Rash with Fever
Rash with Fever: Excerpt from In a Page: Signs and Symptoms
The etiologies of rash with fever are vast, but a systematic approach will help the clinician quickly narrow the differential. Patients who appear “toxic” with fever and prostration must be rapidly and thoroughly evaluated to rule out life-threatening infections and illnesses. Also, the type and distribution of the rash are important in identifying the etiology, as are associated symptoms and signs (e.g., cough, URI symptoms, pharyngitis, myalgias).
Differential Diagnosis
- Viral exanthems
–Leading cause of fever and rash in childhood
–Most children present with low-grade fevers, viral prodromal symptoms, and a secondary diffuse exanthem that is usually nonspecific and morbilliform
–Often last only a few days and requires only supportive management
-
Drug reactions
–Account for a large portion of rashes with associated fever
–Immune complex disease or serum sickness has been reported with many medications
-
Meningococcemia
–Most common under age 1
–After a brief prodrome; onset is abrupt with spiking fevers, diffuse purpuric lesions, delirium, and death
–DIC and purpura fulminans with secondary necrosis of digits and limbs can occur
- Rocky Mountain Spotted Fever
–A fulminant and deadly rickettsial disease transmitted by a tick bite
–Only 60% of patients are aware of tick bite
–Characteristic rash starts acrally on wrists and ankles and spreads toward the trunk
–Initially, pink macules evolve over 10–24 hours into red papules, then purpuric macules and violaceous patches involving most of the body surface area
–Necrosis and DIC may occur
- Toxic shock syndrome, Staphylococcus aureus, and streptococcal diseases
–Most cases due to toxin production
–Rapid onset of fever, hypotension with generalized skin (palms and soles common) and mucous membrane erythema (“erythroderma” in case definition), and subsequent multiorgan failure
–Palmar/solar desquamation in 1–3 weeks
–A morbilliform rash and skin “pain” or hyperesthesia is common
–Nonsurgical and surgical wounds are often the source of infection in the more common nonmenstrual variant of TSS
-
Fifth disease
-
Measles
-
Rubella
-
Parvovirus
-
Varicella
Workup and Diagnosis
-
Because of a seemingly endless list of possible etiologies for fever and rash, a focused history and physical exam are essential to a quick, accurate diagnosis
-
Determine whether the patient appears toxic; age and presence of co-morbid conditions aid diagnosis
-
If there is any evidence of purpura;
–Quickly consider the diagnosis of RMSF, meningococcemia, or systemic vasculitis
–In the cases of meningococcemia and RMSF, the diagnosis must be made empirically, then later confirmed so that therapy is immediately initiated
Obtain bacterial cultures from any wounds, culture the pharynx if indicated, and consider skin biopsy and culture; blood cultures are indicated in toxic patients; consider immediate lumbar puncture for CSF culture and Gram stain if meningococcemia is suspected
Acute and convalescent antibody titers can confirm RMSF; skin biopsy with immunofluorescnce may demonstrate a vasculitis with visible rickettsial organisms within the endothelium
TSS is often diagnosed by history and examination alone; recent cutaneous injury and nonspecific morbilliform rash in a hypotensive patient in association with the presence of epidermal necrosis on skin biopsy can confirm the diagnosis; wound cultures with growth of staph or strep
Treatment
-
Supportive management and thorough evaluation for multisystem disease is imperative in this patient subset.
-
Doxycycline is the treatment of choice for RMSF, while ceftriaxone is commonly used for meningococcal therapy; because these two diseases can present similarly and rapidly evolve, many clinicians empirically treat with both of these antibiotics until the diagnosis is confirmed
-
Unfortunately, a complete discussion of fever and rash is far beyond the scope of this brief excerpt; the importance of rapid and accurate assessment of every patient presenting with this complaint cannot be overemphasized; rule out the most serious diagnoses first, then “a watch and wait” approach may be considered
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
More About Colorado tick fever
More Medical Textbooks Online about Colorado tick fever
Review other book chapters online related to Colorado tick fever:
Medical Books Excerpts
- Fever
- "In a Page: Signs and Symptoms" (2004)
- [ read ]
- FEVER
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Fever
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Lassa fever
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Fever
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Fever
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Fever
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Fever
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- FEVER
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
|
|
» Next page: Fever – Cyclic (In A Page: Pediatric Signs and Symptoms)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
