Infectious Disease Book

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Cutaneous Conditions in Febrile Patients

Aka: Cutaneous Conditions in Febrile Patients, Dermatologic Manifestations in Patients with Fever, Rash in the Febrile Patient, Febrile Patient with Rash, Fever and Rash, Febrile Eruption, Viral Exanthem, Diffuse Erythema and Desquamation in the Febrile Patient, Vesiculobullous Eruptions in the Febrile Patient, Petechial Eruptions in the Febrile Patient, Nodular Eruptions in the Febrile Patient, Centripetal Rash, Blanching, Maculopapular Rashes in Febrile Children
  1. See Also
    1. Cutaneous Conditions in Febrile Returning Traveler
    2. Skin Infection (e.g. Cellulitis)
    3. Oral Ulcers
  2. Causes: Classic Exanthems (historical order of first identified)
    1. First: Rubeola (Measles)
    2. Second: Scarlet Fever (Streptococcus Pyogenes)
    3. Third: Rubella (German Measles)
    4. Fourth: Dukes' Disease (Coxsackievirus or Echovirus)
    5. Fifth: Fifth Disease (Erythema Infectiosum, Parvovirus)
    6. Sixth: Exanthem Subitum (Roseola Infantum, HH6, HH7)
  3. Causes: Distribution of Febrile Eruption
    1. Central Eruptions (starts with head and neck, trunk)
      1. Viral Exanthem
        1. Rubeola (Measles)
        2. Rubella
        3. Parvovirus B19 (Erythema Infectiosum)
        4. Roseola Infantum (HH6)
      2. Drug eruption
      3. Typhoid Fever
    2. Peripheral Eruptions (Centripetal Rash - starts on distal extremities)
      1. Erythema Multiforme
      2. Secondary Syphilis
      3. Meningococcemia
      4. Rocky Mountain Spotted Fever
      5. Dengue Fever
      6. Coxsachievirus
  4. Causes: Petechial Eruptions in the Febrile Patient
    1. See Purpura (or Petechiae)
    2. Common and Urgent Causes
      1. Toxic Appearing Patient
        1. Rocky Mountain Spotted Fever
        2. Meningococcemia
          1. Rash may first appear blanching, maculopapular before becoming petechial
      2. Well-Appearing Patient
        1. Henoch-Schonlein Purpura
          1. Afebrile, well appearing child with preceding viral syndrome in prior 1-3 weeks
          2. Symmetric lower extremity Petechiae and Purpura
    3. Viral Causes
      1. Coxsackievirus A9
      2. Echovirus 9
      3. Epstein-Barr Virus
      4. Cytomegalovirus
      5. Atypical Measles
      6. Viral Hemorrhagic Fever
        1. Arbovirus Infection
        2. Arenavirus Infection
    4. Other Causes
      1. Disseminated Gonococcus
      2. Staphylococcal Sepsis
      3. Thrombotic Thrombocytopenic Purpura
  5. Causes: Diffuse Erythema and Desquamation in the Febrile Patient
    1. See Desquamation
    2. Most Common
      1. Kawasaki Disease
      2. Scarlet Fever
        1. Fever, Pharyngitis and diffuse, fine red papular rash (sandpaper) on trunk, caused by Group A Streptococcus
        2. Distinguish from Kawasaki Disease
      3. Toxic Shock Syndrome
        1. Diffuse Erythroderma with fever, Hypotension and multi-system organ dysfunction due to Strep or Staph
      4. Scalded Skin Syndrome
        1. Burn-like rash in toxic appearing infants and toddlers, starting on the face and genitalia
    3. Less Common
      1. Ehrlichiosis
      2. Streptococcus viridans bacteremia
      3. Enteroviral infection
      4. Toxic Epidermal Necrolysis
      5. Graft-versus-host reaction
      6. Erythroderma
      7. Generalized Pustular Psoriasis (von Zumbusch)
  6. Causes: Vesiculobullous Eruptions in the Febrile Patient
    1. See Vesiculobullous Rash
    2. Common
      1. Herpes Zoster (Shingles)
      2. Varicella Zoster Virus (Chicken Pox)
        1. In vaccinated children, breakthrough varicella causes central eruption, <50 lesions (dew-drop on rose petal)
      3. Hand Foot and Mouth Disease
        1. High fever and variably painful, maculopapular or vesicular lesions on hands, feet as well as Oral Mucosa
      4. Bullous Impetigo
        1. Staphylococcal Skin Infection typically on the extremities or face; some lesions may have honey-colored crust
    3. Less common
      1. Staphylococcal Bacteremia
      2. Gonococcemia
    4. Immunocompromised Patient Causes
      1. Disseminated Herpes Simplex Virus
      2. Vibrio vulnificus (seafood exposure)
      3. Rickettsia akari
  7. Causes: Nodular Eruptions in the Febrile Patient
    1. See Nodular Lymphangitis
    2. See Subcutaneous Nodule
    3. Erythema Nodosum
    4. Disseminated fungal infection (Immunocompromised)
      1. Disseminated Candidiasis
      2. Cryptococcosis
      3. Blastomycosis
      4. Histoplasmosis
      5. Coccidioidomycosis
      6. Sporotrichosis
    5. Other rare causes
      1. Nocardia
      2. Pseudomonas
      3. Mycobacterium species
  8. Causes: Important Blanching, Maculopapular Rashes in Febrile Children
    1. Measles
      1. Rash preceded by cough, Coryza and Conjunctivitis and high fever (>39 C)
      2. Rash starts on day 2-4 of symptoms, scalp and face first, then spreads to body (see Central Eruptions above)
    2. Parvovirus
      1. Slapped cheek on face, followed by lacy reticular rash on extremities (but spares palms and soles)
      2. Many viral causes of edematous, pupuric socks and gloves syndrome
    3. Roseola
      1. Three days of high fever, Conjunctivitis, Rhinorrhea, irritability, followed by development of central erupting rash
      2. Diffuse, blanching maculopapular rash (first on trunk, then extremities)
    4. Acute Rheumatic Fever
      1. Erythema Marginatum (pink rash, pale center, serpiginous margin)
      2. Associated with Jones Criteria (Migratory Arthritis, carditis, Nodules, Sydenham's Chorea)
    5. Kawasaki Disease
      1. Variable non-vesicular rash associated with Conjunctivitis, adenopathy, strawberry Tongue and distal extremity edema
  9. References
    1. Behar and Claudius in Herbert (2020) EM:Rap 20(6): 6-8
    2. Cunha (1998) Crit Care Clin 14:35-53 [PubMed]
    3. McKinnon (2000) Am Fam Physician 62(4):804-16 [PubMed]
    4. Schlossberg (1996) Infect Dis Clin North Am 10:101-10 [PubMed]

Viral exanthem (C0153062)

Concepts Disease or Syndrome (T047)
ICD9 057.9
ICD10 B09
SnomedCT 186504007, 421512008, 266188005, 186586006, 154319002, 49882001
English Viral diseases + exanthem NOS, Viral diseases with exanthemata NOS, Nonspecific viral rash, Nonspecific exanthematous viral infection (disorder), Nonspecific exanthematous viral infection, Nonspecific viral exanthem, Viral dis char by exanthem, viral exanthem (diagnosis), viral exanthem, Viral exanthema, unspecified, Viral exanthemata, unspecified, Non-specific viral rash, Viral rash NOS, Viral exanthemata NOS, non-specific viral rash, nonspecific viral rash, viral rash, Exanthema;viral, exanthems viral, rash viral, Rash;viral, exanthem viral, viral exanthemata, Viral exanthema NOS, Exanthem - viral, Viral diseases with exanthemata NOS (disorder), Viral exanthem, Viral exanthemata, Viral disease characterised by exanthem, Viral disease characterized by exanthem, Viral rash, Viral disease characterized by exanthem (disorder), Viral exanthem (disorder), exanthema; virus, virus; exanthem, Viral exanthem, unspecified, viral exanthema
Italian Esantema virale, Esantemi virali non specificati, Esantema virale NAS, Esantema virale non specifico
Spanish exantema viral inespecífico, exantema viral no específico, exantema viral inespecífico (trastorno), Exantemas víricos no especificados, Exantema vírico, Exantema vírico inespecífico, Exantema vírico no especificado, Erupción vírica NEOM, exantema virósico, exantema vírico, exantema vírico inespecífico, infección vírica exantematosa inespecífica, infección viral exantematosa inespecífica, enfermedad vírica caracterizada por exantema, enfermedades virales con exantema, SAI, enfermedades virales con exantema, SAI (trastorno), enfermedad viral caracterizada por exantema (trastorno), enfermedad viral caracterizada por exantema, enfermedad virosa caracterizada por exantema (trastorno), enfermedad virosa caracterizada por exantema, exantema viral (trastorno), exantema viral, Erupción vírica
Dutch niet-specifieke virale rash, virale exanthemen, niet-gespecificeerd, viraal exantheem, niet-gespecificeerd, virale rash NAO, viraal exantheem, exantheem; virus, virus; exantheem, virale rash
French Exanthème viral, non précisé, Exanthème viral, Eruption virale SAI, Rash viral non précisé, Rash viral
German virales Exanthem, nichtspezifischer viraler Hautausschlag, virales Exanthem, unspezifisch, virusbedingter Ausschlag NNB, virale Exantheme, unspezifisch, viraler Hautausschlag
Portuguese Erupção cutânea viral NE, Erupção cutânea vírica inespecífica, Exantema vírico, Exantema vírico NE, Exantemas víricos NE, Erupção cutânea viral
Japanese 非特異的ウイルス性発疹, ウイルス性発疹, ウイルス性発疹、詳細不明, ウイルス性発疹NOS, ウイルスセイホッシン, ウイルスセイハッシンショウサイフメイ, ウイルスセイハッシン, ヒトクイテキウイルスセイホッシン, ウイルスセイホッシンショウサイフメイ, ヒトクイテキウイルスセイハッシン, ウイルスセイハッシンNOS, ウイルスセイホッシンNOS
Czech Virový exantém, Virový exantém NOS, Virový exantém, blíže neurčený, Virové exantémy, blíže neurčené, Nespecifický virový exantém
Hungarian Viralis exanthema, nem meghatározott, vírusos kiütés k.m.n., Viralis nem specifikus kiütés, Vírusos kiütés, nem meghatározott, Viralis kiütés, vírusos kiütés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


fever with rash (C0847014)

Concepts Sign or Symptom (T184)
English fever rash, fevers rash, Pyrexia;with rash, rash fever, fever with rash, rash with fever, pyrexia with rash
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Centripetal rash (C1301978)

Concepts Finding (T033)
SnomedCT 398591002
English Centripetal rash (finding), Centripetal rash
Spanish erupción centrípeta (hallazgo), erupción centrípeta, exantema centrípeto, rash centrípeto, sarpullido centrípeto
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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