Fever and rash resident survival guide (pediatrics): Difference between revisions
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|[[Fever and rash resident survival guide (pediatrics)|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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{{CMG}} {{AE}} {{EAM}} | {{CMG}} {{AE}} {{EAM}} | ||
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======{{SK}}====== | ======{{SK}}====== | ||
======Fever :====== | ======Fever:====== | ||
Frenzy | Frenzy,[[Temperature]], Feverishness, [[Heat]], [[Fermentation|Ferment]], [[Pyrexia]], | ||
[[Temperature]] | |||
Feverishness | |||
[[Heat]] | |||
[[Fermentation|Ferment]] | |||
[[Pyrexia]] | |||
[[Hyperthermia]] | Excitement, [[Agitation]], [[Febrile]], [[Feverish]], Furor, [[Sweat]], [[Ecstasy]], Febricity, [[Hyperthermia]]. | ||
======Rush:====== | ======Rush:====== | ||
Reckless | Reckless, Impetuous, Impulsive, Hasty, Overhasty, Foolhardy, Incautious, [[Precipitate]], Precipitous, [[Premature]], [[Carelessness|Careless]], Heedless, Thoughtless. | ||
Impetuous | |||
Impulsive | |||
Hasty | |||
Overhasty | |||
Foolhardy | |||
Incautious | |||
[[Precipitate]] | |||
Precipitous | |||
[[Premature]] | |||
[[Carelessness|Careless]] | |||
Heedless | |||
Thoughtless | |||
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==Overview== | ==Overview== | ||
<br /> | [[Fever]] with [[rash]] is a common symptom redundancy in patients presenting to clinicians' offices and [[Emergency|emergenc]]<nowiki/>y departments. [[Skin Disease|Skin]] manifestations may provide the only early clue to an underlying [[infection]], may be the hallmark of [[contagious]] disease, and/or may be an early sign of a life-threatening infection or serious noninfectious disorder. The differential diagnosis of [[fever]] and [[rash]] is extremely broad, but this symptom complex show an fortuity for the exacting clinician to start a probable [[etiology]] through a careful [[History and Physical examination|history]] and [[physical examination]]. | ||
A [[Systematics|systematic]] method is crucial for starting a timely [[diagnosis]], determining early [[therapy]] when appropriate, and considering [[Isolation transformer|isolation]] of the patient if necessary. The [[treatment]] must to be belonging to euch cause specifeclly. | |||
and the most important part is the advice that patient have to be aware of [[fever]] and rush diseases, to avoid the severity of the [[fever]] and rush side effect.<br /> | |||
==Causes== | ==Causes== | ||
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*[[Bacterial endocarditis]]<ref name="pmid8154507">{{cite journal| author=Durack DT, Lukes AS, Bright DK| title=New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. | journal=Am J Med | year= 1994 | volume= 96 | issue= 3 | pages= 200-9 | pmid=8154507 | doi=10.1016/0002-9343(94)90143-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8154507 }}</ref><ref name="pmid26373316">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ | display-authors=etal| title=Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. | journal=Circulation | year= 2015 | volume= 132 | issue= 15 | pages= 1435-86 | pmid=26373316 | doi=10.1161/CIR.0000000000000296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26373316 }}</ref><ref name="pmid25975469">{{cite journal| author=Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A | display-authors=etal| title=Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. | journal=J Am Coll Cardiol | year= 2015 | volume= 65 | issue= 19 | pages= 2070-6 | pmid=25975469 | doi=10.1016/j.jacc.2015.03.518 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25975469 }}</ref> | *[[Bacterial endocarditis]]<ref name="pmid8154507">{{cite journal| author=Durack DT, Lukes AS, Bright DK| title=New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. | journal=Am J Med | year= 1994 | volume= 96 | issue= 3 | pages= 200-9 | pmid=8154507 | doi=10.1016/0002-9343(94)90143-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8154507 }}</ref><ref name="pmid26373316">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ | display-authors=etal| title=Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. | journal=Circulation | year= 2015 | volume= 132 | issue= 15 | pages= 1435-86 | pmid=26373316 | doi=10.1161/CIR.0000000000000296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26373316 }}</ref><ref name="pmid25975469">{{cite journal| author=Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A | display-authors=etal| title=Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. | journal=J Am Coll Cardiol | year= 2015 | volume= 65 | issue= 19 | pages= 2070-6 | pmid=25975469 | doi=10.1016/j.jacc.2015.03.518 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25975469 }}</ref> | ||
*[[Rocky Mountain spotted fever]]<ref name="pmid9868640">{{cite journal| author=Thorner AR, Walker DH, Petri WA| title=Rocky mountain spotted fever. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 6 | pages= 1353-9; quiz 1360 | pmid=9868640 | doi=10.1086/515037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9868640 }}</ref><ref name="pmid6491365">{{cite journal| author=Helmick CG, Bernard KW, D'Angelo LJ| title=Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. | journal=J Infect Dis | year= 1984 | volume= 150 | issue= 4 | pages= 480-8 | pmid=6491365 | doi=10.1093/infdis/150.4.480 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6491365 }}</ref><ref name="pmid15152183">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Fatal cases of Rocky Mountain spotted fever in family clusters--three states, 2003. | journal=MMWR Morb Mortal Wkly Rep | year= 2004 | volume= 53 | issue= 19 | pages= 407-10 | pmid=15152183 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152183 }}</ref><ref name="pmid2299975">{{cite journal| author=Kirk JL, Fine DP, Sexton DJ, Muchmore HG| title=Rocky Mountain spotted fever. A clinical review based on 48 confirmed cases, 1943-1986. | journal=Medicine (Baltimore) | year= 1990 | volume= 69 | issue= 1 | pages= 35-45 | pmid=2299975 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2299975 }}</ref><ref name="pmid98686402">{{cite journal| author=Thorner AR, Walker DH, Petri WA| title=Rocky mountain spotted fever. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 6 | pages= 1353-9; quiz 1360 | pmid=9868640 | doi=10.1086/515037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9868640 }}</ref> | *[[Rocky Mountain spotted fever]]<ref name="pmid9868640">{{cite journal| author=Thorner AR, Walker DH, Petri WA| title=Rocky mountain spotted fever. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 6 | pages= 1353-9; quiz 1360 | pmid=9868640 | doi=10.1086/515037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9868640 }}</ref><ref name="pmid6491365">{{cite journal| author=Helmick CG, Bernard KW, D'Angelo LJ| title=Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. | journal=J Infect Dis | year= 1984 | volume= 150 | issue= 4 | pages= 480-8 | pmid=6491365 | doi=10.1093/infdis/150.4.480 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6491365 }}</ref><ref name="pmid15152183">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Fatal cases of Rocky Mountain spotted fever in family clusters--three states, 2003. | journal=MMWR Morb Mortal Wkly Rep | year= 2004 | volume= 53 | issue= 19 | pages= 407-10 | pmid=15152183 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152183 }}</ref><ref name="pmid2299975">{{cite journal| author=Kirk JL, Fine DP, Sexton DJ, Muchmore HG| title=Rocky Mountain spotted fever. A clinical review based on 48 confirmed cases, 1943-1986. | journal=Medicine (Baltimore) | year= 1990 | volume= 69 | issue= 1 | pages= 35-45 | pmid=2299975 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2299975 }}</ref><ref name="pmid98686402">{{cite journal| author=Thorner AR, Walker DH, Petri WA| title=Rocky mountain spotted fever. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 6 | pages= 1353-9; quiz 1360 | pmid=9868640 | doi=10.1086/515037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9868640 }}</ref> | ||
*[[Necrotizing fasciitis]] | *[[Necrotizing fasciitis]]<ref name="pmid327844">{{cite journal| author=Giuliano A, Lewis F, Hadley K, Blaisdell FW| title=Bacteriology of necrotizing fasciitis. | journal=Am J Surg | year= 1977 | volume= 134 | issue= 1 | pages= 52-7 | pmid=327844 | doi=10.1016/0002-9610(77)90283-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=327844 }}</ref><ref name="pmid7985069">{{cite journal| author=Laucks SS| title=Fournier's gangrene. | journal=Surg Clin North Am | year= 1994 | volume= 74 | issue= 6 | pages= 1339-52 | pmid=7985069 | doi=10.1016/s0039-6109(16)46485-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7985069 }}</ref> | ||
*[[Toxic shock syndrome]] | *[[Toxic shock syndrome]]<ref name="pmid82681">{{cite journal| author=Todd J, Fishaut M, Kapral F, Welch T| title=Toxic-shock syndrome associated with phage-group-I Staphylococci. | journal=Lancet | year= 1978 | volume= 2 | issue= 8100 | pages= 1116-8 | pmid=82681 | doi=10.1016/s0140-6736(78)92274-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=82681 }}</ref><ref name="pmid7432401">{{cite journal| author=Davis JP, Chesney PJ, Wand PJ, LaVenture M| title=Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention. | journal=N Engl J Med | year= 1980 | volume= 303 | issue= 25 | pages= 1429-35 | pmid=7432401 | doi=10.1056/NEJM198012183032501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7432401 }}</ref><ref name="pmid7432402">{{cite journal| author=Shands KN, Schmid GP, Dan BB, Blum D, Guidotti RJ, Hargrett NT | display-authors=etal| title=Toxic-shock syndrome in menstruating women: association with tampon use and Staphylococcus aureus and clinical features in 52 cases. | journal=N Engl J Med | year= 1980 | volume= 303 | issue= 25 | pages= 1436-42 | pmid=7432402 | doi=10.1056/NEJM198012183032502 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7432402 }}</ref><ref name="pmid8958166">{{cite journal| author=Stevens DL| title=The toxic shock syndromes. | journal=Infect Dis Clin North Am | year= 1996 | volume= 10 | issue= 4 | pages= 727-46 | pmid=8958166 | doi=10.1016/s0891-5520(05)70324-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8958166 }}</ref> | ||
*[[Miliary tuberculosis]]<ref name="pmid1889256">{{cite journal| author=Rieder HL, Kelly GD, Bloch AB, Cauthen GM, Snider DE| title=Tuberculosis diagnosed at death in the United States. | journal=Chest | year= 1991 | volume= 100 | issue= 3 | pages= 678-81 | pmid=1889256 | doi=10.1378/chest.100.3.678 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1889256 }}</ref> | *[[Miliary tuberculosis]]<ref name="pmid1889256">{{cite journal| author=Rieder HL, Kelly GD, Bloch AB, Cauthen GM, Snider DE| title=Tuberculosis diagnosed at death in the United States. | journal=Chest | year= 1991 | volume= 100 | issue= 3 | pages= 678-81 | pmid=1889256 | doi=10.1378/chest.100.3.678 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1889256 }}</ref><ref name="pmid25387498">{{cite journal| author=Dias MF, Bernardes Filho F, Quaresma MV, Nascimento LV, Nery JA, Azulay DR| title=Update on cutaneous tuberculosis. | journal=An Bras Dermatol | year= 2014 | volume= 89 | issue= 6 | pages= 925-38 | pmid=25387498 | doi=10.1590/abd1806-4841.20142998 | pmc=4230662 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25387498 }}</ref><ref name="pmid12069638">{{cite journal| author=Barbagallo J, Tager P, Ingleton R, Hirsch RJ, Weinberg JM| title=Cutaneous tuberculosis: diagnosis and treatment. | journal=Am J Clin Dermatol | year= 2002 | volume= 3 | issue= 5 | pages= 319-28 | pmid=12069638 | doi=10.2165/00128071-200203050-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12069638 }}</ref> | ||
===Common Causes<ref name="pmid8443297">{{cite journal| author=Cherry JD| title=Contemporary infectious exanthems. | journal=Clin Infect Dis | year= 1993 | volume= 16 | issue= 2 | pages= 199-205 | pmid=8443297 | doi=10.1093/clind/16.2.199 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8443297 }}</ref>=== | ===Common Causes<ref name="pmid8443297">{{cite journal| author=Cherry JD| title=Contemporary infectious exanthems. | journal=Clin Infect Dis | year= 1993 | volume= 16 | issue= 2 | pages= 199-205 | pmid=8443297 | doi=10.1093/clind/16.2.199 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8443297 }}</ref>=== | ||
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==FIRE: Focused Initial Rapid Evaluation== | ==FIRE: Focused Initial Rapid Evaluation== | ||
The diagnostic approach to the child patient with fever and rash should focus on the appearance of the rash and the detailed epidemiologic history<ref name="pmid11486283">{{cite journal| author=O'Brien D, Tobin S, Brown GV, Torresi J| title=Fever in returned travelers: review of hospital admissions for a 3-year period. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 5 | pages= 603-9 | pmid=11486283 | doi=10.1086/322602 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11486283 }}</ref><ref name="pmid146393752">{{cite journal| author=Lupi O, Tyring SK| title=Tropical dermatology: viral tropical diseases. | journal=J Am Acad Dermatol | year= 2003 | volume= 49 | issue= 6 | pages= 979-1000; quiz 1000-2 | pmid=14639375 | doi=10.1016/s0190-9622(03)02727-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14639375 }}</ref><ref name="pmid10453260">{{cite journal| author=Suh KN, Kozarsky PE, Keystone JS| title=Evaluation of fever in the returned traveler. | journal=Med Clin North Am | year= 1999 | volume= 83 | issue= 4 | pages= 997-1017 | pmid=10453260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10453260 }}</ref> | |||
[[Seasonal allergy|Season]]<ref name="pmid16177685">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Vibrio illnesses after Hurricane Katrina--multiple states, August-September 2005. | journal=MMWR Morb Mortal Wkly Rep | year= 2005 | volume= 54 | issue= 37 | pages= 928-31 | pmid=16177685 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16177685 }}</ref><ref name="pmid758155">{{cite journal| author=Blake PA, Merson MH, Weaver RE, Hollis DG, Heublein PC| title=Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. | journal=N Engl J Med | year= 1979 | volume= 300 | issue= 1 | pages= 1-5 | pmid=758155 | doi=10.1056/NEJM197901043000101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=758155 }}</ref> | |||
Geography | |||
[[Incubation period]] | |||
[[Exposure and response|Exposure]] history<ref name="pmid2051013">{{cite journal| author=Craven RB, Barnes AM| title=Plague and tularemia. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 165-75 | pmid=2051013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051013 }}</ref><ref name="pmid20510122">{{cite journal| author=Fox JG, Lipman NS| title=Infections transmitted by large and small laboratory animals. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 131-63 | pmid=2051012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051012 }}</ref><ref name="pmid2051011">{{cite journal| author=Goldstein EJ| title=Household pets and human infections. | journal=Infect Dis Clin North Am | year= 1991 | volume= 5 | issue= 1 | pages= 117-30 | pmid=2051011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2051011 }}</ref><ref name="pmid14727806">{{cite journal| author=Hankenson FC, Johnston NA, Weigler BJ, Di Giacomo RF| title=Zoonoses of occupational health importance in contemporary laboratory animal research. | journal=Comp Med | year= 2003 | volume= 53 | issue= 6 | pages= 579-601 | pmid=14727806 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727806 }}</ref><ref name="pmid9887159">{{cite journal| author=Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ| title=Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 2 | pages= 85-92 | pmid=9887159 | doi=10.1056/NEJM199901143400202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9887159 }}</ref> | |||
[[Arthropods|Arthropod]] exposures<ref name="pmid8147546">{{cite journal| author=Fishbein DB, Dawson JE, Robinson LE| title=Human ehrlichiosis in the United States, 1985 to 1990. | journal=Ann Intern Med | year= 1994 | volume= 120 | issue= 9 | pages= 736-43 | pmid=8147546 | doi=10.7326/0003-4819-120-9-199405010-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8147546 }}</ref><ref name="pmid18452807">{{cite journal| author=Masters EJ, Grigery CN, Masters RW| title=STARI, or Masters disease: Lone Star tick-vectored Lyme-like illness. | journal=Infect Dis Clin North Am | year= 2008 | volume= 22 | issue= 2 | pages= 361-76, viii | pmid=18452807 | doi=10.1016/j.idc.2007.12.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452807 }}</ref><ref name="pmid3565971">{{cite journal| author=Mackowiak PA, LeMaistre CF| title=Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. | journal=Ann Intern Med | year= 1987 | volume= 106 | issue= 5 | pages= 728-33 | pmid=3565971 | doi=10.7326/0003-4819-106-5-728 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3565971 }}</ref><ref name="pmid8604172">{{cite journal| author=Bakken JS, Krueth J, Wilson-Nordskog C, Tilden RL, Asanovich K, Dumler JS| title=Clinical and laboratory characteristics of human granulocytic ehrlichiosis. | journal=JAMA | year= 1996 | volume= 275 | issue= 3 | pages= 199-205 | pmid=8604172 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8604172 }}</ref><ref name="pmid9233663">{{cite journal| author=Dumler JS| title=Is human granulocytic ehrlichiosis a new Lyme disease? Review and comparison of clinical, laboratory, epidemiological, and some biological features. | journal=Clin Infect Dis | year= 1997 | volume= 25 Suppl 1 | issue= | pages= S43-7 | pmid=9233663 | doi=10.1086/516164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9233663 }}</ref> | |||
[[Medication]] history<ref name="pmid128641">{{cite journal| author=Arndt KA, Jick H| title=Rates of cutaneous reactions to drugs. A report from the Boston Collaborative Drug Surveillance Program. | journal=JAMA | year= 1976 | volume= 235 | issue= 9 | pages= 918-23 | pmid=128641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=128641 }}</ref> | |||
[[Immunization]] history<ref name="pmid20170376">{{cite journal| author=Weinberg A, Lazar AA, Zerbe GO, Hayward AR, Chan IS, Vessey R | display-authors=etal| title=Influence of age and nature of primary infection on varicella-zoster virus-specific cell-mediated immune responses. | journal=J Infect Dis | year= 2010 | volume= 201 | issue= 7 | pages= 1024-30 | pmid=20170376 | doi=10.1086/651199 | pmc=3136368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20170376 }}</ref><ref name="pmid3033012">{{cite journal| author=Hayward AR, Herberger M| title=Lymphocyte responses to varicella zoster virus in the elderly. | journal=J Clin Immunol | year= 1987 | volume= 7 | issue= 2 | pages= 174-8 | pmid=3033012 | doi=10.1007/BF00916011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3033012 }}</ref><ref name="pmid6244336">{{cite journal| author=Arvin AM, Pollard RB, Rasmussen LE, Merigan TC| title=Cellular and humoral immunity in the pathogenesis of recurrent herpes viral infections in patients with lymphoma. | journal=J Clin Invest | year= 1980 | volume= 65 | issue= 4 | pages= 869-78 | pmid=6244336 | doi=10.1172/JCI109739 | pmc=434474 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6244336 }}</ref><ref name="pmid6277260">{{cite journal| author=Burke BL, Steele RW, Beard OW, Wood JS, Cain TD, Marmer DJ| title=Immune responses to varicella-zoster in the aged. | journal=Arch Intern Med | year= 1982 | volume= 142 | issue= 2 | pages= 291-3 | pmid=6277260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6277260 }}</ref> | |||
[[Sexual activities|Sexual]] history<ref name="pmid9142802">{{cite journal| author=Vanhems P, Allard R, Cooper DA, Perrin L, Vizzard J, Hirschel B | display-authors=etal| title=Acute human immunodeficiency virus type 1 disease as a mononucleosis-like illness: is the diagnosis too restrictive? | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 5 | pages= 965-70 | pmid=9142802 | doi=10.1093/clinids/24.5.965 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9142802 }}</ref><ref name="pmid1743707">{{cite journal| author=de Jong MD, Hulsebosch HJ, Lange JM| title=Clinical, virological and immunological features of primary HIV-1 infection. | journal=Genitourin Med | year= 1991 | volume= 67 | issue= 5 | pages= 367-73 | pmid=1743707 | doi=10.1136/sti.67.5.367 | pmc=1194734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1743707 }}</ref><ref name="pmidPMID 3928202">{{cite journal| author=Koss PG| title=Disseminated gonococcal infection. The tenosynovitis-dermatitis and suppurative arthritis syndromes. | journal=Cleve Clin Q | year= 1985 | volume= 52 | issue= 2 | pages= 161-73 | pmid=PMID 3928202 | doi=10.3949/ccjm.52.2.161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3928202 }}</ref> | |||
[[Immunocompetence]] of the host<ref name="pmid114477142">{{cite journal| author=Lopez FA, Sanders CV| title=Dermatologic infections in the immunocompromised (non-HIV) host. | journal=Infect Dis Clin North Am | year= 2001 | volume= 15 | issue= 2 | pages= 671-702, xi | pmid=11447714 | doi=10.1016/s0891-5520(05)70164-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11447714 }}</ref><ref name="pmid11447714">{{cite journal| author=Lopez FA, Sanders CV| title=Dermatologic infections in the immunocompromised (non-HIV) host. | journal=Infect Dis Clin North Am | year= 2001 | volume= 15 | issue= 2 | pages= 671-702, xi | pmid=11447714 | doi=10.1016/s0891-5520(05)70164-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11447714 }}</ref> | |||
{{Family tree/start}} | |||
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01= [[Differential diagnosis]] of [[fever and rash]] based on the accompanying symptoms}} | |||
{{Family tree | |,|-|-|-|-|v|-|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|v|-|^|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | }} | |||
{{Family tree | B01 | | | B02 | | | | | | | | B03 | | | | | | | | B04 | | B05 | | B06 | | B07 | | B08 | | |B01=[[Arthritis]]/[[arthralgia]]|B02=[[Desquamation]]|B03=Lymphadenopathy|B04=Enanthems|B05=Ulcerative/vesicular stomatitis|B06=Palm-soul involvement|B07=Rash predominantly on extremities|B08=Pulmonary infiltrations}} | |||
{{Family tree | |!| | | | |!| | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | |!| | | |!| | | |!| | | |!| | | |!| | | }} | |||
{{Family tree | B01 | | | B02 | | B03 | | B04 | | B05 | | B06 | | B07 | | B08 | | B09 | | B10 | | B11 | | |B01=|B02=|B03=Generalized|B04=Hilar|B05=Cervical|B06=Inguinal|B07=|B08=|B09=|B10=|B11=}} | |||
{{Family tree/end}} | |||
Differential diagnosis of fever and rash based upon accompanying signs: | |||
===[[Arthritis]] or [[arthralgia]]=== | |||
[[Acute meningococcemia]] | |||
[[Allergic purpura]] | |||
Disseminated gonoccal | |||
[[Erythema marginatum]]([[acute rheumatic fever]]) | |||
[[hepatitis B virus]], [[prodromal]] phase. | |||
[[lyme disease]] | |||
[[Parvovirus B19|parvovirus]] [[Parvovirus B19|B19]] | |||
[[Reiter's syndrome|reiter's syndrom]] | |||
[[Rocky Mountain spotted fever|rocky mountain spotted fever]] | |||
[[roseola]] (especially in adults) | |||
[[rubella]] | |||
[[serum sickness]] | |||
stills disease | |||
[[systemic lupus erythematous]] <br /> | |||
===[[Desquamation]]=== | |||
''Arcanobacterium haemolyticum'' infection | |||
[[Drug hypersensitivity]] | |||
Graft-versus-host reaction | |||
[[Kawasaki syndrome]] | |||
[[Measles]] | |||
[[Rocky Mountain spotted fever]] | |||
[[Scarlet fever]] | |||
Staphylococcal scalded-skin syndrome | |||
[[Stevens-Johnson syndrome]] | |||
[[Toxic epidermal necrolysis]] | |||
[[Toxic shock syndrome]] | |||
von Zumbusch pustular psoriasis | |||
===[[Lymphadenopathy]]=== | |||
====[[Cervical]]==== | |||
[[Kawasaki syndrome]] | |||
[[Rubella]] | |||
[[Scarlet fever]] | |||
====Generalized==== | |||
[[Infectious mononucleosis]] | |||
[[Secondary syphilis]] | |||
[[Serum sickness]] | |||
[[Sarcoidosis]] | |||
[[Systemic lupus erythematosus]] | |||
[[Toxoplasmosis]] | |||
====[[Hilar]]==== | |||
Atypical [[measles]] | |||
[[Sarcoidosis]] | |||
====Local==== | |||
[[Cat-scratch disease]] | |||
[[Tularemia]] | |||
====[[Meningitis]]==== | |||
[[Acute meningococcemia]] | |||
[[Cryptococcosis]] | |||
[[Enterovirus]] (Coxsackieviruses, echoviruses) | |||
[[Leptospirosis]] | |||
[[Lyme disease]] | |||
[[Rocky Mountain spotted fever]] | |||
[[Secondary syphilis]] | |||
===Mucosal membrane lesions (enanthems)=== | |||
[[Herpes simplex]] | |||
[[Infectious mononucleosis]] (palatal petechiae) | |||
[[Measles]] (Koplick's spots)= Strawberry tongue,Atypical measles,Kawasaki disease,Scarlet fever,Toxic shock syndrome | |||
[[Varicella zoster]] | |||
===Ulcerative or vesicular stomatitis=== | |||
[[Hand-foot-mouth disease]] | |||
[[Herpes simplex]] | |||
[[Histoplasmosis]] | |||
[[Inflammatory bowel disease]] | |||
[[Secondary syphilis]] | |||
[[Systemic lupus erythematosus]] | |||
===Palm-sole involvement=== | |||
[[Acute meningococcemia]] | |||
Atypical [[measles]] | |||
[[Dengue]] | |||
[[Drug rash]] | |||
[[Erythema multiforme]] | |||
[[Hand-foot-mouth disease]] | |||
[[Kawasaki syndrome]] | |||
[[Measles]] | |||
[[Rocky Mountain spotted fever]] | |||
[[Secondary syphilis]] | |||
''[[Staphylococcus aureus]]'' endocarditis | |||
===Rash predominantly on extremities=== | |||
[[Allergic purpura]] | |||
[[Brucellosis]] | |||
[[Disseminated gonococcal infection]] | |||
[[Ecthyma gangrenosum]] | |||
[[Erythema nodosum]] | |||
[[Sporotrichosis]] (fever rare) | |||
<br /> | |||
===[[Pulmonary]] infiltrate=== | |||
Atypical measles | |||
[[Coccidioidomycosis]] | |||
[[Cryptococcosis]] | |||
[[Fat embolism]] | |||
[[Histoplasmosis]] | |||
''[[Mycoplasma pneumoniae]]'' | |||
North American [[blastomycosis]] | |||
[[Psittacosis]] | |||
[[Rocky Mountain spotted fever]] | |||
[[Sarcoidosis]] | |||
[[Varicella zoster]] | |||
==Complete Diagnostic Approach== | ==Complete Diagnostic Approach== | ||
Shown below is an algorithm summarizing the diagnosis of | Shown below is an algorithm summarizing the diagnosis of fever and rush according to ...., Inc. and/or its affiliatesin three categories: | ||
{{ | |||
{{ | {{Family tree/start}} | ||
{{ | {{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01=Complete diagnostic aproach}} | ||
{{ | {{Family tree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|.| | | | | | | }} | ||
{{ | {{Family tree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | A02 | | A03 | |A01=Characteristics of the rash |A02=Physical examination |A03=Laboratory testing }} | ||
{{ | {{Family tree | | | |,|-|-|-|-|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|-|-|-|-|.| | | | | |!| | | |!| | | | }} | ||
{{Family tree | | | A01 | | | | | | A02 | | | | | | A03 | | | | | | A04 | | | | A05 | | A06 |-| A07 | |A01=• Macules<br>• Papules<br>• Nodules<br>• Plaques |A02=• Vesicles<br>• Pustules<br>• Bullae|A03=• Purpuric papules<br>• Purpuric macules<br>• Purpuric vesicles |A04=Widespread erythema with or without edema followed by desquamation |A05=• Vital signs<br>• General appearance<br>• Strict attention to lymph nodes, mucous membranes, genitalia and conjuctiva<br>• Evaluate liver and spleen size<br>• Joint examination<br>• Skin examination|A06=Non-specific testing |A07=• Complete blood count<br>• Urianalysis }} | |||
{{Family tree | |,|-|^|-|.| | | |,|-|^|-|.| | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | | | |!| | | | | | }} | |||
{{Family tree | A01 | | A02 | | A03 | | A04 | | A05 | | A06 | | A07 | | A08 | | | | | | A10 |-| A11 | |A01=Non-infectious |A02=Infectious |A03=Non-infectious |A04=Infectious |A05=Non-infectious |A06=Infectious |A07=Non-infectious |A08=Infectious |A10=Blood culture |A11=• Bacteria<br>• Mycobacteria<br>• Fungal}} | |||
{{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | |!| | | | | | | | | | | | | | | }} | |||
{{Family tree | A01 | | |!| | | A03 | | |!| | | A05 | | |!| | | A07 | | |!| | | | | | | A10 |-| A11 | |A01=|A03=|A05=|A07=|A10=Serology test|A11=• Coccidioides immitis<br>• Hepatitis B<br>• Toxoplasma Gondii<br>• Borrelia Burgdorferi<br>• Treponema Pallidum<br>• Dengue virus<br>• HIV}} | |||
{{Family tree | |,|-|-|-|+|-|-|-|.| | | |!| | | | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | |!| | | | | | }} | |||
{{Family tree | A01 | | A02 | | A03 | | |!| | | | | A04 | | A05 | | A06 | | A07 | | | | A08 |-| A09 | | | |A01=Bacterial|A02=Viral|A03=Fungal|A04=Bacterial|A05=Viral|A06=Bacterial|A07=Viral|A08=Antigen test|A09=Criptococcal antigen }} | |||
{{Family tree | | | | | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{Family tree | | | | | | | | | A01 | | A02 | | A03 | | | | | | | | | | | | | | | | | | A04 |-| A05 | | |A01=Bacterial|A02=Viral|A03=Fungal|A04=Fluorescent antibody or PCR or viral culture|A05=• Varicella zoster<br>• herpes virus}} | |||
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 |-| A02 | |A01=Darkfield microscopy or fluorescent antibody |A02=Syphilis }} | |||
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 |-| A02 | |A01=Immunofluorescent |A02=Rikettsia (Rocky mountain spotted fever) }} | |||
{{Family tree/end}} | |||
===''1.Characteristics of the [[rash]]'':=== | |||
===[[Macules]], [[papules]], [[nodules]], or [[plaques]]=== | |||
===Noninfectious=== | |||
[[Erythema multiforme]] | |||
[[Systemic lupus erythematosus]] | |||
[[Dermatomyositis]] | |||
Drug hypersensitivities | |||
[[Gianotti-Crosti syndrome]] | |||
[[Inflammatory bowel disease]] | |||
[[Pityriasis rosea]] (fever rare) | |||
[[Sarcoidosis]] | |||
[[Serum sickness]] | |||
[[Sweet syndrome]] ([[acute febrile neutrophilic dermatosis]]) | |||
[[Still's disease]] ([[juvenile idiopathic arthritis]]) | |||
===[[Bacterial]]=== | |||
''[[Arcanobacterium haemolyticum]]'' | |||
''[[Bacillus anthracis]]'' | |||
''[[Bartonella bacilliformis]]'' | |||
''[[Bartonella henselae]]'' ([[cat scratch disease]]) | |||
''[[Bartonella quintana]]'' ([[trench fever]]) | |||
''[[Borrelia burgdorferi]]'' ([[Lyme disease]]) | |||
''[[Borrelia]]'' spp ([[relapsing fever]]) | |||
''[[Brucellosis|Brucella]]'' spp ([[brucellosis]]) | |||
''[[Calymmatobacterium granulomatis]]'' ([[donovanosis]]) | |||
''[[Chlamydia psittaci]]'' ([[psittacosis]]) | |||
[[Ehrlichiosis]] | |||
''[[Ehrlichia]] chafeensis'' (HME) | |||
Human granulocytic erlichiosis | |||
''[[Erysipelothrix rhusiopathiae]]'' ([[erysipeloid]]) | |||
''[[Francisella tularensis]]'' ([[tularemia]]) | |||
''[[Listeria monocytogenes]]'' | |||
''[[Leptospira]]'' spp ([[leptospirosis]]) | |||
''[[Mycobacterium leprae]]'' | |||
''[[Mycobacterium marinum]]'' | |||
''[[Mycobacterium tuberculosis]]'' | |||
''[[Mycoplasma pneumoniae]]'' | |||
''[[Neisseria gonorrhoeae]]'' ([[gonorrhea]]) | |||
''[[Neisseria meningitidis]]'' ([[meningococcemia]]) | |||
''[[Pseudomonas aeruginosa]]'' | |||
''[[Rickettsial|Rickettsia]] akari'' ([[rickettsialpox]]) | |||
''[[Rickettsial|Rickettsia]] prowazekii'' ([[epidemic]]/louse-borne typhus) | |||
''[[Rickettsial|Rickettsia]] rickettsii'' (RMSF-early lesions) | |||
''[[Rickettsial|Rickettsia]] orientalis''/''tsutsugamushi'' ([[scrub typhus]]) | |||
''[[Rickettsial|Rickettsia]] typhi'' (endemic/murine typhus) | |||
''[[Salmonella]] typhi'' ([[typhoid fever]]) | |||
''[[Spirillum]] minor'' ([[rat-bite fever]])<br /> | |||
===[[Fungal]]=== | |||
''[[Blastomyces dermatitidis]]'' | |||
''[[Candida]]'' spp | |||
''[[Coccidioides immitis]]'' | |||
''[[Cryptococcus neoformans]]'' | |||
''[[Histoplasma capsulatum]]'' | |||
Other disseminated deep fungal infections in [[immunocompromised]] patients<br /> | |||
===[[Viral]]=== | |||
[[Adenovirus]] | |||
[[Arbovirus]] | |||
Atypical [[measles]] | |||
[[Chikungunya]] virus | |||
[[Colorado tick fever]] | |||
Coxsackieviruses A and B | |||
[[Cytomegalovirus]], primary infection | |||
[[Dengue virus]] | |||
[[Epstein-Barr virus]], primary infection | |||
Echoviruses | |||
[[Hepatitis B]] ([[urticaria]]) | |||
[[Human herpesvirus 6]] ([[exanthem subitum]]) | |||
[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] ([[Human Immunodeficiency Virus (HIV)|HIV-1]]) | |||
[[Kawasaki syndrome]] (presumed viral) | |||
[[Molluscum contagiosum]] | |||
[[Orf]] | |||
[[Parvovirus B19]] ([[erythema infectiosum]] [<nowiki/>[[fifth disease]]]) | |||
[[Rubella]] ([[German measles]]) | |||
[[Rubeola]] ([[measles]]) | |||
[[Varicella]] ([[chickenpox]]) | |||
[[Varicella-zoster]] ([[Disseminated disease|disseminated]]) | |||
Viral hemorrhagic fevers (many) | |||
[[West nile virus|West Nile virus]] | |||
[[Zika virus]] | |||
===[[Vesicles]], bullae, or [[pustules]]=== | |||
===Noninfectious=== | |||
[[Erythema multiforme]] bullosum | |||
[[Toxic epidermal necrolysis]] | |||
[[Dermatitis]] from plants | |||
Drug [[hypersensitivities]] | |||
===[[Bacterial]]=== | |||
''[[Bacillus anthracis]]'' | |||
''Ehrlichia canis'' | |||
''[[Listeria monocytogenes]]'' | |||
''[[Mycoplasma pneumoniae]]'' | |||
''[[Neisseria gonorrhoeae]]'' | |||
''[[Neisseria meningitidis]]'' | |||
''[[Pseudomonas aeruginosa]]'' | |||
''[[Rickettsiae|Rickettsia]] akari'' | |||
''[[Rickettsia rickettsii]]'' | |||
''[[Staphylococcus aureus]]'' (TSS, SSSS) | |||
''[[Streptococcus]]'' group A | |||
''[[Treponema pallidum]]'' (secondary syphilis) | |||
''[[Vibrio vulnificus]]'' | |||
===[[Fungal]]=== | |||
''[[Histoplasma capsulatum]]'' | |||
===[[Viral]]=== | |||
[[Colorado tick fever]] | |||
[[Coxsackie virus|Coxsackie]] A5, 9, 10, 16, B2, 7 | |||
Echoviruses | |||
[[Eczema herpeticum]] | |||
[[Herpes simplex]] ([[Disseminated intravascular coagulation|disseminated]]) | |||
[[Varicella]] ([[chickenpox]]) | |||
[[Varicella-zoster virus|Varicella-zoster]] (disseminated) | |||
===[[Purpuric]] [[macules]], [[purpuric]] [[papules]], or [[purpuric]] [[vesicles]]=== | |||
===Noninfectious=== | |||
"Allergic" [[vasculitis]] | |||
[[Erythroderma]] | |||
[[Cholesterol embolization]] | |||
[[Disseminated intravascular coagulation]] ([[purpura fulminans]]) | |||
Drug [[hypersensitivities]] | |||
[[Fat embolism]] | |||
[[Henoch-Schönlein purpura]] | |||
[[Immune thrombocytopenic purpura]] | |||
[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis CT|Wegener's]]) | |||
===[[Bacterial]]=== | |||
[[Bacteremia]] | |||
''[[Borrelia]]'' spp | |||
''[[Clostridium]]'' spp | |||
[[Infective endocarditis]] (many species) | |||
''[[Haemophilus influenzae]]'' type B | |||
''[[Neisseria gonorrhoeae]]'' (disseminated gonococcal infection) | |||
''[[Neisseria meningitidis]]'' (acute or chronic meningococcemia) | |||
''[[Pseudomonas]] aeruginosa'' | |||
''[[Rickettsia prowazekii]]'' | |||
''[[Rickettsia rickettsii]]'' | |||
''Spirillum minor'' | |||
''[[Staphylococcus aureus]]'' (bacteremia) | |||
''[[Streptobacillus moniliformis]]'' | |||
''Streptococcus'' group A (streptococcal toxic shock syndrome, scarlet fever) | |||
''[[Streptococcus pneumoniae]]'' (asplenic patient) | |||
''[[Vibrio vulnificus]]'' | |||
''[[Yersinia pestis]]'' | |||
===[[Viral]]=== | |||
[[Adenovirus]] (rare) | |||
Atypical measles | |||
[[Chikungunya]] virus | |||
[[Colorado tick fever]] | |||
[[Congenital cytomegalovirus infecttion|Congenital cytomegalovirus]] | |||
[[Coxsackie virus|Coxsackie]] A and B (rare, types A-9, B2-5) | |||
[[Dengue fever]] | |||
[[Epstein-Barr virus]] (rare) | |||
Echoviruses (rare, types 3, 4, 9) | |||
[[Rubella]] | |||
[[Varicella-zoster virus]] | |||
[[West nile virus|West Nile virus]] | |||
[[Yellow fever]] | |||
===Widespread [[erythema]] with or without [[edema]] followed by [[desquamation]]=== | |||
===Noninfectious=== | |||
[[Erythroderma]] | |||
Drug [[hypersensitivities]] | |||
Graft-versus-host reaction | |||
[[Stevens-Johnson syndrome]] | |||
[[Toxic epidermal necrolysis]] | |||
von Zumbusch pustular psoriasis | |||
===[[Bacterial]]=== | |||
''[[Streptococcus Group A|Streptococcus]]'' group A (scarlet fever, streptococcal toxic shock syndrome) | |||
''Stapylococcus'' aureus (TSS, SSSS) | |||
===Viral=== | |||
[[Kawasaki syndrome]] (presumed viral) | |||
<br /> | |||
====''2.[[Physical examination]]''==== | |||
*[[Vital signs]] | |||
*General appearance to assess the severity of illness | |||
*Strict attention to [[lymph nodes]], [[mucous membranes]], [[Conjunctiva|conjunctiv]]<nowiki/>ae, and [[genitalia]] | |||
*[[Meningeal signs]] and complete [[Neurology|neurologic]] evaluation | |||
*[[Liver]] and [[spleen]] size | |||
*[[Joint]] examination | |||
*[[Skin]] examination | |||
===''3.Laboratory testing''=== | |||
*Nonspecific tests like: [[complete blood count]] and [[urinalysis]] | |||
*[[Blood cultures]] (including specific media and isolation methods for [[bacterial]], [[mycobacterial]], and [[fungal]] organisms) should be inoculated prior to beginning [[Antimicrobial drug|antimicrobial]] therapy | |||
*[[Serologic]] tests, when appropriate (eg, for ''[[Coccidioides immitis]]'', [[hepatitis B]], ''[[Toxoplasma gondii]]'', ''[[Borrelia burgdorferi]]'', ''[[Treponema pallidum]]'', [[dengue virus]], and [[HIV]]) | |||
*[[Antigen detection test|Antigen]] tests, when appropriate (eg, serum [[Cryptococcal infection|cryptococcal]] [[Antigen presenting cells|antigen]]) | |||
*[[herpes simplex virus]] and [[varicella-zoster virus]] can be diagnosed with direct [[fluorescent antibody]] or [[polymerase chain reaction]] ([[PCR]]) assays. [[Viral culture]] can also be performed | |||
*In suspected cases of [[syphilis]], can be evaluated with [[Darkfield microscope|darkfield]] microscopy or direct [[fluorescent antibody]] testing | |||
*in suspected cases of [[Rocky Mountain spotted fever]], direct [[immunofluorescent]] demonstration of [[rickettsial]] organisms is diagnostic | |||
<br /> | |||
==Treatment== | ==Treatment== | ||
Shown below is an algorithm summarizing the treatment of | Shown below is an algorithm summarizing the treatment of fever and rush disease according the the [...] guidelines. | ||
{{ | |||
{{familytree | | | | | | | | | Treatment of [[fever]] depending on the cause of the [[symptoms]], in severe cases, a child might sometimes need to stay in the [[hospital]].<br /> patient of fever can take [[acetaminophen]] and [[ibuprofen]], if patient have [[Itchy skin|itchy]] [[viral]] '''rash''', you can try applying a cool [[Compressed fluid|compress]] or [[calamine lotion]] to the affected area. | ||
{{familytree | | | | | |||
{{familytree | | | | <br /> | ||
{{familytree | |||
{{Family tree/start}} | |||
{{familytree | | | {{familytree | | | | | | | A01 | | | A01= Child with fever and rush }} | ||
{{familytree | | |,|-|-|-|-|^|-|-|-|-|.| | }} | |||
{{familytree | | {{familytree | | C01 | | | | | | | | C02 | C01= Non-Infectious| C02= Infectious}} | ||
{{familytree | | |!| | | | | |,|-|-|-|+|-|-|-|.| | }} | |||
{{familytree | | | | | | | | | | | | {{familytree | | A01 | | | | A02 | | A03 | | A04 | | | A01= Treat every case according to the cause of disease | A02= Bacterial| A03= Viral| A04= Fungal}} | ||
{{familytree | | | | | | | | |!| | | |!| | | |!| | | | | | | | }} | |||
{{familytree/end}} | {{familytree | | | | | | | | A01 | | A02 | | A03 | | | A01= Antibiotic and antihistaminic | A02=• Rest<br>• Antipiretics<br>• Plenty of oral fluids| A03= Antifungals according to the microorganism}} | ||
{{familytree/end}}<br />[[Antibiotics]] can get rid of the infection, but they will not treat the rash, so we use the antibiotic in: | |||
*[[cellulitis]] and similar [[skin]] [[infections]]. | |||
*[[Streptococcus|strep]] [[infections]]. | |||
*A viral [[rash]] becomes infected, especially if a child scratches it a lot. So a child might need [[antibiotics]]. | |||
<br /> | |||
==Do's== | ==Do's<ref name="urlwww.infectiousdiseaseadvisor.com">{{cite web |url=https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/fever-and-rash/ |title=www.infectiousdiseaseadvisor.com |format= |work= |accessdate=}}</ref>== | ||
* | *Cough etiquette, contact precautions, and hand hygiene are easy and cost-effective measures in reducing the spread of [[infectious]] agents causing [[fever]] and [[rash]]. | ||
*For [[measles]], [[mumps]], [[rubella]] ([[MMR]]) prevention can be achieved by [[vaccination]] (two doses in childhood). In adolescents and adults, if none confirmatory immunization documentation exists, they need to receive two doses of MMR, at least 4-week apart.(Vaccines have been accepted in most national immunization programs) | |||
*Prevention of [[varicella]] and [[meningococcemia]] can also be achieved by [[vaccination]]. (vaccines have been accepted in most national immunization programs). | |||
*For [[Meningococcal Disease|meningococcal]] disease, [[chemoprophylaxis]] can also be useful. Among household contacts, the incidence of transmission of meningococcus is approximately 5%; therefore, it is recommended that household contacts of bacteriologically confirmed cases receive [[rifampin]] (adults: 600 mg bid for a total of 4 doses; children older than 1 month: 10 mg/kg; children younger than 1 month: 5 mg/kg). These contacts should be advised to watch for [[fever]], [[rash]], [[sore throat]], or any symptoms of [[meningitis]]. Intimate, non-household contacts who have had mucosal exposure to the patient’s oral secretions should also receive prophylaxis. Health-care workers are not at an increased risk for the disease and do not require prophylaxis unless they have had direct mucosal contact with patient secretions (i.e., mouth-to-mouth resuscitation, endotracheal intubation, or nasotracheal suctioning). [[Ciprofloxacin]] (500 mg by mouth; adults only) or [[ceftriaxone]] (250 mg IM for adults or 125 mg IM for children) are single dose alternatives. | |||
*With the increasing vector borne diseases (e.g., [[Zika virus infection|Zika]], [[chinkungunya]], [[Dengue fever|dengue]], [[yellow fever]]) efforts to prevent mosquito bites are cornerstone. Some of the recommended measures in persons living or traveling to endemic areas are: | |||
*Long-sleeved shirts and pants. | |||
*If possible, keep indoors at sunset. | |||
*Cover water storage containers so that mosquitos cannot get inside to lay eggs. | |||
*Discard or empty regularly any items that hold water like tires, buckets, pools, birdbaths, flowerpot saucers, or trash containers. | |||
*Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites. | |||
*Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET (≥20%), picardin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. For men who live in or have traveled to an area with [[Zika virus infection|Zika]], and have a pregnant partner they either have to use [[condoms]] correctly from start to finish, every time they have [[vaginal]], [[anal]], and [[oral]] sex, or do not have sex during pregnancy. Women who had [[Zika virus disease]] should wait at least 8 weeks after exposure to attempt conception and men with [[Zika virus disease]] should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to [[Zika virus]] but without clinical illness consistent with [[Zika virus disease]] should wait at least 8 weeks after exposure to attempt conception. | |||
==Don'ts== | ==Don'ts== | ||
* | *Suggest not combining or alternating [[acetaminophen]] with [[ibuprofen]]. | ||
*Suggest not using external cooling for [[temperature]] reduction. | |||
*Suggest not to clean the rush area to avoid the [[secondary infection]] by [[chemical]] products. | |||
*Avoiding unnecessary drug prescriptions prevents [[Drug-induced|drug]]-related adverse events. | |||
*[[MMR]] is contraindicated in [[pregnancy]], [[HIV]] with [[CD4+ lymphocytes|CD4]] lymphocyte < 200 cells/mm3, or [[immune]]<nowiki/>compromised patients. | |||
*There are variations across the globe depending on the [[epidemiology]] of the disease (e.g., [[meningococcal disease]]), health budget, and authority decisions (e.g., [[varicella vaccine]] is not on the immunization program of France or the United Kingdom). | |||
==References== | ==References== | ||
Line 153: | Line 709: | ||
[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Primary care]] |
Latest revision as of 10:36, 7 March 2021
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]
Synonyms and keywords:
Fever:
Frenzy,Temperature, Feverishness, Heat, Ferment, Pyrexia,
Excitement, Agitation, Febrile, Feverish, Furor, Sweat, Ecstasy, Febricity, Hyperthermia.
Rush:
Reckless, Impetuous, Impulsive, Hasty, Overhasty, Foolhardy, Incautious, Precipitate, Precipitous, Premature, Careless, Heedless, Thoughtless.
Fever and rash resident survival guide (pediatrics) Microchapters |
---|
Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
Fever with rash is a common symptom redundancy in patients presenting to clinicians' offices and emergency departments. Skin manifestations may provide the only early clue to an underlying infection, may be the hallmark of contagious disease, and/or may be an early sign of a life-threatening infection or serious noninfectious disorder. The differential diagnosis of fever and rash is extremely broad, but this symptom complex show an fortuity for the exacting clinician to start a probable etiology through a careful history and physical examination.
A systematic method is crucial for starting a timely diagnosis, determining early therapy when appropriate, and considering isolation of the patient if necessary. The treatment must to be belonging to euch cause specifeclly.
and the most important part is the advice that patient have to be aware of fever and rush diseases, to avoid the severity of the fever and rush side effect.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Meningococcal infection[1][2]
- Bacterial endocarditis[3][4][5]
- Rocky Mountain spotted fever[6][7][8][9][10]
- Necrotizing fasciitis[11][12]
- Toxic shock syndrome[13][14][15][16]
- Miliary tuberculosis[17][18][19]
Common Causes[20]
- Measles (rubeola)[21]
- Chickenpox (varicella)[22][23]
- Rubella
- Erythema infectiosum (fifth disease)[24][25][26]
- Roseola infantum (exanthem subitum; sixth disease)[27]
- Scarlet fever[28]
- Acute rheumatic fever(ARF)[29]
- Kawasaki syndrome[30]
- Enteroviruses[31][32]
- Mononucleosis[33][34]
- Arcanobacterium haemolyticum[35]
- Mycoplasma pneumoniae[36]
FIRE: Focused Initial Rapid Evaluation
The diagnostic approach to the child patient with fever and rash should focus on the appearance of the rash and the detailed epidemiologic history[37][38][39]
Geography
Exposure history[42][43][44][45][46]
Arthropod exposures[47][48][49][50][51]
Medication history[52]
Immunization history[53][54][55][56]
Immunocompetence of the host[60][61]
Differential diagnosis of fever and rash based on the accompanying symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Arthritis/arthralgia | Desquamation | Lymphadenopathy | Enanthems | Ulcerative/vesicular stomatitis | Palm-soul involvement | Rash predominantly on extremities | Pulmonary infiltrations | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Generalized | Hilar | Cervical | Inguinal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Differential diagnosis of fever and rash based upon accompanying signs:
Arthritis or arthralgia
Disseminated gonoccal
Erythema marginatum(acute rheumatic fever)
hepatitis B virus, prodromal phase.
roseola (especially in adults)
stills disease
Desquamation
Arcanobacterium haemolyticum infection
Graft-versus-host reaction
Staphylococcal scalded-skin syndrome
von Zumbusch pustular psoriasis
Lymphadenopathy
Cervical
Generalized
Hilar
Atypical measles
Local
Meningitis
Enterovirus (Coxsackieviruses, echoviruses)
Mucosal membrane lesions (enanthems)
Infectious mononucleosis (palatal petechiae)
Measles (Koplick's spots)= Strawberry tongue,Atypical measles,Kawasaki disease,Scarlet fever,Toxic shock syndrome
Ulcerative or vesicular stomatitis
Palm-sole involvement
Atypical measles
Staphylococcus aureus endocarditis
Rash predominantly on extremities
Disseminated gonococcal infection
Sporotrichosis (fever rare)
Pulmonary infiltrate
Atypical measles
North American blastomycosis
Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of fever and rush according to ...., Inc. and/or its affiliatesin three categories:
Complete diagnostic aproach | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Characteristics of the rash | Physical examination | Laboratory testing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
• Macules • Papules • Nodules • Plaques | • Vesicles • Pustules • Bullae | • Purpuric papules • Purpuric macules • Purpuric vesicles | Widespread erythema with or without edema followed by desquamation | • Vital signs • General appearance • Strict attention to lymph nodes, mucous membranes, genitalia and conjuctiva • Evaluate liver and spleen size • Joint examination • Skin examination | Non-specific testing | • Complete blood count • Urianalysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Non-infectious | Infectious | Non-infectious | Infectious | Non-infectious | Infectious | Non-infectious | Infectious | Blood culture | • Bacteria • Mycobacteria • Fungal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Serology test | • Coccidioides immitis • Hepatitis B • Toxoplasma Gondii • Borrelia Burgdorferi • Treponema Pallidum • Dengue virus • HIV | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Bacterial | Viral | Fungal | Bacterial | Viral | Bacterial | Viral | Antigen test | Criptococcal antigen | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Bacterial | Viral | Fungal | Fluorescent antibody or PCR or viral culture | • Varicella zoster • herpes virus | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Darkfield microscopy or fluorescent antibody | Syphilis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Immunofluorescent | Rikettsia (Rocky mountain spotted fever) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1.Characteristics of the rash:
Macules, papules, nodules, or plaques
Noninfectious
Drug hypersensitivities
Pityriasis rosea (fever rare)
Sweet syndrome (acute febrile neutrophilic dermatosis)
Still's disease (juvenile idiopathic arthritis)
Bacterial
Bartonella henselae (cat scratch disease)
Bartonella quintana (trench fever)
Borrelia burgdorferi (Lyme disease)
Borrelia spp (relapsing fever)
Brucella spp (brucellosis)
Calymmatobacterium granulomatis (donovanosis)
Chlamydia psittaci (psittacosis)
Ehrlichia chafeensis (HME)
Human granulocytic erlichiosis
Erysipelothrix rhusiopathiae (erysipeloid)
Francisella tularensis (tularemia)
Leptospira spp (leptospirosis)
Neisseria gonorrhoeae (gonorrhea)
Neisseria meningitidis (meningococcemia)
Rickettsia akari (rickettsialpox)
Rickettsia prowazekii (epidemic/louse-borne typhus)
Rickettsia rickettsii (RMSF-early lesions)
Rickettsia orientalis/tsutsugamushi (scrub typhus)
Rickettsia typhi (endemic/murine typhus)
Salmonella typhi (typhoid fever)
Spirillum minor (rat-bite fever)
Fungal
Candida spp
Other disseminated deep fungal infections in immunocompromised patients
Viral
Atypical measles
Chikungunya virus
Coxsackieviruses A and B
Cytomegalovirus, primary infection
Epstein-Barr virus, primary infection
Echoviruses
Human herpesvirus 6 (exanthem subitum)
Human immunodeficiency virus (HIV-1)
Kawasaki syndrome (presumed viral)
Parvovirus B19 (erythema infectiosum [fifth disease])
Varicella-zoster (disseminated)
Viral hemorrhagic fevers (many)
Vesicles, bullae, or pustules
Noninfectious
Erythema multiforme bullosum
Dermatitis from plants
Drug hypersensitivities
Bacterial
Ehrlichia canis
Rickettsia akari
Staphylococcus aureus (TSS, SSSS)
Streptococcus group A
Treponema pallidum (secondary syphilis)
Fungal
Viral
Coxsackie A5, 9, 10, 16, B2, 7
Echoviruses
Varicella-zoster (disseminated)
Purpuric macules, purpuric papules, or purpuric vesicles
Noninfectious
"Allergic" vasculitis
Disseminated intravascular coagulation (purpura fulminans)
Drug hypersensitivities
Immune thrombocytopenic purpura
Granulomatosis with polyangiitis (Wegener's)
Bacterial
Borrelia spp
Clostridium spp
Infective endocarditis (many species)
Haemophilus influenzae type B
Neisseria gonorrhoeae (disseminated gonococcal infection)
Neisseria meningitidis (acute or chronic meningococcemia)
Pseudomonas aeruginosa
Spirillum minor
Staphylococcus aureus (bacteremia)
Streptococcus group A (streptococcal toxic shock syndrome, scarlet fever)
Streptococcus pneumoniae (asplenic patient)
Viral
Adenovirus (rare)
Atypical measles
Chikungunya virus
Coxsackie A and B (rare, types A-9, B2-5)
Epstein-Barr virus (rare)
Echoviruses (rare, types 3, 4, 9)
Widespread erythema with or without edema followed by desquamation
Noninfectious
Drug hypersensitivities
Graft-versus-host reaction
von Zumbusch pustular psoriasis
Bacterial
Streptococcus group A (scarlet fever, streptococcal toxic shock syndrome)
Stapylococcus aureus (TSS, SSSS)
Viral
Kawasaki syndrome (presumed viral)
2.Physical examination
- General appearance to assess the severity of illness
- Strict attention to lymph nodes, mucous membranes, conjunctivae, and genitalia
- Meningeal signs and complete neurologic evaluation
- Joint examination
- Skin examination
3.Laboratory testing
- Nonspecific tests like: complete blood count and urinalysis
- Blood cultures (including specific media and isolation methods for bacterial, mycobacterial, and fungal organisms) should be inoculated prior to beginning antimicrobial therapy
- Serologic tests, when appropriate (eg, for Coccidioides immitis, hepatitis B, Toxoplasma gondii, Borrelia burgdorferi, Treponema pallidum, dengue virus, and HIV)
- Antigen tests, when appropriate (eg, serum cryptococcal antigen)
- herpes simplex virus and varicella-zoster virus can be diagnosed with direct fluorescent antibody or polymerase chain reaction (PCR) assays. Viral culture can also be performed
- In suspected cases of syphilis, can be evaluated with darkfield microscopy or direct fluorescent antibody testing
- in suspected cases of Rocky Mountain spotted fever, direct immunofluorescent demonstration of rickettsial organisms is diagnostic
Treatment
Shown below is an algorithm summarizing the treatment of fever and rush disease according the the [...] guidelines.
Treatment of fever depending on the cause of the symptoms, in severe cases, a child might sometimes need to stay in the hospital.
patient of fever can take acetaminophen and ibuprofen, if patient have itchy viral rash, you can try applying a cool compress or calamine lotion to the affected area.
Child with fever and rush | |||||||||||||||||||||||||||||||||||||||||||||||||
Non-Infectious | Infectious | ||||||||||||||||||||||||||||||||||||||||||||||||
Treat every case according to the cause of disease | Bacterial | Viral | Fungal | ||||||||||||||||||||||||||||||||||||||||||||||
Antibiotic and antihistaminic | • Rest • Antipiretics • Plenty of oral fluids | Antifungals according to the microorganism | |||||||||||||||||||||||||||||||||||||||||||||||
Antibiotics can get rid of the infection, but they will not treat the rash, so we use the antibiotic in:
- cellulitis and similar skin infections.
- strep infections.
- A viral rash becomes infected, especially if a child scratches it a lot. So a child might need antibiotics.
Do's[62]
- Cough etiquette, contact precautions, and hand hygiene are easy and cost-effective measures in reducing the spread of infectious agents causing fever and rash.
- For measles, mumps, rubella (MMR) prevention can be achieved by vaccination (two doses in childhood). In adolescents and adults, if none confirmatory immunization documentation exists, they need to receive two doses of MMR, at least 4-week apart.(Vaccines have been accepted in most national immunization programs)
- Prevention of varicella and meningococcemia can also be achieved by vaccination. (vaccines have been accepted in most national immunization programs).
- For meningococcal disease, chemoprophylaxis can also be useful. Among household contacts, the incidence of transmission of meningococcus is approximately 5%; therefore, it is recommended that household contacts of bacteriologically confirmed cases receive rifampin (adults: 600 mg bid for a total of 4 doses; children older than 1 month: 10 mg/kg; children younger than 1 month: 5 mg/kg). These contacts should be advised to watch for fever, rash, sore throat, or any symptoms of meningitis. Intimate, non-household contacts who have had mucosal exposure to the patient’s oral secretions should also receive prophylaxis. Health-care workers are not at an increased risk for the disease and do not require prophylaxis unless they have had direct mucosal contact with patient secretions (i.e., mouth-to-mouth resuscitation, endotracheal intubation, or nasotracheal suctioning). Ciprofloxacin (500 mg by mouth; adults only) or ceftriaxone (250 mg IM for adults or 125 mg IM for children) are single dose alternatives.
- With the increasing vector borne diseases (e.g., Zika, chinkungunya, dengue, yellow fever) efforts to prevent mosquito bites are cornerstone. Some of the recommended measures in persons living or traveling to endemic areas are:
- Long-sleeved shirts and pants.
- If possible, keep indoors at sunset.
- Cover water storage containers so that mosquitos cannot get inside to lay eggs.
- Discard or empty regularly any items that hold water like tires, buckets, pools, birdbaths, flowerpot saucers, or trash containers.
- Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.
- Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET (≥20%), picardin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. For men who live in or have traveled to an area with Zika, and have a pregnant partner they either have to use condoms correctly from start to finish, every time they have vaginal, anal, and oral sex, or do not have sex during pregnancy. Women who had Zika virus disease should wait at least 8 weeks after exposure to attempt conception and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception.
Don'ts
- Suggest not combining or alternating acetaminophen with ibuprofen.
- Suggest not using external cooling for temperature reduction.
- Suggest not to clean the rush area to avoid the secondary infection by chemical products.
- Avoiding unnecessary drug prescriptions prevents drug-related adverse events.
- MMR is contraindicated in pregnancy, HIV with CD4 lymphocyte < 200 cells/mm3, or immunecompromised patients.
- There are variations across the globe depending on the epidemiology of the disease (e.g., meningococcal disease), health budget, and authority decisions (e.g., varicella vaccine is not on the immunization program of France or the United Kingdom).
References
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