Fever and RashDJATNIKA SETIABUDI
Tropical Medicine Block/System Medical Faculty Padjadjaran University
Introduction Common problem in clinic
Wide range of severity : self limited disease life-threatening
Wrong 1st suspicion fatal outcome
Knowledge of differential diagnosis !!!
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
Differential Diagnosis (2)Feature of the rash :Category: - macular or maculo-papular - papulo-vesicular - petechial or purpuricCharacter : discrete or confluentDistributionDurationThe appearance associated with fever?
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
Pathology Lesion particularly at : - Skin - Mucous membranes : respiratory : nasopharyng, bronchi digestive : oral cavity, intestine - Conjungtiva Serous exudate, mononuclear cell predominant
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
Diagnosis
Anamnesis : - symptoms - history : - contact - imunization
Clinical signs: typical
Laboratorium : - leukopenia, - relative lymphocytosis
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
Prognosis Particularly good prognosis
CFR decreased
Mortality caused by complication
Treatment Symptomatic
Supportive
Vitamin A : Unicef/WHO reccomendation
Management of complication
Prevention Active immunization: - Measles vaccine - when ? 9 months old - booster: 15 months --> MMR
Passive immunization
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
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
Congenital rubella Syndrome
Depend on gestational age Abortus Stillbirth Congenital anomaly
gravida 1 4 weeks : 61% 5 8 weeks : 26 % 9 12 weeks : 8%
Congenital rubella Syndrome
Opthalmologic : cataract Micropthalmia Glaukoma - chorioretinitis Cardiac : Septal Defect PDA
Neurologic : Meningoencephalitis Microcephaly mental Retardation
Auditoric : sensorineural deafness
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
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
Prognosis Particularly good prognosis
Bad prognosis : - hyperpyrexia with persistent convulsion
Treatment Symptomatic
Supportive
Prevention : ?
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
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
Diagnosis
History and physical examination
Pharyngeal swab : bacterial culture
Serologic : ASTO/ ASLO/ ASO Complete blood count : leukositosis CRP increased or (+) : not specific
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
Treatment Antibiotics : - Penicillin group - Allergy to penicillin : Erythromycin lincomycin Clindamycin- Cephadroxil
Symptomatic
Supportive
Management of Complication
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