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FEVER WITH CENTRAL
MACULOPAPULAR RASH
ANBARASAN.S
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RASH
Exanthem
Skin eruption occuring as a symptom of a general
disease
Enanthem Eruptive lesions on the mucous membrane
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EXANTHEM
MACULE a flat skin lesion
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EXANTHEM
PAPULE
a raised lesion
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CLASSIFICATION
Based on Aetiology
Viral exanthems
Bacterial infections (including those that are toxin
mediated) Rickettsial infections
Drug eruptions
Systemic diseases
Rheumatological diseases.
Measles
(Rubeola)Rubella
(German
measles)
Filatow-Dukes
Disease
ErythemaInfectiosum
Roseola
Infantum
Dengue fever
Epidemic
typhusEndemic
typhus
Scrub
typhus
Rickettsial
spottedfever
Lyme
disease
Leptospir
osis
Rat-bite
fever
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CLASSIFICATION
Based on age group
Paediatric
Adult
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General considerations in F+MPR
Primary lesion type, number, and distribution
Mucous membranes involved or spared
Associated signs and symptoms (e.g., fever,pruritus, lymphadenopathy,
hepatosplenomegaly
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FEBRILE ILLNESS AND RASH
Fever + rash + associated signs -----EMERGENCY
Meningococcaemia
Anaphylactic reactions
Toxic epidermal necrolysis (TEN) and Stevens-Johnsonsyndrome (SJS)
Drug reaction with eosinophilia and systemic symptoms(DRESS)
Staphylococcal scalded skin syndrome (SSSS) and toxic shocksyndrome (TSS)
Rickettsial spotted fever.
Fever + with no rash.not urgent to treat
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MEASLES
Paramyxovirus
Incubation period: 10-12days
Kopliksspot: appears 2 days before rash
RASH an erythematous, nonpruritic, maculopapular rash
appears, first behind the ears and at the hairline, andthen spreads inferiorly.
spreads to involve the trunk and extremities, thediscrete macules coalesce.
Infectious period: 1-2days before prodrome to4days after onset of rash
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MEASLES
Kopliksspots - pathognomonic feature
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RUBELLA
Togavirus
Incubation period: 14-21 days
RASH A faint pink/red maculopapular rash appears first
on the face, then rapidly spreading inferiorly.
Infectious period: 5-7days before rash to
3-5days after rash
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ERYTHEMA INFECTIOSUM
Human Parvovirus B19
Incubation period: 4-14 days
RASH
bright, fiery, red macular rash across the cheeks
SLAPPED CHEEK OR SUNBURNEDAPPEARANCE
Spread to the extremities in a lacy reticularpattern
Infectious period: up until onset of the rash
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EXANTHEM SUBITUM
(Roseola infantum)
Human Herpes Virus6(and 7)
Incubation period: 9 days
RASH: blanching, evanescent, pinkmaculopapular exanthem on the neck and
trunk.
Infectious period: virus is intermittantlyshed
into saliva throughout life; asymp persistent
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SURPRISE
RASH
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DENGUE
Incubation period: 2-7 days
RASH
Maculopapular rash which begins on trunk and spread
centrifugally to extremities and face
The rash also may occur on the palms of the hands and
the bottom of the feet, areas frequently spared in many
viral and bacterial infections
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HERMANS RASH
Appears on the third to
fourth day of the fever
Start on the elbows and
knees Spread to the face,
arms and legs
Last for two to three
days
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TYPHUS FEVER
Epidemic typhus
Maculopapular eruption appearing in axillae, spreading
to trunk and later to extremities
Spares face, palms, soles
Blanchable macules to petechiae
Endemic typhus
Maculopapular rash usually sparing palms and soles
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SYSTEMIC DISEASE
Acute graft-versus-host disease (aGVHD)
rash frequently begins on the hands and feet as
acral erythema and also favours the upper back,
ears, cheeks, and neck.
associated with diffuse erythroderma and
desquamation.
mucous membranes (particularly conjunctiva)may be involved.
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SYSTEMIC DISEASE
Kawasaki disease (mucocutaneous lymph
node syndrome)
rash is typically generalised and maculopapular,
without petechiae.
perineal erythema is particularly pronounced.
rash resembles a viral exanthem.
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RHEUMATOLOGICAL DISEASES
Juvenile rheumatoid arthritis (JRA or Stills
disease)
eruption of the maculopapular rash associated
with JRA is typically transient (recurring withfever), erythematous, and non-pruritic
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MORBILLIFORM DRUG REACTION
comprising 95% of all drug-induced skin
reactions.
Most common cause of rash in adults .
Resembles viral exanthems
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CHARACTERISTIC FEATURES OF DRUG
ERUPTIONS
Most reactions develop within 2 to 8 weeks.
The eruption is characteristicallypolymorphic.
Moderate pruritus, a low-grade fever, and general malaisemay be present.
Mucous membranes are typically spared, andlymphadenopathy is mild if present.
The eruption generally fades over 1 to 2 weeks withoutcomplication.
Post-inflammatory desquamation is common and, in the
absence of other findings, does not portend a more seriousdiagnosis such as toxic epidermal necrolysis orstaphylococcal scalded skin syndrome (SSSS). Death isexceedingly rare.
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DRUGS CAUSING MP RASH
Antibiotics
sulphonamides, aminopenicillins, cephalosporins
Anticonvulsants
Carbamazepine, Phenytoin
Other drugs
Lamotrigine, minocycline, dapsone, allopurinol,
abacavir and zalcitabine in HIV-infected patients Epidermal growth factor receptor inhibitors
(EGFRs; e.g., cetuximab)
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30-40 % of patients with HIV infections may
develop skin rash when exposed to sulfa
drugs.(co-trimoxazole)
Infectious Mononucleosis develops macular
erythematous on exposure to ampicillin/
amoxicillin
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DRUG REACTION WITH EOSINOPHILIA
AND SYSTEMIC SYMPTOMS
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