Differential diagnosis of fever and rash in infants

Evaluating the febrile patient with a rash american. Monkeypox the presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Fever management in children aged 3 months to 3 years. Assistant professor, division of general pediatrics, doernbecher childrens hospital, oregon health sciences university, portland, or. Clinicians must maintain a high index of suspicion for serious bacterial andor viral infections in febrile infants and toddlers. Infants 7 of fever without other explanation should undergo laboratory testing and, if. The differential diagnosis includes other causes of fever accompanied by. Signs of otitis media include tense, bulging tympanic membrane, but this can be difficult to visualize in small infants. Assessment of fever in children differential diagnosis of. Mar 21, 2017 a maculopapular rash looks like red bumps on a flat, red patch of skin. The differential diagnosis of fever and rash is extremely broad, but this symptom complex provides an opportunity for the diligent clinician to establish a probable etiology through a careful history and physical examination. Fever pocket book of hospital care for children ncbi. These include infants with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia including sickle cell disease.

The risk of meningococcal disease is highest in infants, asplenic patients. However, when fever or signs of illness are present, urgent evaluation and treatment must be considered. Fever is an extremely common pediatric presentation and has many different causes. The differential diagnosis of acute fever and rash in an adult is quite extensive and. The differential diagnosis is extensive but selflimited illnesses predominate. Infectious disease emergencies and diseases that can have public health implications can present as fever and rash. Approach to the child with a fever and rash learn pediatrics. Mononucleosis is a viral infection causing extreme fatigue, sore throat, fever, rash, muscle aches, and more. Although the differential diagnosis is very broad, adequate history and physical examination can help the clinician narrow down a list of more probable etiologies.

The differential diagnosis is extensive, ranging from selflimiting conditions e. Diseases that present with fever and rash are usually classified according to the. Pityriasis rosea is a rash causing pink, reddish, or purplish oval patches on the chest, belly, arms, and legs. Children frequently present at the physicians office or emergency room with a fever and rash. Aug 15, 2000 the differential diagnosis for febrile patients with a rash is extensive. Vasoconstriction, shivering causes fever patient experiences euthermia, though may feel malaise, fatigue resolution patient experiences sweats until core temperature returns to normal set point references. Wellappearing children without systemic symptoms or signs are unlikely to have a. However, fever says that something is not right with the body and that the body is reacting to it, usually as a selfprotective mechanism. Preceding staphylococcus aureus infection of skin, throat, mouth, nose, and or umbilicus, often with fever, malaise, and irritability. Fever and rash university of massachusetts medical school.

Although viral exanthems are usually associated with benign, selflimited diseases, in some cases correct diagnosis of an exanthem may be required for proper treatment, monitoring, and initiation of preventive measures for contacts. Contact dermatitis is a rash on the skin that can be itchy, painful, tender swollen and even blistered. The rash associated with scarlet fever usually develops on the upper trunk. The differential diagnosis is extensive, ranging from. These include infants with recognized persistent complement pathway deficiencies. It is important for physicians to be diligent, as the differential diagnosis can include contagious infections or lifethreatening diseases. In areas where typhus is common, it may be difficult to distinguish between typhoid fever and typhus by clinical examination alone see standard paediatrics textbook for diagnosis. Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever. At times, a rash can develop after the fever passes. Diagnosis and treatment a doctor usually knows your child has roseola because of the telltale symptoms. The presence or absence of associated symptoms can help clinicians develop a differential diagnosis. Rheumatic fever and its most serious complication, rheumatic heart disease rhd, are believed to result from an autoimmune response. It has been historically used to describe a subacute presentation of a single illness of at least 3 weeks duration during which a fever 38.

This article addresses the most common etiologies of fever in these age groups and the appropriate clinical prediction rules for identifying infants and toddlers at lowest risk for serious bacterial infections. Mar 05, 20 5yo girl brought to the pediatric emergency department by her mother due to 3 days of fever. It is important for physicians to be diligent, as the differential diagnosis can include. Culture of local or distant focus of colonization often negative. Rash in infants and young children pediatrics msd manual.

Cutaneous burns differential diagnosis epocrates online. Typhoid fever can present atypically in young infants as an acute febrile illness with shock and hypothermia. Jun 06, 2016 roseola infantum is most common in children under age 2. Febrile illness with skin rashes pubmed central pmc. Fever by itself rarely causes a problem for children unless it is extreme, i. Fever and rash infectious disease and antimicrobial agents. This is generally a mild disease in infants and children but it can cause a. Fever in infants and children pediatrics merck manuals. When fever accompanies a rash in children, it is usually caused by viral infections. Roseola infantum is most common in children under age 2. Jun 21, 2019 scarlet fever known as scarlatina in older literature references is a syndrome characterized by exudative pharyngitis see the image below, fever, and brightred exanthem. Generally, rash in the absence of fever or systemic symptoms is not urgent. Associated with fever, tachypnea, tachycardia, altered level of consciousness increased irritability or lethargy, bulging fontanel, rash, highpitched cry. The diagnosis of roseola is made clinically based on the presence of the two phases.

Teething can raise your babys body temperature, but only slightly. Approach to fever and drooling in infants and toddlers. Its most common in infants and children between 6 and 24 months old. For clinical diagnosis of diseases accompanied by a rash and fever. Drug adverse reactions occur in approximately 5% of patients. Jan 07, 2011 differential diagnosis of fever with rash 9. The differential diagnosis of conditions characterized by fever and a maculopapular rash is substantial. Badriya almahrouqi senior specialist family physician 2. A drug reaction must be considered in those patients with a. Evaluating the febrile patient with a rash american family. Fever seizures, childhood seizures that occur with a fever, can cause loss of consciousness and twitching. Scarlet fever differential diagnoses medscape reference. The differential diagnosis for febrile patients with a rash is extensive. Approach to a the child with a fever and rash learn pediatrics.

Signs symptoms associated with rash fever duration and characteristics. A maculopapular rash looks like red bumps on a flat, red patch of skin. Diagnostic studies in children aged 3 months to 3 years. Read more about the differential diagnoses, alternative diagnoses, misdiagnoses, diagnosis methods, hidden causes, rare types, and other diagnosis information.

Rash in infants and young children pediatrics merck manuals. Causes of a rash after fever in toddlers include roseola, scarlet fever, fifth. In evaluating a patient with fever and rash, determining the type of rash, and its general characteristics such. It is caused by toxinproducing group a betahemolytic streptococci gabhs found in secretions and discharge from the nose, ears, throat, and skin. Disorders of infant feeding differential diagnosis. Wellappearing children without systemic symptoms or signs are unlikely to have a dangerous disorder. Mar 21, 2019 diagnosis includes other autoimmune diseases, infectious causes, vitamin deficiencies, and some chromosomal disorders.

Various infectious and noninfectious agents can cause different skin reactions and or similar clinical syndromes or vice versa. The appearance of the rash typically narrows the differential diagnosis. Sudden onset of high fever without rash or other symptoms in a child younger than 3 years. Although the differential diagnosis is very broad, adequate history and physical examination can help the clinician narrow down a list of more. A fever is likely with roseola, erythema infectiosum, and. Stephen paget presents the case of a 24yearold woman with fever, extremity swelling, and a fleeting rash. The patients fever was first noted 3 days ago, measured at home to 103f. Touch the skin with a gloved hand to determine if the lesions are flat or raised. It usually starts with a high fever, between 102f and 105f 38. In evaluating a patient with fever and rash, determining the type. For clinical diagnosis of diseases accompanied by a rash and fever, a complete history must be taken, including recent travel, contact with animals, medications, and exposure to forests and other natural environments. Investigations examine a clean, fresh, uncentrifuged specimen of urine under a microscope. A 9monthold girl is brought to the clinic because of worsening fever and rash.

Exanthems associated with a variety of viral illnesses are classically seen in the pediatric age group. Her mother reports that she appears lethargic and has been urinating less frequently. It must be emphasized that noninfectious diseases with skin rash can also present with fever and should be considered in the differential diagnosis. Osteomyelitis bone infection osteomyelitis is an infection of a bone that causes pain, swelling, and redness. It is associated with a moist cough, vomiting, and decreased po intake. Jun 28, 2016 rheumatic fever rf is a systemic illness that may occur following group a beta hemolytic streptococcal gabhs pharyngitis in children. The associated symptoms and signs help identify patients with a serious disorder and often suggest the diagnosis see table. Exfoliation usually follows erythematous cellulitis and rash.

Fever in the infant and toddler is one of the most common problems and greatest challenges faced by those caring for them. The fever is followed immediately by the appearance of rosepink, flat or slightly raised bumps 23 mm in diameter that begin on the trunk and may spread to the neck as well as the. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion. Fever in the infant and toddler differential diagnoses.

Approach to a the child with a fever and rash learn. General presentation children frequently present at the physicians office or emergency room with a fever and rash. Sep 30, 2015 when fever accompanies a rash in children, it is usually caused by viral infections. Table 18 differential diagnosis of fever with rash. The differential diagnosis of acute fever and rash in an adult is quite extensive and includes a variety of infectious and noninfectious causes. Half of all infants with a urinary tract infection have fever and no other symptom or sign. The differential diagnosis of fever and rash is extremely broad, but this symptom complex provides an opportunity for the diligent clinician to establish a probable. The age of the patient often assists in narrowing the differential diagnosis. Recognition should trigger a thorough evaluation by the urgent care provider. Fever is defined as a core body temperature greater than 38c 100. Typical drooling is no cause for alarm in infants and toddlers. Other bacteria can cause a pharyngitis and similar rash, such as staphylococcus aureus, haemophilus influenzae, arcanobacterium haemolyticum, and clostridium species. Rheumatic fever rf is a systemic illness that may occur following group a beta hemolytic streptococcal gabhs pharyngitis in children. Core body temperature is best estimated by rectal temperature.

Diaper dermatitis broadly refers to skin disorders that occur in the diaper area, such as skin eruptions triggered by. Head lice are tiny visible insects that infest the hair and scalp causing itchiness and bumps in that. Preceding staphylococcus aureus infection of skin, throat, mouth, nose, andor umbilicus, often with fever, malaise, and irritability. Regardless of clinical findings, a neonate with fever requires immediate hospitalization and testing to rule out a dangerous infection.

Present with erythema chronicum migrans rash and monoarthritis as a later presentation. Clinical characteristics of the rash and and serologic testing confirm the diagnosis. Some common causes of fever in children include localized or generalized infection, connective tissue disease, and cancer. Evaluation of rash in children differential diagnosis of. Assessment of fever in children differential diagnosis.

The rate of cutaneous reactions is highest for antibiotics 18%. Jan 08, 2019 fever in the infant and toddler is one of the most common problems and greatest challenges faced by those caring for them. Aug 27, 2007 fever by itself rarely causes a problem for children unless it is extreme, i. Laboratory testing is seldom used as the results do not alter management of the disease. The rash is sometimes itchy, and it can last from two days. If your child is otherwise well but has a high fever over 102 degrees fahrenheit for 4 days followed by a rash on the trunk, he or she is likely to have roseola. It is a common rash in infants, with clustered and vesicular appearance. It is the sixth of the classical exanthematous diseases and is caused by. An acute, shortlived, viral disease of infants and young children characterized by a high fever at onset that drops to normal after 34 days and the concomitant appearance of a macular or maculopapular rash that appears first on the trunk and then spreads to other areas. Quizlet flashcards, activities and games help you improve your grades. Fever is common in toddlers and usually resolves on its own. Infants at increased risk for meningococcal disease should be vaccinated with a 4 dose series of hib mencytt. Evaluation of rash in children differential diagnosis of symptoms.