Fever and Rash Flashcards
(42 cards)
Papules
Small, solid, palpable lesions elevated above the plane of the skin
Nodules
Masses located deeper within or below the skin
Vesicles and bullae
Blisters of differing size
Pustules
Small, palpable lesions filled with pus
Macule
Flat,nonpalpable, blanching
Purpura or petechiae
Nonblanching due to extravasation of blood
Erythema
Hyperpigmented
Blanching erythematous lesions due to vasodilatation
MACULOPAPULAR RASH Viral illness causes
Measles (Rubeola)
Rubella (German measles)
Erythema infectiosum (Parvovirus)
Roseola (exanthema subitum, usually HHV-6)
Coxsackie
Measles (Rubeola) characteristics
Paramyxoviridae – enveloped (-)ssRNA viruses
Cough, Coryza, Conjunctivitis, posterior Cervical adenopathy, Koplik’s spots precede rash
Rash
Nonpruritic
Cephalocaudal spread
Face -> spreads downward
Cetrifugalspread
Face/neck/trunk -> extremities
Rubella
Togaviridae- enveloped
(+)ssRNA
“little red” – mild measles
Rash also starts on face
Petechial lesions on soft palate, NO Koplik’s spots
Fever,lymphadenopathy
Parvovirus B19
Parvoviridae,unenvelopedssDNA
Erythema infectiosum,“5th disease”- school age children
Clinical manifestations
Viral syndrome=Fever,malaise,GI upset, lymphadenopathy
Rash= “slapped cheek” with relative perioral pallor
Some have secondary diffuse lacy reticular rash
Parvo B19 associations
Infects erythroid precursors
Reticulocytopenia: Severe – pure red cell aplasia
HIV patients, Hemoglobinopathies (SCD, thalassemia)
Acute polyarthritis in adults
Congenital infectionHydrops fetalis
Roseola
HHV-6 and HHV-7
Childhood illness
High fever prior to rash
Rash starts on face or trunk
Syphilis primary sx
Spirochete,Treponemapallidum
Varied skin manifestations
Primary
Chancre
Site of inoculation
Oropharynx
Genitals
Painless
Self-resolving
Syphilis
Varied skin manifestations
Secondary
Disseminating phase
Flu-like symptoms, Lymphadenopathy
Maculopapular rash - Nonpruritic, Palm/soles involved
Condyloma lata, Copper penny spots
Pustules, Mucous patches
Alopecia
Erythema migrans
Lyme disease
Bite from Ixodes tick
Borrelia burgdorferi
Pathognomonic “target” or “bull’s eye” early disease
Fungal causes of nodules
Cryptococcus
Histoplasma
Coccidioides
Sporotrichosis
Nocardia characteristics
Direct inoculation of organisms into the skin
During gardening or farming;
Puncture by a thorn or splinter
Manifestations
Ulcerations, cellulitis, nodules, and subcutaneous abscesses
May involve regional lymphatics, producing a nodular lymphangitis
“sporotrichoid nocardiosis”
Nocardia Diagnosis
Modified AFB stain
Less mycolic acid in cell wall than
mycobacterial species (AFB+)
Nocardia easily decolorizes, will not be visible on normal AFB stain
Culture
Variable colony morphology
Sporotrichosis characteristics
Sporothrix schenkii
Inoculated by organic matter Rose bush
Gardeners
Erythematous nodules
Ulceration
Follow lymphatics
“sporotrichoid spread”
Cryptococcus characteristics (can cause nodules
Large capsule
india ink stain
CNS, lung, skin
Immunosuppressed, HIV
Bird droppings, soil
Molluscum contagiosum can cause nodules (characteristics )
poxvirus
spread by contact
common in childhood
seen in immunosuppression, HIV
Noninfectious nodules
Erythema nodosum
Systemic lupus erythematosis
Sarcoidosis
Ulcerative colitis
Crohn’s disease
Medications
Neoplasm
Vesicles (<0.5cm)
Elevated; Fluid-filled
Herpes viruses – dsDNA viruses
Erythematous base
Tzank smear, multinucleated giant cells
