Fever and Rash
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Transcript of Fever and Rash
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Fever and RashDJATNIKA SETIABUDI
Tropical Medicine Block/System Medical Faculty Padjadjaran University
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Introduction Common problem in clinic
Wide range of severity : self limited disease life-threatening
Wrong 1st suspicion fatal outcome
Knowledge of differential diagnosis !!!
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Differential Diagnosis (1)Past history of infectious disease and immunizationType of pro-dromal periodFeature of the rashPresence of pathognomic or other diagnostic signsLaboratory diagnostic tests
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Differential Diagnosis (2)Feature of the rash :Category: - macular or maculo-papular - papulo-vesicular - petechial or purpuricCharacter : discrete or confluentDistributionDurationThe appearance associated with fever?
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MORBILLI(Measles; Rubeola) Acute infection, contagious, caused by morbilli Virus ( Famili Paramyxoviridae) 3 stadia : Prodromal Erupstion Convalescens Endemic in developing countries Effective imunization program cases decreasing prone to older age group
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Pathology Lesion particularly at : - Skin - Mucous membranes : respiratory : nasopharyng, bronchi digestive : oral cavity, intestine - Conjungtiva Serous exudate, mononuclear cell predominant
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Clinical manifestations Incubation period : 10 12 days Stadium prodromal : - Coryza, Cough, Conjungtivitis - Koplik spots - Fever Stadium eruption : - High fever : 40 40,50C - Typical rash: maculopapular eritromatosus Head truncus extremities Stadium convalescens: - rash : hyperpigmentation macule/squama - sign and symptoms resolve
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Diagnosis
Anamnesis : - symptoms - history : - contact - imunization
Clinical signs: typical
Laboratorium : - leukopenia, - relative lymphocytosis
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Complication Pneumonia / Bronchopneumonia ; Otitis media CNS : - meningoensefalitis - Subacute Sclerosing Pan Encephalitis Persisten diarrhea protein lossing enteropathy Exaserbation of TBC Keratoconjunctivitis blindness Secondary bacterial infection of skin Myocarditis Noma
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Prognosis Particularly good prognosis
CFR decreased
Mortality caused by complication
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Treatment Symptomatic
Supportive
Vitamin A : Unicef/WHO reccomendation
Management of complication
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Prevention Active immunization: - Measles vaccine - when ? 9 months old - booster: 15 months --> MMR
Passive immunization
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RUBELLA (German Measles) Acute infection, contagious, caused by rubela virus (family Togaviridae) prodromal sign : + / - Rash : short periode 3 days Typical sign: lymphadenopathy post auricular suboccipital posterior colli Problems in pregnant women Congenital rubella Syndrome
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Clinical Manifestation Incubation period : 18 + 3 days
Mild prodromal sign: - mild fever - adolescent : more severe
Rash : maculopapular face sentrifugal to neck trunk extremities 24 hours all of body resolve in 3rd day
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Congenital rubella Syndrome
Depend on gestational age Abortus Stillbirth Congenital anomaly
gravida 1 4 weeks : 61% 5 8 weeks : 26 % 9 12 weeks : 8%
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Congenital rubella Syndrome
Opthalmologic : cataract Micropthalmia Glaukoma - chorioretinitis Cardiac : Septal Defect PDA
Neurologic : Meningoencephalitis Microcephaly mental Retardation
Auditoric : sensorineural deafness
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Exanthem subitum ( Roseola infantum )
Acute infection caused by Human Herpes Virus 6 ( some HHV 7 )
Mostly in infant
Sporadic ( sometimes epidemic)
Typical feature : - Severity of clinical sign unproportionally with degree of fever - Simultaniously resolve of rash and clinical sign
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Clinical Manifestation Incubation period : 7 17 days ( + 10 days ) Most common in 6 18 months old Fever - abruptly high ; 39,4 41,20C - Duration: 1 5 days ( mostly 3 4 days ) - Convulsion can occur Mild clinical sign : - mild pharyngitis and coryza Rash : not specific macule / maculopapular ; rose colour : chest > exremities and neck face Appear while temperature has return to normal Disappear on 1 2 days with normal skin
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Prognosis Particularly good prognosis
Bad prognosis : - hyperpyrexia with persistent convulsion
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Treatment Symptomatic
Supportive
Prevention : ?
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SCARLET FEVER (SCARLATINA) Grup A beta-hemolytic Streptococcus pyrogenic toxin (erytrogenic toxin) Clinical manifestation : - Incubation period : 1 7 days (mean : 3 days) - Acute symptoms: high fever headache vomiting- chills - Signs: severe pharyngitis hyperemis edema eksudate- dysphagia - Circum oral pallor dan Pastia lines - white strawbey tongue desquamation red strawberry tongue
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Typical rash: Reddish macule / papule blanching on pressure Firstly on axilla, groin and neck 24 hours all of body Severe disease : miliaria sudamina Petechiae can occur Desquamation occur from end of 1stweek to 6th week of disease
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Diagnosis
History and physical examination
Pharyngeal swab : bacterial culture
Serologic : ASTO/ ASLO/ ASO Complete blood count : leukositosis CRP increased or (+) : not specific
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Complication Local spread / per continuitatum: - Sinusitis Otitis media - Mastoiditis - Retro / para parapharyngeal absces - Bronchopneumonia - Servical adenitis
Hematogenic spread: - Meningitis Osteomyelitis Arthritis (septic)
Non-suppurative (late) complication: - Acute rhematic fever - Acute Glomerulonephritis
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Treatment Antibiotics : - Penicillin group - Allergy to penicillin : Erythromycin lincomycin Clindamycin- Cephadroxil
Symptomatic
Supportive
Management of Complication