Fever With Skin Rash in Children
Rubella(German Measles)
(3 day Measles)
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· It was initially recognized as resembling measles & was closely studied by German Physicians. Later on, continued to be called as German Measles.
· Post natal infection with rubella à mild disease,
· Low grade fever, sore throat, red eyes, headache,
· Suboccipital, posterior auricular, anterior cervical lymphnodes are enlarged.
· Petechiael haemorrhages on soft palate.
· Rashes for 3 days
· Thrombocytopenia, Arthritis, Encephalitis & Progressive rubella panencephalitis are known complications.
Congenital Rubella Syndrome
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· Maternal rubella infection in first trimester (embryogenesis) à defects in 90% of the off springs
· Nerve deafness (single most common)
· CHD (PDA, Pulmonarystenosis, Septal defects)
· Cataract
· Salt & pepper ratinopathy
· Microcephaly
· Hepatosplenomegaly
· Thrombocytopenia.
· Rubella vaccine to all girls is most effective preventive measure for congenital rubella syndrome
Infectious Mononucleosis (EBV)
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· Fever of long duration, malaise, fatigue, sore throat, abdominal pain
· Marked pharyngotonsillitis, periorbital oedema, generalized tender lymphadenopathy, hepatosplenomegaly
· Soft Splenomegaly is the characteristics, rupture spleen following trivial injury is known
· Epitrochlear LN is almost pathognomonic
· Macular rash, precipitated or aggravated by ampicillin / amoxicillin.
· Infectious mononucleosis is named because of the mononuclear lymphocytosis with atypical lymphocytes that accompany the clinical syndrome
· It is also called as kissing disease due to transmission of EBV by oral kissing in adolescents.
· It was called as glandular disease due to lymphadenopathy.
· EBV infection can occur without manifestations of disease, while infectious mononucleosis means clinical manifestations of EBV infections.
· Transmission by,
× Exposure to saliva.
× Oral kissing in adolescents.
× Blood transfusion.
× Bone marrow transplantation.
× No spread by droplets, fomites or sexual contact.
· Pharyngitis is often associated with whitish or gray – green exudates having an offensive odour
Erythema Infectiosum (Fifth disease)
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· Parvovirus B19
· 5 to 15 years of age
· Prodromal symptoms à Rash of “slapped cheek” appearance à spreads to trunk & extremities
· Complications like arthropathy, ITP, aseptic meningitis, transient aplastic crisis in patients with chronic hemolytic anaemia, HLH, hydrops fetalis, myocarditis
Hand – Foot and Mouth Disease
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· Frequently caused by coxasackievirus A 16, also by enterovirus 71, coxasackie A virus 5, 7, 9 & 10
· Mild illness, with or without low grade fever
· Inflamed oropharynx, scattered vesicles on tongue, buccal mucosa, palate lips, may ulcerate
· Maculopapular, vesicular &/or pustular lesions over hands, feet, buttocks, groins
· Hand – Foot & Mouth disease by enterovirus 71 is frequently severe, neurological disease, pulmonary haemorrhage, shock & rapid death
Dengue Fever
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· High grade fever
· Blanchable erythematous flush (measly look)
· Swollen face, injected eyes, redness of ears,
· Maculopapular rash may develop on the top of erythematous flush
· Catarrh, typical characteristics of respiratory virus is missing
· Headache, retro – orbital pain, photophobia, backache, myalgia, arthralgia, anorexia etc
· Petechiael spots & mucous membrane bleeding (nose, gum, conjunctiva) may be seen
Chikungunya
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· 3 months Male.
· Fever high grade 7 days.
· Irritable.
· Generalized hyperpigmentation 3 days.
· H/o chikungunya to mother.
· Chikungunya RT – PCR: Detected.
Chikungunya
· Chikungunya named is derived from stooped position of the patient due to severe arthralgia in a case of chikungunya.
· Chikungunya is the mosquito born arboviral disease.
· It is transmitted to human through day – biting mosquitoes, Aedes aegypti & Aedes albopictus. Some cases of blood born transmission also have been reported. Fetomaternal transmission has been documented during pregnancy mainly in perinatal period.
· Sudden onset of fever with polyarthralgia more often bilateral symmetric pattern, myalgia, headache, fatigue & skin rashes are common symptoms. Fever may rise upto 104. F & may be associated with rigors. Fever may last upto 7days.
· Atypical & Severe manifestations
× Vesiculobullous skin lesions, Hyperpigmentation.
× Febrile seizures.
× Meningoencephalitis.
× GBS.
× Encephalopathy.
× Cerebellar syndrome.
× Myocarditis, arrhythmias.
× Acute Renal failure.
Bleeding dyscrasias.
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