Infection and Rashes

Rashes are a common feature of infection whose features may overlap with non-
infective syndromes
They may range from florid manifestations of minor illnesses to subtle warnings
of severe disease

Skin infections
Bacterial
• Impetigo - superficial crusting rash
• Erysipelas - Strep pyogenes usually with marked toxicity, raised lesion
sharply demarcated often on face
• Cellulitis - Staph aureus or Strep pyogenes, flat erythema spreading
• Recurrent pustules, boils, carbuncles, skin abscess - think of diabetes
• Toxin mediated Staphylococcal Scalded Skin Syndrome
• Necrotising fasciitis

Viral
• Chickenpox
• Shingles
• Herpes simplex virus
• Enteroviruses e.g. hand, foot & mouth disease
• Viral warts
• Molluscum contagiosum - pox virus
• Orf

Fungal
• Pityriasis versicolor
• Tinea (ringworm - dermatophyte infection)

Athropod
• Scabies - prolonged latency before itch due to allergic reaction develops

Assorted uncommon causes

• Cutaneous larva migrans - dog hookworm larvae lost in wrong host!
• Rickettsial infection - may cause black eschar at site of tick or mite bite,
imported
• Erythema Chronicum Migrans due to Lyme disease - spreading annular rash
after tick bite (uncommon)
• Rose spots of typhoid - very difficult to spot on pigmented skin
• Leprosy - depigmented anaesthetic patch (rare in UK) in tuberculoid leprosy,
thickened skin in lepromatous disease
• Cutaneous leishmaniasis
The traditional exanthems
Uncommon (now):
• Measles
• Rubella

Common:
• Erythema infectiosum / slapped cheeks / 5th disease - due to human
parvovirus B19, also switches off red cell production so aplastic crisis in
sickle cell anaemia or other haemolytic anaemias, chronic anaemia in
immunodeficiency
• Roseola infantum (exanthem subitum) due to HHV6, 3 day fever ends with
rash

Common 'new' exanthems

• EBV - more marked rash with antibiotics especially amoxicillin or ampicillin

Rare new exanthems

• HIV seroconversion - acute HIV may be associated with macular
erythematous rash

Rashes associated with immunological reactions to underlying infection

• Erythema nodosum
• Erythema multiforme
• Urticaria

Rashes associated with superantigen mediated syndromes

• Streptococcal scarlet fever
• Toxic shock syndrome
• Kawasaki syndrome

Rashes associated with endothelial damage - vasculitis, purpura

• Infection-related coagulopathy and vascular damage e.g. meningococcaemia
• Infection-related vasculitis e.g. syphilis
• Immunological reaction to infection e.g. manifestations of endocarditis
• Possible immunological reaction to infection e.g. Henoch-Schonlein
Purpura

Interaction with existing rashes

• Impetiginised eczema - secondary bacterial infection
• Eczema herpeticum - eczema infected with HSV, widespread, severe

Pseudo infectious rashes

• Petechiae on head and neck due to retching and vomiting
• Allergic reactions to antibiotics
• Insect bites/papular urticaria - may take a few weeks exposure to become
sensitised. Even then rash often takes 1-2 days after exposure to appear