Differential Diagnosis of Dengue with Rash

Total Page：16

File Type：pdf, Size：1020Kb

Learn More Dengue Clinical Case Management E-learning Differential Diagnosis of Dengue with Rash Illness History Exam Test Occurs most commonly in children, 5 to Fever, facial erythema or “slapped • None: clinical diagnosis 15 years, during winter and spring. If cheek” rash in first 1–4 days, • Anti-Parvovirus B19 IgM antibody: history of exposure to person with cold- followed by a generalized lacy rash positive like symptoms, patient would have been that lasts 4–10 days and can be Erythema infected 4–14 days before onset of pruritic. Arthritis involving hands, Infectiosum symptoms. Family gives history of feet or knees can be present, (Fifth disease) fever, headache, runny nose, and rash. especially in adults. Patient might complain of arthralgia. Occurs most commonly in infants and High fever, generalized rose-pink • None: clinical diagnosis children, 1 to 5 years. Family gives macular rash on trunk and proximal • Serum for anti-human herpes virus history of high fever for 3–5 days, then extremities, cervical or occipital types 6 or 7 antibodies: positive abrupt appearance of rash at lymphadenopathy, red papules and Roseola defervescence which lasts for 1–3 days. erosions of soft palate, and Infantum Might have history of seizure with fever periorbital or eyelid edema. Patient (Sixth disease) or mild upper respiratory symptoms, can develop encephalopathy or including runny nose and sore throat. aseptic meningitis. Occurs most commonly in young Fever, lymphadenopathy, periorbital • Monospot test: positive detects EBV children and adolescents. Family gives edema, hepatosplenomegaly, and heterophile IgM antibody history of fever, sore throat, malaise morbilliform rash, initially on trunk • EBV viral capsid antigen: IgM positive and headache, then rash at day 4–6 of and upper extremities which later in primary infection until 4–6 weeks, illness. extends to entire body. Genital IgG appears in acute phase, peaks at Epstein-Barr ulceration can be noted. 2–4 weeks, and then persists for life. Virus (EBV) Infection • EBV nuclear antigen: antibody negative in primary infections • CBC: atypical lymphocytes ≥ 10% • Liver function test: elevated AST and ALT Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases .

Copy Link

Recommended publications

Roseola Fact Sheet
Sixth Disease/ Exanthem Subitum DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH Division of Epidemiology, Disease Surveillance and Investigation 899 N. Capitol Street, NE, Suite 580 Washington, D.C. 20002 202-442-9371 Fax 202-442-8060 * www.dchealth.dc.gov What is Roseola? medications. Frequent hand washing may Roseola is an acute, febrile rash illness caused by a limit transmission (spread). Women who are virus. pregnant and have been exposed to this illness should discuss the exposure with Who gets Fifth Disease? their doctor. Roseola occurs in children usually under four years of age. It is most common in children under the age Should a child with Roseola be excluded of two. from Child-care? Yes, a child with fever and rash should be What are the symptoms of Roseola? excluded from child-care until seen by a The symptoms of roseola include a high fever that health-care provider. The child may return lasts for three to five days. A runny nose, irritability, to child-care once the fever has gone, even if eyelid swelling, and tiredness may also be present. the rash is present. When the fever disappears, a rash appears, mainly on the face and body. How can Roseola be prevented? There is no vaccine or medicine that How is Roseola spread? prevents roseola. Frequent and thorough Roseola is spread from person to person but the hand washing is recommended as a practical exact way is not known. It appears that saliva may be and effective method of preventing most an important way for the spread of the virus.
[Show full text]
Communicable Disease Chart
COMMON INFECTIOUS ILLNESSES From birth to age 18 Disease, illness or organism Incubation period How is it spread? When is a child most contagious? When can a child return to the Report to county How to prevent spreading infection (management of conditions)*** (How long after childcare center or school? health department* contact does illness develop?) To prevent the spread of organisms associated with common infections, practice frequent hand hygiene, cover mouth and nose when coughing and sneezing, and stay up to date with immunizations. Bronchiolitis, bronchitis, Variable Contact with droplets from nose, eyes or Variable, often from the day before No restriction unless child has fever, NO common cold, croup, mouth of infected person; some viruses can symptoms begin to 5 days after onset or is too uncomfortable, fatigued ear infection, pneumonia, live on surfaces (toys, tissues, doorknobs) or ill to participate in activities sinus infection and most for several hours (center unable to accommodate sore throats (respiratory diseases child’s increased need for comfort caused by many different viruses and rest) and occasionally bacteria) Cold sore 2 days to 2 weeks Direct contact with infected lesions or oral While lesions are present When active lesions are no longer NO Avoid kissing and sharing drinks or utensils. (Herpes simplex virus) secretions (drooling, kissing, thumb sucking) present in children who do not have control of oral secretions (drooling); no exclusions for other children Conjunctivitis Variable, usually 24 to Highly contagious;
[Show full text]
Clinical Impact of Primary Infection with Roseoloviruses
Available online at www.sciencedirect.com ScienceDirect Clinical impact of primary infection with roseoloviruses 1 2 1 Brenda L Tesini , Leon G Epstein and Mary T Caserta The roseoloviruses, human herpesvirus-6A -6B and -7 (HHV- infection in different cell types, have the ability to reac- 6A, HHV-6B and HHV-7) cause acute infection, establish tivate, and may be intermittently shed in bodily fluids [3]. latency, and in the case of HHV-6A and HHV-6B, whole virus Unlike other human herpesviruses, HHV-6A and HHV- can integrate into the host chromosome. Primary infection with 6B are also found integrated into the host genome HHV-6B occurs in nearly all children and was first linked to the (ciHHV-6). Integration has been documented in 0.2– clinical syndrome roseola infantum. However, roseolovirus 1% of the general population and along with latency infection results in a spectrum of clinical disease, ranging from has confounded the ability to correlate the presence of asymptomatic infection to acute febrile illnesses with severe viral nucleic acid with active disease [4]. neurologic complications and accounts for a significant portion of healthcare utilization by young children. Recent advances The syndrome known as roseola infantum was reported as have underscored the association of HHV-6B and HHV-7 early as 1809 by Robert Willan in his textbook ‘On primary infection with febrile status epilepticus as well as the cutaneous diseases’ [5]. This clinical entity is also com- role of reactivation of latent infection in encephalitis following monly referred to as exanthem subitum and early pub- cord blood stem cell transplantation.
[Show full text]
Measles Diagnostic Tool
Measles Prodrome and Clinical evolution E Fever (mild to moderate) E Cough E Coryza E Conjunctivitis E Fever spikes as high as 105ºF Koplik’s spots Koplik’s Spots E E Viral enanthem of measles Rash E Erythematous, maculopapular rash which begins on typically starting 1-2 days before the face (often at hairline and behind ears) then spreads to neck/ the rash. Appearance is similar to “grains of salt on a wet background” upper trunk and then to lower trunk and extremities. Evolution and may become less visible as the of rash 1-3 days. Palms and soles rarely involved. maculopapular rash develops. Rash INCUBATION PERIOD Fever, STARTS on face (hairline & cough/coryza/conjunctivitis behind ears), spreads to trunk, Average 8-12 days from exposure to onset (sensitivity to light) and then to thighs/ feet of prodrome symptoms 0 (average interval between exposure to onset rash 14 day [range 7-21 days]) -4 -3 -2 -1 1234 NOT INFECTIOUS higher fever (103°-104°) during this period rash fades in same sequence it appears INFECTIOUS 4 days before rash and 4 days after rash Not Measles Rubella Varicella cervical lymphadenopathy. Highly variable but (Aka German Measles) (Aka Chickenpox) Rash E often maculopapular with Clinical manifestations E Clinical manifestations E Generally mild illness with low- Mild prodrome of fever and malaise multiforme-like lesions and grade fever, malaise, and lymph- may occur one to two days before may resemble scarlet fever. adenopathy (commonly post- rash. Possible low-grade fever. Rash often associated with painful edema hands and feet. auricular and sub-occipital).
[Show full text]
Fundamentals of Dermatology Describing Rashes and Lesions
Dermatology for the Non-Dermatologist May 30 – June 3, 2018 - 1 - Fundamentals of Dermatology Describing Rashes and Lesions History remains ESSENTIAL to establish diagnosis – duration, treatments, prior history of skin conditions, drug use, systemic illness, etc., etc. Historical characteristics of lesions and rashes are also key elements of the description. Painful vs. painless? Pruritic? Burning sensation? Key descriptive elements – 1- definition and morphology of the lesion, 2- location and the extent of the disease. DEFINITIONS: Atrophy: Thinning of the epidermis and/or dermis causing a shiny appearance or fine wrinkling and/or depression of the skin (common causes: steroids, sudden weight gain, “stretch marks”) Bulla: Circumscribed superficial collection of fluid below or within the epidermis > 5mm (if <5mm vesicle), may be formed by the coalescence of vesicles (blister) Burrow: A linear, “threadlike” elevation of the skin, typically a few millimeters long. (scabies) Comedo: A plugged sebaceous follicle, such as closed (whitehead) & open comedones (blackhead) in acne Crust: Dried residue of serum, blood or pus (scab) Cyst: A circumscribed, usually slightly compressible, round, walled lesion, below the epidermis, may be filled with fluid or semi-solid material (sebaceous cyst, cystic acne) Dermatitis: nonspecific term for inflammation of the skin (many possible causes); may be a specific condition, e.g. atopic dermatitis Eczema: a generic term for acute or chronic inflammatory conditions of the skin. Typically appears erythematous,
[Show full text]
Pathogenic Viruses Commonly Present in the Oral Cavity and Relevant Antiviral Compounds Derived from Natural Products
medicines Review Pathogenic Viruses Commonly Present in the Oral Cavity and Relevant Antiviral Compounds Derived from Natural Products Daisuke Asai and Hideki Nakashima * Department of Microbiology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan * Correspondence: [email protected]; Tel.: +81-44-977-8111 Received: 24 October 2018; Accepted: 7 November 2018; Published: 12 November 2018 Abstract: Many viruses, such as human herpesviruses, may be present in the human oral cavity, but most are usually asymptomatic. However, if individuals become immunocompromised by age, illness, or as a side effect of therapy, these dormant viruses can be activated and produce a variety of pathological changes in the oral mucosa. Unfortunately, available treatments for viral infectious diseases are limited, because (1) there are diseases for which no treatment is available; (2) drug-resistant strains of virus may appear; (3) incomplete eradication of virus may lead to recurrence. Rational design strategies are widely used to optimize the potency and selectivity of drug candidates, but discovery of leads for new antiviral agents, especially leads with novel structures, still relies mostly on large-scale screening programs, and many hits are found among natural products, such as extracts of marine sponges, sea algae, plants, and arthropods. Here, we review representative viruses found in the human oral cavity and their effects, together with relevant antiviral compounds derived from natural products. We also highlight some recent emerging pharmaceutical technologies with potential to deliver antivirals more effectively for disease prevention and therapy. Keywords: anti-human immunodeﬁciency virus (HIV); antiviral; natural product; human virus 1. Introduction The human oral cavity is home to a rich microbial ﬂora, including bacteria, fungi, and viruses.
[Show full text]
RASH in INFECTIOUS DISEASES of CHILDREN Andrew Bonwit, M.D
RASH IN INFECTIOUS DISEASES OF CHILDREN Andrew Bonwit, M.D. Infectious Diseases Department of Pediatrics OBJECTIVES • Develop skills in observing and describing rashes • Recognize associations between rashes and serious diseases • Recognize rashes associated with benign conditions • Learn associations between rashes and contagious disease Descriptions • Rash • Petechiae • Exanthem • Purpura • Vesicle • Erythroderma • Bulla • Erythema • Macule • Enanthem • Papule • Eruption Period of infectivity in relation to presence of rash • VZV incubates 10 – 21 days (to 28 d if VZIG is given • Contagious from 24 - 48° before rash to crusting of all lesions • Fifth disease (parvovirus B19 infection): clinical illness & contagiousness pre-rash • Rash follows appearance of IgG; no longer contagious when rash appears • Measles incubates 7 – 10 days • Contagious from 7 – 10 days post exposure, or 1 – 2 d pre-Sx, 3 – 5 d pre- rash; to 4th day after onset of rash Associated changes in integument • Enanthems • Measles, varicella, group A streptoccus • Mucosal hyperemia • Toxin-mediated bacterial infections • Conjunctivitis/conjunctival injection • Measles, adenovirus, Kawasaki disease, SJS, toxin-mediated bacterial disease Pathophysiology of rash: epidermal disruption • Vesicles: epidermal, clear fluid, < 5 mm • Varicella • HSV • Contact dermatitis • Bullae: epidermal, serous/seropurulent, > 5 mm • Bullous impetigo • Neonatal HSV • Bullous pemphigoid • Burns • Contact dermatitis • Stevens Johnson syndrome, Toxic Epidermal Necrolysis Bacterial causes of rash
[Show full text]
Blanching Rashes
BLANCHING RASHES Facilitators Guide Author Aoife Fox (Edits by the DFTB Team) [email protected] Author Aoife Fox Duration 1-2h Facilitator level Senior trainee/ANP and above Learner level Junior trainee/Staff nurse and Senior trainee/ANP Equipment required None OUTLINE ● Pre-reading for learners ● Basics ● Case 1: Chicken Pox (15 min) ● Case 2: Roseola (15 min) ● Case 3: Scarlet fever (20 min) ● Case 4: Kawasaki disease (including advanced discussion) (25 min) ● Game ● Quiz ● 5 take home learning points PRE-READING FOR LEARNERS BMJ Best Practice - Evaluation of rash in children PEDS Cases - Viral Rashes in Children RCEM Learning - Common Childhood Exanthems American Academy of Dermatology - Viral exanthems 2 Infectious Non-infectious Blanching Blanching Staphylococcus scalded skin syndrome Sunburn Impetigo Eczema Bullous impetigo Urticaria Eczema hepeticum Atopic dermatitis Measles Acne vulgaris Glandular fever/infectious mononucleosis Ichthyosis vulgaris keratosis pilaris Hand foot and mouth disease Salmon patch Erythema infectiosum/Fifth disease Melasma Chickenpox (varicella zoster) Napkin rash Scabies Seborrhoea Tinea corporis Epidermolysis bullosa Tinea capitis Kawasaki disease Molluscum contagiosum Steven-Johnson syndrome Scarlet fever Steven-Johnson syndrome/toxic epi- Lyme disease dermal necrolysis Congenital syphilis Erythema multiforme Congenital rubella Erythema nodosum Herpes simplex Roseola (sixth disease) Non-blanching Epstein-Barr virus Port-wine stain Pityriasis rosea Henoch-Schoenlein purpura Idiopathic thrombocytopenia Acute leukaemia Haemolytic uremic syndrome Trauma Non-blanching Mechanical (e.g. coughing, vomiting – in Meningococcal rash distribution of superior vena cava) 3 BASE Key learning points Image: used with gratitude from Wikipedia.org Definitions/rash description: ● Macule: a flat area of colour change <1 cm in size (e.g., viral exanthem [such as measles and rubella], morbilliform drug eruption).
[Show full text]
Differential Diagnosis of Viral Exanthemas
The Open Vaccine Journal, 2010, 3, 65-68 65 Open Access Differential Diagnosis of Viral Exanthemas Juan José Garcia Garcia* Paediatric Service, Sant Joan de Déu Hospital, University of Barcelona Abstract: This article describes the differential diagnosis of maculopapular rashes, which can be divided into three large groups: classic rashes, nonspecific rashes and paraviral eruptions, the last two of which can be grouped together as atypical rashes. The differential diagnosis of maculopapular rash depends on the setting and the percentage of the population vaccinated. The diagnosis is broad and includes infectious processes and other etiologies. A correct diagnostic orientation requires the availability of the relevant epidemiological data which will aid the suspicion of a specific etiology. Keywords: Measles, Rubella, Scarlet fever, Roseola, Infectious mononucleosis, Erythema infectiosum, Paraviral eruption. INTRODUCTION with any of the classic rashes identified the causal agent in 76 (68%) cases, with the most-frequent causes being viruses Maculopapular rashes can be divided into three large (28.6%) and drugs (22.3%) [3]. In macular or maculopapular groups: classic rashes, nonspecific rashes and paraviral rashes, the type of rash most-frequently found (66.1%), the eruptions, the last two of which can be grouped together as main causes were drugs (18.7%) and viruses (17%). atypical rashes. With respect to measles and rubella, the differential diag- The six classic rashes are measles, rubella, scarlet fever, nosis should be made with other infectious exanthematic exanthem subitum, erythema infectiosum and varicella. All, diseases, drug reactions and Kawasaki disease. except varicella, are maculopapular and can thus be consid- ered within the same differential diagnosis.
[Show full text]
A Quick Guide to Common Childhood Diseases
A Quick Guide To Common Childhood Diseases May 2009 Table of Contents Introduction ................................................................................................................... 1 How are illnesses and infestations spread?............................................................... 2 Routine Practices.......................................................................................................... 4 Handwashing................................................................................................................. 5 Other Resources ........................................................................................................... 8 Campylobacteriosis ...................................................................................................... 9 Chickenpox (Varicella)................................................................................................ 10 Cold Sores ................................................................................................................... 11 Croup............................................................................................................................ 12 Cryptosporidiosis (“Crypto”) ..................................................................................... 13 E. Coli (Escherichia Coli): Diarrhea Illness and Hemolytic Uremic Syndrome ...... 14 Fifth Disease (Erythema Infectiosum) ....................................................................... 15 Giardiasis (“Beaver Fever”) ......................................................................................
[Show full text]
With Acute HHV6 Infection
Archives ofDisease in Childhood 1990; 6s: 1297-1300 1297 ORIGINAL ARTICLES Arch Dis Child: first published as 10.1136/adc.65.12.1297 on 1 December 1990. Downloaded from Roseola infantum and other syndromes associated with acute HHV6 infection W L Irving, J Chang, D R Raymond, R Dunstan, P Grattan-Smith, A L Cunningham Abstract mother is pregnant, and to exclude either the Eight cases of acute human herpesvirus type need to prescribe antibiotics in a febrile child, 6 (HHV6) infection in infants were diagnosed or the diagnosis of antibiotic allergy. serologically by the demonstration of IgM anti-HHV6 (8/8) and a significant change in Methods total anti-HHV6 antibody titre (6/8). Four SELECTION OF SERA infants were sufficientlyill to require admission During the course of this study (December 1988 to hospital and further investigations: one to February 1990) all sera sent to the virology with encephalitis and three with gross hepato- laboratory, Westmead Hospital, from infants splenomegaly, two of whom had evidence of up to the age of 3 years were tested for evidence simultaneous infection with another herpes- of recent HHV6 infection. In addition, sera virus. The remaining four infants had an from infants presenting with hepatospleno- illness compatible with roseola infantum, megaly were kindly referred to us from the although this diagnosis had not been made Royal Alexandra Hospital for Children, Sydney, clinically. Sera from two of those infants with the Royal Children's Hospital, Melbourne, and rash had been sent for analysis to exclude the Royal Brisbane Hospital, Brisbane. The rubella because the infants' mothers were infants fell into the following diagnostic cate- pregnant.
[Show full text]
Guidelines for Surveillance of Congenital Rubella Syndrome and Rubella
Guidelines for surveillance of congenital rubella syndrome and rubella Field test version, May 1999 DEPARTMENT OF VACCINES AND OTHER BIOLOGICALS (8) World Health Organization ~ ~ ;J Geneva ~~ WHON&B/99.22 ORIGINAL: ENGLISH DISTR.: GENERAL Guidelines for surveillance of congenital rubella syndrome and rubella Field test version, May 1999 Felicity T. Cutts, MD, MSc, WHO Collaborating Centre on Clinical Evaluation of Vaccines in Developing Countries, London School of Hygiene and Tropical Medicine, London, United Kingdom Jennifer Best, PhD, FRCPath, Department of Virology, Guys, King's and St Thomas' School of Medicine, St Thomas' Hospital, London, United Kingdom Marilda M. Siqueira, PhD, Department of Virology, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Kristina Engstrom, Training Consultant, Department of Vaccines and Biologicals, W~O, Ge1,1eva, Switzerland Susan E. Robertson, MD, MPH, MS, Department of Vaccines and Biologicals, WHO, Geneva, Switzerland DEPARTMENT OF VACCINES AND BIOLOGICALS World Health Organization Geneva 1999 The Department of Vaccines and Biologicals thanks the donors whose unspecified financial support has made the production of this document possible. This document was produced by the Vaccine Assessment and Monitoring Team of the Department ofVaccines and Biologicals Ordering code: WHO/V&B/99.22 Printed: December 1999 This document is available on the Internet at: www.who.int/gpv-documents/ Copies may be requested from: World Health Organization Vaccines and Biologicals CH-1211 Geneva 27, Switzerland • Fax: +22 7914193/4192 • £-mail: [email protected] • © World Health Organization 1999 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes.
[Show full text]