FEVER WITH RASH

BLOK 26
 Objective
Provide basic overview of the diagnosis
approach to fever with rash

Highlight several common cases of fever with

rash
 Introduction
Fever with exanthems is a disease that manifested as
:
Fever
Diffuse skin eruption
Related with systemic infection
Commonly caused by virus infection
Mechanism :
Pathogen invasion
Multiplication and toxin production
Immunity host responds
 Introduction

Infection

Bacterial Virus Others

Maligna Ras Allergy

ncy
h reaction

Autoim
mune
process
 Diagnosis establishment

Fever and rash

constellation of symptoms and
feature of rashe (characteristic of lesion,
distribution and progression of the rash,
timing of the onset in relation to fever)
clinically diagnosis
Primary Lesion
Secondary Lesion
 Differential Diagnosis
(appearance)

Erythematous maculapapular Vesiculopapular

Measles Varicella-zooster
Atypical measles Variola
Rubella Impetigo
Scarlet fever Eczema herpeticum
SSSS Inscti bite
Staphylococcal toxic shock syndrome Coxsackie infection
Menicoccemia Insect bite
Eryhtema infectiosum Drup eruption
Roseola infantum Moluscum contangiosum
Etc Ricketsialpox
Etc
 Measles

Etiology : Morbilivirus

Incubation period : 14-

21 days

Contagious perod : 2
days berfore prodromal
4 days after eruption
 Eruption from
retroauricular
whole body
Rash fades
hyperpigmentiation
 Diagnosis
Clinical manifestaion, Complication
pathognomonic sign
Otitis media
kopliks spot
Virus isolation Mastoidits
Serologic 2 weeks Pneumonia
after Encephomyelitis
SSPE
 Therapy
Supportive Prevention
Vitamin A 200.000 Vaccination
iu 2 days in a row 9 months
12 months (MMR)
or 24 months
(measles)
6 years
 Rubella
Etiology : Rubivirus
Incubation period : 14-
21 days
Contagious period : End
of incubation 5 days
after onset of rash
 Forscheimer spot
Rash distribution : face
whole body
 Diagnosis Therapy
Clinical maifestation Supportive
Virus isolation
Serologic day 3
Prevention
MMR vaccination : 12
Complication months
Arthritis
Encephalitis
 Scarlet Fever

Etiology : Group A -
hemolytic streptococcus
Incubation period : 1-7
days
 Tonsil hypertrophy, hyperemic,
white-greyish exudat at palatum
and uvula
Strawberry tongue >
pathognomonic
Puctiform rash starts from neck,
chest, and flexor within 24 hours
prominent on neck, axilla,
inguinali, and poplitea
Circumoral pallor
After rash fades snadpaper
desquamation on arm and foot
 Diagnosis Therapy
Clinical manifestation Supportive
Nasopharynx culture Penicillin, erythromycin
Serologic (ASTO) or cephalosporin
Complication
Tonsil abscess
Otitis media
Bronchopneumonia
Rheumatic Heart Disease
and Acute
glomerulonephritis
 Roseola infantum

Etiologi : Human herpes

virus type 6 (HHV 6)

Incubation period : hard

to define
 High fever, anorexia, coryza,
irritable, conjunctivitis, cough
Distribution : trunk neck,
upper ext, face, and lower ext

Diagnosis
Clinical maifestation
Therapy
Symptomatic
 Varicella
Etiology : Varicella-
zooster
Incubation period : 10-
21 days
Contagious period : 2
days berfore and 5 days
after eruption (no new
lesion)
 Prodromal
Fever
Sore throat
Decreased appetite
Malaise
First lesion : scalp, face
or trunk
Various stages of lesion
Dew drops on a rose
petal
 Diagnosis Treatment
Clinical manifestation Simptomatic and
Virus isolation supportive
Serologic Acyclovir (oral)
Antibiotic only for
secondary bacterial
Complication infection
Secondary bacterial
infection
Prevention
Encephalitis
Immunization
 Conclusion
Fever with rash is commonly found in
children
Mostly caused by virus
Diagnosis needs comprehensive
anamnesis and physical examination