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Home , Asplenia, Bacillary angiomatosis, Chancre, Desquamation, Ecthyma, Ecthyma gangrenosum

Table IV. Type of and Associated Caused by Infectious Agents Clinical Description Syndrome

CENTRAL DISTRIBUTED MACULOPAPULAR ERUPTIONS

Discrete blanching erythematous “brick-red” lesions, confluent rash Cough, coryza, postration, spreads from hair downward, conjunctivitis sparing palms and soles; lasts >3 d; Koplik´s spots.

Prominent posterior cervical Rubella triangle and/or suboccipital Usually no serious systemic adenopathy. Punctate soft palate symptoms macules, Forchheimer spots. Common in children 3-12 years, Diffuse eruption (sparing ). mild . In adults, arthralgias Exanthema subitum (roseola) Resolves within 2 days. are common, history of exposure to an infected child “Slapped cheek” appearance and Common in children 3-12 years, net-like rash. Bright-red mild fever. In adults arthalgias infectiosum appearance, followed by diffuse and history of exposure to an lacy reticular rash that waxes and affected child wanes over 3 wks. Pharyngitis, , Nonspecific diffuse macules and arthralgias, myalgias, fatigue, Primary HIV infection , urticarial. and gastrointestinal symptoms Infectious mononucleosis Adolescents and young adults, fever, malaise, sweats, Diffuse maculopapular eruption, nausea, chills, sore throat, urticaria in some cases, periorbital hepatosplenomegaly, cervical edemal, palatal petechiae. lymphadenopathy, atypical lymphocytosis, heterophile antibodies

Maculopapular eruption, sparing Exposure to body lice; or rat or face, palms, soles. cat . Headache, myalgias David L Wyles 7/8/16 16:51 Headache, myalgias, regional Eschar at site of bite: Deleted: h lymphadenopathy. Exposure to maculopapular eruption on Rickettsial (Mediterranean region, proximal extremities, spreading to India, Africa, Australia, Siberia, trunk and face. Mongolia) born. In United States Southeast and southern Central maculopapular eruption Midwest. Headache, myalgias, sparing extremities, palms, soles. nausea, emesis, , malaise, altered mental status, elevated transaminase levels, leukopenia and hyponatremia. Contaminated food or water. Blanchable erythematous Abdominal pain and diarrhea, macules and papules 2-4 mm, headache, myalgias, usually on trunk. hepatosplenomegaly Erythematous annular papules Patients with . and plaques occurring in waves Pharyngitis before polyarthritis, Erythema marginatum over trunk and proximal carditis, chorea and extremities, resolving in hour. subcutaneous nodules Exposure to water contaminated Maculopapular eruption; with animal urine. Myalgias, conjunctivitis, sclera hemorrhage aseptic meningitis. Weil´s in some cases. disease (fulminant form): icterohemorrhagic expanding to Bite or tick vector. Headache, erythematous annular lesion with myalgias, chills, photophobia central clearing. Sometimes (acute). CNS disease, concentric rings, or indurated, or myocardial disease, arthritis vesicular center, or multiple weeks to months later secondary lesions are observed. Exposure to ticks or body lice. Central rash at end of febrile Relapsing fever Recurrent fever, headache, episode; sometimes petechiae. myalgias, hepatosplenomegaly Rat bite (primarily found in Asia). Eschar at site of bite. Red-brown Rat bite Regional lymphadenopathy, central rash or blotchy violaceous. recurrent if untreated Dengue is characterized by retro- orbital pain, muscle and joint pain. Chikungunya by long-standing arthralgias. Morbiliform rash, fever, headache, Dengue, Chikungunya, Zika muscle and joint pain. Zika virus is mild and self-limited, David L Wyles 7/8/16 16:52 but there is an association Deleted: c between maternal infection and adverse fetal outcome, such as congenital microcephaly. History of travel to endemic areas. Abrupt onset of symptoms: Headache, chills, high fever, malaise, weakness. Progression Diffuse erythematous rash, which after about 5 days: abdominal spreads from hair, buttocks, arms pain, nausea, aqueous diarrhea, and legs, and then extended to haemorrhagic symptoms, altered trunk. in palms, mental status. Travel history soles and limbs. to/from West Africa. Health-care workers in contact with Ebola patients. PERIPHERAL ERUPTIONS Subacute course: Osler´s nodes Abnormal heart valve. Bacterial endocarditis (tender pink nodules on finger or Intravenous drug users. New toe pads), petechiae on and heart murmur. mucosa, splinter hemorrhages; Acute course: Janeway lesions (painless erythematous or hemorrhagic macules on palms and soles). Central erythema surrounded by area of clearing and another rim of erythema) up to 2 cm. Starts on Drug intake. , backs of and feet and on extensor surfaces of arms and infection. legs, symmetric, may involve palms, soles, oral mucous membranes of . Tender vesicles, erosions in Primarily children younger than mouth. 0.25 cm papules on hands -foot and mouth disease 10 yr. Multiple family members. and feet with rim of erythema Transient fever. evolving into tender vesicles. Tick vector. In United States, more common in southeastern Rash beginning on wrists and and southwest-central. Seasonal ankles and spreading outbreaks. Short incubation centripetally; appears on palms Rocky Mountain Spotted fever period: Headache, fever, and soles late in disease. Lesions malaise, conjunctival suffusion evolution from blanchable and myalgias (adults). Abdominal macules to petechiae. pain (children). Mortality up to 40% if untreated. Coincident primary in 10% of cases; cooper-colored, scaly popular eruption, diffuse but Sexually transmitted. Fever, Secondary prominent on palms and soles; constitutional symptoms. condyloma latum, mucous patches and alopecia in some cases. CONFLUENT DESQUAMATIVE

ERYTHEMAS Diffuse blanchable erythema beginning on face and spreading Most common in children 2-10 yr. to trunk and extremities; Usually follows group A circumoral , sandpaper Streptcoccal pharyngitis. Fever, texture to skin, accentuation of pharyngitis, headache, vomiting linear erythema in skin folds and abdominal pain. (Pastia lines); enanthem of white evolving into red. Occurs in setting of severe group A Streptococcal infections. Streptococcal toxic syndrome Rash often scarlatiform. Multiorgan failure, , 30% mortality rate. Painful, diffuse erythema involving Colonization with toxin- palms and flexure areas, profuse Staphylococcal toxic shock producing S.aureus. Fever erythema of mucosal surfaces. syndrome >39°C, hypotension, multiorgan Progress to large, flaccid bullae. dysfunction. Desquamation 7-10 days of illness. Diffuse tender erythema, often Colonization with toxin- Staphylococcal scalded-skin with bullae and desquamation: producing S.aureus. Irritability, syndrome Nikolsky´s sign. nasal or conjunctival secretions. Rash on hands and feet starting 3-5 days after onset of fever in Bilateral conjuntival injection, children younger than 8 yrs hyperemic oral mucosa and red, (usually younger than 4 yrs) dry, cracked, bleeding injected blanching macular exanthema on , cervical adenopathy, trunk, especially groin and diaper coronary . area,. Life-threating condition, rapidly spreading infection that involves and superficial fascia and typically Black eschar that sloughs off, spares muscle tissue. Type I crepitus, dusky blue discoloration, usually polymicrobial and type II erythema. usually monomicrobial. Fever, warmth, swelling, , pain out of proportion, systemic toxicity. VESICULOBULLOUS

ERUPTIONS Usually affects children. More Macules, papules (sometimes common in winter and spring. Varicella (chicken- pox) umbilicated), pustules then Malaise, mild disease in children, forming crusting. more severe disease in adults and in immunocompromised. Zoster cutaneous dissemination: Immunosupressed individuals. Dissemination herpes-virus >25 lesions extending outside Visceral organ involvement infection involved dermatome; HSV: (especially of liver) may occur. mucocutaneous involvement. Patients with diabetes, renal Erythematous lesions evolving failure, cirrhosis; ingestion of infection into hemorrhagic bullae and then contaminated saltwater seafood. into necrotic lesions. Hypotension; 50% mortality. Indurated plaque evolving into hemorrhagic bulla or pustule that Usually affects neutropenic sloughs, resulting in eschar patients; occurs in up to 28% of gangrenosum formation; erythematous halo; individual with Pseudomonas most common in axillary, groin, bacteremia. . perianal regions. Eschar found at site of mite bite; generalized rash involving face, Urban settings, transmitted by trunk, extremities; may involve mouse mites. Headache, Rickettsial pox palms and soles; <100 papules myalgias, regional and plaques (2-10 mm), top of lymphadenopathy, mild disease. lesions develop vesicles that may evolve into pustules. NODULAR ERUPTIONS Subcutaneous nodules, Immunocompromised hosts. Disseminated infection fluctuance, draining common with Features vary with the organism. mycobacteria; necrotic nodules common with Aspergillus, Mucor. More common in females 15-30 Large violaceous, nonulcerative, years of age. Arthralgias (50%): subcutaneous nodules; exquisitely features vary with associated tender; usually on extremities. condition. Erythematous, smooth vascular Usually in HIV. Peliosis of liver nodules, friable, exophytic lesions, Bacillary and . Lesions may involve erythematous plaques, multiple organs. subcutaneous nodules. PURPURIC ERUPTIONS Numerous petechiae, sometimes Most common in children, enlarging becoming vesicular, asplenia, or complement Acute meningococcemia most commonly in trunk and deficiency. Fever, myalgia, extremities. May include purpura somnolence, headache and fulminans. nausea. Hypotension, meningitis. Large ecchymoses with sharply Individuals with sepsis, irregular shapes evolving into malignancy, or massive trauma. hemorrhagic bullae and then into Asplenic patients at high risk for black necrotic lesions. sepsis. Hypotension. Recurrent eruptions: Complement deficiencies. Fever, Chronic meningococcemia maculopapular, nodules, arthritis, myalgias, headache. petechial, purpuric areas. Papules evolving over 1-2 days into hemorrhagic pustules. Sexually active individuals, some Disseminated gonococcal infection Lesions (<40) distributed with complement deficiency. peripherally near joints. Residence or travel to endemic areas. Fever, shock, hemorrhage Viral hemorrhagic fever Disseminated petechial rash. from mucosa or gastrointestinal tract. Outbreaks. Pharyngitis, Enteroviral petechial rash Petechial lesions. headache, aseptic meningitis. ERUPTIONS WITH ULCERS

AND/OR ESCHARS Ulceroglandular Exposure to ticks, biting flies. form: erythematous tender papule Fever, headache, evolves into necrotic, tender . lymphadenopathy. 35% eruptions may occur. Pruritic enlarging papule evolving Organism has two distinct niches into 1-3 cm painless ulcer in which can survive: soil and Anthrax surrounded by vesicles, later mammals, including humans. developing a central eschar with Outbreaks seen occasionally. edema. Seen in heroin users.