Fever with rash

FEVER

• Fever is an elevation of body temperature that

exceeds the normal daily variation and occurs in
conjunction with an increase in the
hypothalamic set point.
• An a.m. temperature of >37.2°C (>98.9°F) or a
p.m. temperature of >37.7°C (>99.9°F) would
define a fever.
• The normal daily temperature variation is
typically 0.5°C (0.9°F).
Pathogenesis of Fever

• Pyrogens
• Pyrogenic cytokines
Rash

• A rash is a change in skin appearance, colour or

texture.
Pathogenesis of Rash

1) Direct multiplication of organism causing cell

swelling and damage.

2) Bacterial toxins
3) Initiation of an autoimmune process.

4) Vascular damage.
Approach to fever with rash
History

Type of lesion

Distribution of lesion
History
• Travel
• Immunization
• Exposure to pets
• Cardiac illness
• Prosthetic material
• Medications
• Immune status
• Exposure.
• Type
• Distribution (central or peripheral )
• Arrangement
• Site of initial onset and progression
• Involvement of palms and soles
Based on distribution of lesions
1) Centrally distributed maculopapular rash
2) Vesiculobullous or pustular
3) Pheripherally distributed
4) Nodular lesions
5) Purpuric eruptions
6) Ulcers and or Eschars.
Primary skin lesions.
• Macule: Flat lesion, Not raised, <2cm

• Patch: Flat lesion, >2cm

• Papule: Raised lesions, <0.5cm.

• Plaque: Flat topped, raised.

• Nodule: 0.5 to 5 cms, raised.

• Tumour: Solid raised growth > 5 cms.

Petechiae <3mm
• Purpura
Ecchymoses >3mm
• Vesicle: Fluid filled lesion, < 0.5cm.

• Bulla: Fluid filled lesion, > 0.5cm.

• Pustule: A vesicle filled with leucocytes.

• Wheal: A raised, erythematous, edematous

papule or plaque, usually representing short-
lived vasodilation and vasopermeability.
Centrally distributed maculopapular
rash

• Rickettsial fever.
• Leptospirosis.
• Dengue fever.
• Typhoid fever.
• Acute Meningococcemia.
• Measles.
• Rubella.
• Erythema infectiosum.
• Exanthem subitum.
• Primary HIV infection.
• Infectious mononucleosis.
• Lyme disease.
• Relapsing fever.
Vesiculobullous or pustular
• Hot tub folliculitis.
• HSV infection
• Variola
• Varicella
Peripheral distribution
• Secondary syphilis
• Chickungunya fever
• Hand foot and mouth disease
• Bacterial endocarditis
• Rocky mountain spotted fever
Nodular eruptions
• Disseminated infection
• Erythema nodosum
• Sweet syndrome
• Bacillary angiomyomatosis
Purpuric eruptions
• Acute meningococcemia
• Disseminated gonococcal infection
• Viral haemorrhagic fever
• Rocky Mountain spotted fever
• Rat-bite fever
• Endocarditis
Ulcers and/or Eschars
• Anthrax
• Tularemia
• Scrub typhus
• Rat bite fever
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