malaise
• Photophobia, cough
Dengue Fever (3)
Skin
Skin rash
Primary
Primary rash
rash
Rash:
Rash: morbilliform
morbilliform (maculopapule):
(maculopapule):
chest
chest and joint
joint fold
fold
Secondary
Secondary rash
rash
After
After day-4,
day-4, especially
especially day-6
day-6 or
or day-7
day-7
Maculopapule/petechiae
Maculopapule/petechiae /purpura/mixed
/purpura/mixed
Confluence:
Confluence: usually
usually hand
hand and
and foot
Sometimes
Sometimes itching
itching
Dengue Fever (4)
•• Hemorrhage ?
40 oC
39 oC
38 oC
37 oC
36 oC
Primary
Primary rash
rash Secondary
Secondary rash
rash
Dengue Virus Infection
Petechia
Flushing
Secondary rash (convalescent rash)
Meningococcemia
Clinical manifestations
– Progressive severe
meningitis, sepsis, septic shock
Meningococcemia
Varicella/Chickenpox
Clinical manifestations
Prodromal: 1–2 days, mild fever
Papular erythromatous
vesicle pustule crusta
Distribution of rash from body to face
neck and extremities
Pruritus +++
Mucous membrane
Spesific: several kinds of rash in
the same time
Varicella/Chickenpox
Complication
Pneumonia
syndrome
Hemorrhagic: thrombocytopenia
Varicella/Chickenpox
Complication
Superinfection
Etiologi
- Coxackie virus type 16 (A 16) >>
- Enterovirus 71 encephalitis
- Others: A5, A7, A9, A10, B2, B5
Polymorpho
us rash
One or more of the following
extremity changes
Indurativ
Erythema e edema
of palms of hands
and/ or and/or
soles feet
Nonpurulent
Strawberry
cervical
tongue
lymphadenopathy
Conclusions
Children Who Present Fever
and Rash
Group 1 : children with symptoms of serious illness
who require
immediate intervention
Individual Lesions
Color
Size
Blanches?
Characteristics
THANK YOU
Common Primary Skin
Lesions
Demographic Data
Appearance of rash
History of Exposure
Other complaint
Systemic complaint
(multiorgan/multisystem diseases)