Approach to Child with Fever

& Skin Rash

By :
Heba Mohamed Mostafa
Attya
Lecturer of Family Medicine
FOMSCU
Session plan:
● Title: approach to a child with
fever and skin rash
● Time: 60 minutes

● Objectives:
❖ To discuss the common causes of
fever with skin rash
❖ To illustrate the Egyptian
guidelines
Quizzzz?
Causes of fever with skin rash
● Chickenpox (varicella)
● Measles
● Rubella (German measles)
● Scarlet fever (scarlatina)
● Fifth disease (erythema infectiosum)
● Roseola infantum
● Coxsackieviruses and other
enteroviruses
 Chicken pox
● Causative organism: varicella- zoster virus
● Mode of transmission: droplet or vesicular
fluid
● Incubation period: 2-3 wks
● Infectivity period: The patients are infectious
from 2 days before the onset of eruption until
all the lesions have crusted (5 days )
● Clinical picture:
● Pleomorphic (Vesicles, macule → papule →
vesicle → crust)
● Centripetal
● Itching
● 2ry bacterial infections
Complications (rare):
● Pneumonia.
● Encephalitis.
● Nephritis.
● Hepatitis.
Prevention
● Active immunization (Varicella vaccine)
● < 13 years (12-18 m): single dose
● > 13 years : 2 doses 4-8 weeks apart
● Passive immunization.

Treatment:
● - symptomatic
● - Oral antiviral therapy is also required
in children who are receiving long-term
salicylate therapy to avoid the
complication of Reyes syndrome
 Measles (Rubeola, Morbilli)
● Causative organism: Paramyxovirus
● Mode of transmission: droplet
● Clinical picture
- Prodromal stage: (non-specific symptoms):3–4
days before the eruption of the rash.
- Enanthem: Koplik’s spot are bluish white spots
surrounded by a red halo appearing on the buccal
mucous membrane, opposite the premolar teeth.
They appear 24–48 hours before the exanthem and
remain for 2–4 days.
- Exanthem (maculopapular skin rash): The rash
begins on the face, behind the ears; it soon spreads
to the trunk and extremities. Rashes reach
maximum intensity in about 3 days, and then fade
in 5–10 days
- Desquamation ( not in hand &foot)
Complications
● Otitis media
● Bronchopneumonia
● Encephalitis (1/1000)
● Myocarditis/pericarditis
● 30% mortality in developing
countries
● N.B measles virus infection has a
transient immunosuppressive
effect
 Prevention
● Active immunization ( MMR At 12 month
obligatory vaccine)
● Passive immunization
Treatment:
● - Symptomatic
● - Vitamin A supplementation:
• Below 6 months 50,000 IU
• 6 months–2 years 100,000 IU
• Above 2 years 200,000 IU
A repeated dose can be given on the
following day
 German measles
(Rubella or 3 days measles)
● Causative organism: Rubivirus
● Mode of transmission: droplet
● Incubation period: 2-3 wks
● Clinical picture
- Prodromal stage: (non-specific symptoms)
- lymphadenopathy (sub-occipital, post
auricular & posterior cervical)
- Exanthem Rash – fine pink maculopapular
rash on face then trunk & limbs
- Desquamation
● Prevention
- Active immunization( MMR At 12
month obligatory vaccine)
- Passive immunization
● Treatment: symptomatic
 Scarlet fever
Etiology Group A beta-hemolytic Strep
Mode of transmission: droplet
Incubation period: 1-7 days
Clinical picture:
-Erythamatous rash, blanch on pressure.
- Circum-oral pallor
- Pinpoint papules (sandy patch)
- Tongue: strawberry
- Desquamation (involve hand& foot)
Complications OF SCARLET
FEVER
● - RF
● -PSGN
Treatment
● Symptomatic relief
● Penicillin V 7-10 days
 Fifth disease or Parvovirus:
● Otherwise known as ‘slapped cheek disease’ or 5th
disease or erythema infectiosum
● Incubation period 4-14 days
● Most people will have no symptoms..
● Fever in 15-30% for 1-2 days
● Slapped cheek appearance
● Generalised maculopapular rash for 7-10 days –
lace-like
● a low-grade fever, headache, sore throat, nausea,
vomiting, and/or diarrhea in the eight to 10 days
before the rash appears. The rash only appears
once the viral illness is over.

Management
● Supportive
 Roseola infantum
Cause
HHV6/7

Roseola is also called exanthem subitum and is a

common childhood illness

Features
● Affects those aged 6-36 months
● 3-5 days high fever with no obvious source
● Sub-occipital nodes
● Rose-pink macular rash appears once fever settles
● Starts on trunk, may spread to face & extremities
● Lasts up to 2 days
Treatment
⚫ Despite the worrisome fever, the
disease is not harmful and gets
better without specific therapy.
The fever associated with roseola
can occasionally cause a seizure.
⚫ Symptomatic TTT
Coxsackieviruses and other
enteroviruses
Are a very common cause of fever
and rash in children.
Two diseases are caused by
coxsackieviruses, called
hand-foot-and-mouth disease and
herpangina.
Coxsackievirus infections are more
common in the summer and autumn.
 Hand, foot & mouth disease
Cause
Coxsackie viral infection

Features
Low grade fever, headache, vesicles on hands & feet
(last 3-10 days)
Can be widespread
Mouth lesions-yellow ulcers with red borders
Can be complicated by aseptic meningitis

Management
Supportive
Egyptian guidelines
MCQs
1. A 4-year-old boy is brought to your
office by his mother with fever. The child
has evidence of a stomatitis and a
vesicular rash that affects his hands and
feet. The most likely cause is:

A. coxsackievirus
B. adenovirus
C. syphilis
D. varicella
E. measles
2. Erythema infectiosum (fifth disease) is
caused by:
A. parvovirus
B. adenovirus
C. rhinovirus
D. paramyxovirus
E. herpes virus
3. A young baby presents with history of
fever, skin rash and diarrhea.
Examination of the oral cavity shows
koplik spots in the buccal cavity. The most
likely diagnosis is:

A. Chicken pox
B. Measles
C. Diphtheria
D. Small pox
E. Typhoid
4. Which of the following statements
concerning measles are correct?

A. the incubation period is 2 weeks

B. the incubation period is shorter in case of
partial immunity
C. eruptions develop 4 days after the onset of
symptoms
D. the disease is infectious until the end of the
furfuraceous desquamation
E. measles virus infection has a transient
immunosuppressive effect
5. A 3-year-old boy is brought to the physician for
evaluation of an itchy rash on his face and trunk for the
past 3 days. He has mild fever but no chills, sore throat, or
other symptoms. He takes no medications and his
immunizations are up to date. His vital signs are normal.
Examination shows erythematous papules, vesicles, and
crusts all over his trunk. Which of the following is the
most likely diagnosis?

A. Chickenpox
B. Eczema herpeticum
C. Hand-foot-mouth syndrome
D. Herpes simplex infection
E. Impetigo