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Differential Diagnosis of Dengue with Rash

Illness History Exam Tests • Occurs most commonly in • Fever, circumoral pallor, red swollen • Rapid strep test (pharyngeal swab): children, 1–10 years, during (strawberry) tongue, pharyngeal positive the nonsummer months erythema with exudate and palatal • Anti-streptolysin O titer: positive petechiae, and tender cervical • Family gives history of abrupt adenopathy onset of fever, sore throat, (Group A beta- headache, malaise, and • Sandpaper-like generalized hemolytic vomiting, 2–5 days post erythematous rash with discrete - exposure colored papules and linear petechial streaks in skin folds, particularly ) • Skin rash appears in all areas axillary, inguinal, and antecubital at same time and fossa desquamates and fades after 4–5 days

• Occurs most commonly in • Fever, hypotension, and a diffuse • Blood cultures: usually negative in children, 5–15 years, during erythematous rash on trunk, palms, staphylococcal infection (S. aureus); winter and spring and soles of feet, which desquamates might be positive in streptococcal 1–2 days after disease onset infection (S. pyogenes) • If history of exposure to person with cold-like • Patient can have mucous membrane • Acute and convalescent antibody symptoms, patient would inflammation (redness of eyes, serology: positive for S. aureus have been infected 4–14 days mouth, and throat), and evidence of infection Toxic Shock before onset of symptoms. central nervous system and multi- • Toxin serology: evidence of Syndrome (TSS) organ involvement with renal, liver, or • Family gives history of fever, respiratory dysfunction • Serum creatinine: elevated > 2 times headache, runny nose, and upper limit of normal for age rash • Platelet count: < 100,000/mm3 • Patient might complain of arthralgia • Liver function test: AST, ALT > 2 times upper limit of normal

Centers for Disease Control and Prevention

National Center for Emerging and Zoonotic Infectious Diseases