Fever with Rash Urticaria Purpura Eschar near medial canthus History

1. Prodromal Symptoms 2. Evolution of rash 3. Associated Symptoms 4. Exposure to Infections – Persons, insects, animals 5. Travel, time of year, drug exposure Examinations

1. Nature of rash 2. Rash distribution – Exanthem and enanthem 3. Mucosal conjunctival lesion 4. Lymph node – Liver and spleen 5. Genital lesion and CNS involvement 6. Timing in relation to fever Broadly they are classified as

• Centrally distributed maculopapular • Peripheral • Confluent desquamative erythema • Vesiculobullous • Urticaria • Purpuric Centrally distributed maculopapular rashes

Common viral exanthem Drug rash Measles

Maculopapular rash over face Enanthem: mucus membrane

Maculopapular rash over trunk Maculopapular rash over palm Rubella

9 Rubella

. Fever : Not high grade

. Rash scattered

. Fever disappears when rash appears

. Occipital, epitrochlear lymph node appears

. No significant coryza

. Short duration

. Relatively benign diseases

10 Roseola

11 Roseola infantum (HSV 6)

• Rash appears on 4th or 5th day • Fever resolves by crisis or subsides by lysis • Caused by HSV 6 • Called as “sixth disease” • May cause febrile seizures, encephalitis, aseptic meningitis

12 Erythema infectiousum (Fifth disease) Parvo virus • Fever for 3-5 days • Rash on face

13 Lacy reticular rash

14 Drug rash Features of drug rash

Features Drug rash Rhinnorhea Uncommon /conjunctivitis Itching Present Enanthem Absent

Eosinophilia and raised Usually present IgE

16 Peripheral rash with fever Erythema multiforme Secondary syphilis Hand foot and mouth disease Dengue – Both central and peripheral

Hand foot and mouth disease Dengue rash

Morbiliform rash Dengue rash Spotted Fever and Typhus belongs to Rickettsial group 21 Eschar near medial canthus and chest

22 Spotted fever and typhus belongs to rickettsial group – they are not uncommon in our country as numerous reports are there References

1. Mahajan SK. Scrub Typhus. J Assoc Physic India 2005;53:954-8 2. Singh P. Scrub Typhus, a case report: Military and regionalsignificance. MJAFI 2004; 60: 89-90. 3. Soman DW. Tsutsugamushi disease (scrub typhus) inBombay City and suburbs J Indiana State Med Assoc1954;23:389-94. 4. Menon RD, Padbidri VS, Gupta NP. Sero-epidemiologicalsurvey of scrub typhus. J Hyg Epidemiol Microbiol Immunol.1978;22:306-11. 5. Saxena VK. Chigger mite infestation of small mammals in aferal biotope of a public park area of south Delhi. J CommunDis. 1989;21:360-4. 6. Sharma A, Mahajan S, Gupta ML, et al. Investigation of an Outbreak of Scrub Typhus in Himalayan Region of India. Jpn J Infect Dis 2005;58:208-10. Herpes Simplex Virus 2 closely related types – HSV1 and HSV2

• Type of infection : ü Primary infection – HSV seronegative, no preexisting immunity ü Non primary 1st infection – Already infected with one type but first time infected with other type. ü Recurrent infection – virus from latent infection periodically reactivate • Spread by direct contact between skin and mucous membrane Herpes Simplex Infection

Herpes labialis/cold Herpes labialis/cold Herpetic Herpangina sore (Primary) sore (Recurrent) Gingivostomatitis

Genital herpes Whitlow Fever with diffuse erythema and desquamation

1. Scarlet fever 2. Kawasaki disease 3. Streptococcal toxic shock syndrome 4. Staphylococcal toxic shock syndrome 5. Staphylococcal scalded skin syndrome Scarlet fever

27 Skin and mucous membrane manifestation of Kawasaki diseases Skin and mucous membrane manifestation of Kawasaki diseases Purpuric eruption with fever

Meningococcemia Viral infection – Coxsackie A9, echo virus, EB virus Atypical measles Dengue hemorrhagic fever Bacteremia Acute Meningococcemia Fever with Inflammation of Subcutaneous tissue Causes of Erythema nodosum Idiopathic Infections Beta hemolytic streptococci Mycobacterium species Hepatitis B and C Fungal Infection Medicines Sulfonamides, Oral contraceptives SLE Erythema nodosum Sarcoidosis Inflammatory bowel disease Malignancy – lymphoma and leukemia