STUDY - Technical - New Dacian's Medicine
Fever
and rashes / Erythema
Translation Draft
The patient with acute fever disease and rashes/ rash/ rash is a diagnosed challenge for doctors. The distinct occurrence of an rash consistent with a clinical syndrome may facilitate prompt diagnosis and the establishment of life-saving therapy or infection control interventions.
A thorough anamnesis of patients with fever and rash/ erythema/ rash includes the following important information: immune status, medicines taken during the previous month, detailed travel history, immunisation status, contact with pets or other animals, animal bites or arthropods in the past, the existence of cardiac abnormalities, the presence of prosthetic materials, recent contact with sick individuals and exposure to sexually transmitted diseases.
Anamnesis must also include the onset place of the rash, its direction and speed of spread. A thorough physical examination pays close attention to the rash, with the precise evaluation and definition of its characteristic features.
First it is decisive to determine the type of lesions that form the eruption. Macles are smooth lesions, defined as a modified colour zone (i.e. an erythema that disappears through vitropressure). Papules are embossed, solid lesions with a diameter of less than 5 millimeters, the plates are lesions larger than 5 millimeters in diameter, with a smooth surface, in the plateau, and the nodules are lesions more than 5 millimeters in diameter, with a relatively round configuration.
Plates (urticaria, "gentle") are lesions of the pink-pal papule type and can appear round (like a ring) as they enlarge (classic, nonvascular plates, being transient, persisting only 24-48 hours in any area that appears). Vesicles (less than 5 millimeters) and bubbles (more than 5 millimeters) are circumscribed, embossed lesions containing liquid.
Pustules are embossed lesions containing purulent exudate, with vesicular infections such as chickenpox or herpes simplex that can progress to pustules. Non-palpable purple is a smooth lesion, which is due to bleeding from inside the skin and is classified in spots, purple lesions with a diameter of less than 3 millimeters, and bruising, if the diameter is more than 3 millimeters.
Palpable purpura is an embossed lesion, which is due to inflammation of the vascular wall (vasculitis) with subsequent hemorrhage. Other characteristic features of rashes include their shape (i.e. ring or target), the disposition of lesions and their distribution (i.e. central or peripheral).
We will now review rashes/rashes that reflect systemic diseases, not including localized skin rashes (such as cellulite, impetigo) that may also be associated with fever, which will be classified on the basis of the morphology and distribution of lesions. For practical purposes, this classification system is based on the clinical aspects of the most typical diseases.
However, morphology may vary as rashes evolve and the appearance of rash diseases is subject to many changes. Febrile diseases with rash can be classified by type of rash: centrally distributed maculopapular, confluent descuaamative erythematous, vesicular, urticarian, nodular and purple peripherally distributed.
We'll first address centrally distributed maculopapular eruptions. Centrally distributed rashes, in which lesions appear primarily on the trunk, are the most common types of eruption. The rash in measles (rujeola) begins at the hair line after 2 to 3 days of illness and spreads lower throughout the body, avoiding palms and plants.
Initially, discrete erythematous lesions occur, which become confluenced as the rash expands. Koplik's spots (white or bluish lesions of 1 to 2 mm with an erythematous halo appearing on the oral mucosa) are pathognomonic for measles and are generally observed during the first 2 days of symptoms.
They should not be confused with Fordyce's spots (ectopic sebaceous glands), which do not have erythematous halos and are found in the oral cavities of healthy individuals. Koplik's spots can be partially covered by measles exanthema. Rubella extends lower from the hair demarcation limit.
However, unlike measles, rubella rash tends to disappear from the initially affected areas as it migrates and may be itchy. Forchheimer's spots (palatine spots) may occur, but they are nonspecific, as they can also occur in mononucleosis and scarlet fever. Retrourical and suboccipital adenopathy and arthritis commonly occur in adults with rubella.
Contact of pregnant women with sick individuals should be avoided, as rubella causes severe birth defects. Numerous strains of enteroviruses, mainly echoviruses and coxsackieviruses, cause nonspecific syndromes with fever and rashes, which can mimic rubella and measles.
Both infectious mononucleosis caused by the Epstein-Barr virus and primary human immunodeficiency virus (HIV) infection may also present pharyngitis, lymphadenopathy, and a nonspecific maculopapular examination.
The rash in infectious erythema (determined by human parvovirus B19) primarily affects children aged 3 to 12 years. It occurs after the resolution of fever as a bright discolorable erythema on the cheeks ("slapped cheeks"), with perioral pallor.
A more diffuse rash (often pruriginous) occurs the next day on the trunk and extremities and then quickly turns into a laced reticular rash, which can increase or decrease (especially with temperature variation) more than 3 weeks. Adults with this infection frequently have arthritis and fetal hydrops may occur in combination with this condition in pregnant women.
Sudden exanthema (roseola) is very common among children under 3 years of age. As in infectious erythema, rash usually occurs after the fever has dropped. It consists of pink-rose macula of 2 - 3 mm and of the papula that rarely merges, initially appearing on the trunk and sometimes at the extremities (bypassing the face) and which fades in 2 days.
Although drug reactions have many manifestations, including hives, drug-induced exantematous rashes are very common and sometimes difficult to differentiate from viral exanthema. Drug rashes are usually more intensely erythematous and itchy than viral exanthemas, but this differentiation cannot be based.
An anamnesis mentioning new medications and the absence of prostration can help distinguish the drug rash from a rash or other etiology. The rash may persist for up to 2 weeks after administration of the causative agent is discontinued.
Some populations are more prone to the development of rashes than others. Of HIV-infected patients, 50 to 60% develop a rash in response to sulfur medications, or 50 to 100% of patients with mononucleosis caused by Epstein-Barr virus develop rash when taking ampicillin.
Diseases caused by rickettsii should be considered when assessing individuals with centrally distributed maculopapular eruptions. The usual context for epidemic typhus is an area of war or natural disaster, where people are exposed to lice.
Endemic typhus or leptospirosis (caused by a spirocheta) can be found in urban environments, where rodents multiply. Some centrally distributed maculopapular eruptions have distinctive characteristics.
Chronic migrating erythema (ECM), the rash of Lyme disease, typically manifests as single or multiple ring plates. Untreated lesions of ECM usually disappear within a month, but may persist for more than a year. The bordered erythema, the rash of acute articular rheumatism has a distinctive evolution with the enlargement and displacement of transient ring lesions.
Vascular collagen diseases can cause fever and rash. Patients with lupus erythematosus typically develop an erythematous rash, well contoured with a butterfly distribution on the cheeks (rash malar), as well as many skin manifestations. Still's disease manifests itself as a passing pink-orange rash on the thorax, coinciding with the febrile peaks.
Peripheral eruptions are more prominent in the periphery or begin in peripheral (sacral) areas before expanding centripetally. The rash of secondary syphilis, which may be diffuse but prominent on palms and plants, should be considered as a differential diagnosis with pinkish pitiriazis, especially in sexually active patients.
Atypical measles is observed in measles individuals who have received the dead virus vaccine. Classical target lesions of multiform erythema appear symmetrically on the elbows, knees, palms and plants. In relatively severe cases, these lesions may spread diffusely and may involve mucous surfaces. Injuries can occur on the hands and feet in endocarditis.
Confluent descuamative erythema consists of diffuse erythema, commonly followed by descuamation. Eruptions caused by Streptoccous group A or Staphylococcus aureus are mediated by toxins. Certain features of the disease may be suggestive for diagnosis. Scarlatine usually follows pharyngitis, patients have red face, raspberry tongue and spots accentuated in body envelopes (Pastia lines).
Kawasaki disease is present in the pediatric population with tongue cracks, raspberry tongue, conjunctivitis, adenopathy and sometimes cardiac abnormalities. Streptococcal toxic shock syndrome is manifested with hypotension, multi-organic failure and, frequently, with a severe streptococcal group A infection (e.g. necrotizing fasceitis).
Staphylococcal toxic shock syndrome also presents with hypotension and multi-organic failure, but only colonization with Streptoccocus aureus and not with a severe infection is usually recorded. Staphylococcal syndrome of scalded skin is observed primarily in children and immunocompromised adults.
Generalized erythema is often evident during the prodrom of fever and malaise, the deep sensitivity of the skin is preserved. In the exfoliative stage, the formation of bubbles by light lateral pressure (Nikolski sign) may be introduced to the skin.
In a mild form, a scarlet rash mimics scarlet fever, but the patient does not exhibit raspberry tongue or perioral pallor. In contrast to the staphylococcal syndrome of the stopped skin, in which the plane of cleavage is superficial in the epidermis, toxic epidermal necrolysis involves the peeling of the entire epidermis, resulting in a severe disease.
This disease is unusual among children and relatively common among HIV-infected patients. Exfoliative erythrodermic syndrome is a serious reaction associated with systemic toxicity, which is often caused by eczema, psoriasis, fungoid mycosis or a severe drug reaction.
It follows the vesicular eruptions. Chickenpox is highly contagious, frequently occurring in winter or spring. Injuries of chickenpox are at different stages of development, at a certain time, in a certain region of the body. In immunodepressed hosts, chickenpox vesicles may lack characteristic erythematous base or may appear hemorrhagic.
The eruption of rickettsii is commonly found in urban settlements and is characterized by blisters and pustules. It can be distinguished from chickenpox by an escar at the site of the mouse tick bite. Disseminated infection with Vibrio vulnificus or egtima gangrenosum caused by Pseudomonas aeruginosa should be considered in immunodepressed individuals with sepsis and hemorrhagic bubbles.
Urticaria eruptions, in the presence of fever, are usually due to urticaria vasculitis (individuals with classical, mild urticaria, usually having a hypersensitivity reaction without associated fever, which disappear within 48 hours), lesions that can last up to 5 days.
Etiologies include serum disease (commonly induced by drugs such as penicillins, sulphates, salicylates or barbiturates), connective tissue diseases (e.g. lupus erythematosus or Sjogren's syndrome) and infections (e.g. hepatitis B virus, parasites, etc.). Malignant conditions may be associated with fever and chronic hives.
Nodular rashes are frequently a disseminated infection in immunodepressed individuals. Patients with disseminated candidiasis (commonly caused by Candida tropicalis) may have a triad with fever, myalgia and eruptive nodules. And other examples can be given.
Purple rashes such as acute meningococcal rash are classically present in children as a petesial rash, but initial lesions can occur in the form of whitish maculates or hives. Large echimotic areas of purpura fulminants reflect severe intravascular disseminated coagulation, which may be due to infectious or non-infectious causes. Thrombocytopenic thrombotic purpura is a non-infectious cause of fever and spots.
And the examples can go on... But I think it's good to stop here...
Hold on! Many of you (those who have gone through my posts) are asking me to move to concrete elements of the new medicine but it is necessary to understand the mechanisms that I will describe later precisely on the basis of the "cutting-edge" discoveries of current, classical, allopathic medicine.
In the main, everything I present here you will see is directly related and supports everything I insert. Offf, for those who are not interested in all this medical data, please come back in to read my posts in April, after
The patient with acute fever disease and rashes/ rash/ rash is a diagnosed challenge for doctors. The distinct occurrence of an rash consistent with a clinical syndrome may facilitate prompt diagnosis and the establishment of life-saving therapy or infection control interventions.
A thorough anamnesis of patients with fever and rash/ erythema/ rash includes the following important information: immune status, medicines taken during the previous month, detailed travel history, immunisation status, contact with pets or other animals, animal bites or arthropods in the past, the existence of cardiac abnormalities, the presence of prosthetic materials, recent contact with sick individuals and exposure to sexually transmitted diseases.
Anamnesis must also include the onset place of the rash, its direction and speed of spread. A thorough physical examination pays close attention to the rash, with the precise evaluation and definition of its characteristic features.
First it is decisive to determine the type of lesions that form the eruption. Macles are smooth lesions, defined as a modified colour zone (i.e. an erythema that disappears through vitropressure). Papules are embossed, solid lesions with a diameter of less than 5 millimeters, the plates are lesions larger than 5 millimeters in diameter, with a smooth surface, in the plateau, and the nodules are lesions more than 5 millimeters in diameter, with a relatively round configuration.
Plates (urticaria, "gentle") are lesions of the pink-pal papule type and can appear round (like a ring) as they enlarge (classic, nonvascular plates, being transient, persisting only 24-48 hours in any area that appears). Vesicles (less than 5 millimeters) and bubbles (more than 5 millimeters) are circumscribed, embossed lesions containing liquid.
Pustules are embossed lesions containing purulent exudate, with vesicular infections such as chickenpox or herpes simplex that can progress to pustules. Non-palpable purple is a smooth lesion, which is due to bleeding from inside the skin and is classified in spots, purple lesions with a diameter of less than 3 millimeters, and bruising, if the diameter is more than 3 millimeters.
Palpable purpura is an embossed lesion, which is due to inflammation of the vascular wall (vasculitis) with subsequent hemorrhage. Other characteristic features of rashes include their shape (i.e. ring or target), the disposition of lesions and their distribution (i.e. central or peripheral).
We will now review rashes/rashes that reflect systemic diseases, not including localized skin rashes (such as cellulite, impetigo) that may also be associated with fever, which will be classified on the basis of the morphology and distribution of lesions. For practical purposes, this classification system is based on the clinical aspects of the most typical diseases.
However, morphology may vary as rashes evolve and the appearance of rash diseases is subject to many changes. Febrile diseases with rash can be classified by type of rash: centrally distributed maculopapular, confluent descuaamative erythematous, vesicular, urticarian, nodular and purple peripherally distributed.
We'll first address centrally distributed maculopapular eruptions. Centrally distributed rashes, in which lesions appear primarily on the trunk, are the most common types of eruption. The rash in measles (rujeola) begins at the hair line after 2 to 3 days of illness and spreads lower throughout the body, avoiding palms and plants.
Initially, discrete erythematous lesions occur, which become confluenced as the rash expands. Koplik's spots (white or bluish lesions of 1 to 2 mm with an erythematous halo appearing on the oral mucosa) are pathognomonic for measles and are generally observed during the first 2 days of symptoms.
They should not be confused with Fordyce's spots (ectopic sebaceous glands), which do not have erythematous halos and are found in the oral cavities of healthy individuals. Koplik's spots can be partially covered by measles exanthema. Rubella extends lower from the hair demarcation limit.
However, unlike measles, rubella rash tends to disappear from the initially affected areas as it migrates and may be itchy. Forchheimer's spots (palatine spots) may occur, but they are nonspecific, as they can also occur in mononucleosis and scarlet fever. Retrourical and suboccipital adenopathy and arthritis commonly occur in adults with rubella.
Contact of pregnant women with sick individuals should be avoided, as rubella causes severe birth defects. Numerous strains of enteroviruses, mainly echoviruses and coxsackieviruses, cause nonspecific syndromes with fever and rashes, which can mimic rubella and measles.
Both infectious mononucleosis caused by the Epstein-Barr virus and primary human immunodeficiency virus (HIV) infection may also present pharyngitis, lymphadenopathy, and a nonspecific maculopapular examination.
The rash in infectious erythema (determined by human parvovirus B19) primarily affects children aged 3 to 12 years. It occurs after the resolution of fever as a bright discolorable erythema on the cheeks ("slapped cheeks"), with perioral pallor.
A more diffuse rash (often pruriginous) occurs the next day on the trunk and extremities and then quickly turns into a laced reticular rash, which can increase or decrease (especially with temperature variation) more than 3 weeks. Adults with this infection frequently have arthritis and fetal hydrops may occur in combination with this condition in pregnant women.
Sudden exanthema (roseola) is very common among children under 3 years of age. As in infectious erythema, rash usually occurs after the fever has dropped. It consists of pink-rose macula of 2 - 3 mm and of the papula that rarely merges, initially appearing on the trunk and sometimes at the extremities (bypassing the face) and which fades in 2 days.
Although drug reactions have many manifestations, including hives, drug-induced exantematous rashes are very common and sometimes difficult to differentiate from viral exanthema. Drug rashes are usually more intensely erythematous and itchy than viral exanthemas, but this differentiation cannot be based.
An anamnesis mentioning new medications and the absence of prostration can help distinguish the drug rash from a rash or other etiology. The rash may persist for up to 2 weeks after administration of the causative agent is discontinued.
Some populations are more prone to the development of rashes than others. Of HIV-infected patients, 50 to 60% develop a rash in response to sulfur medications, or 50 to 100% of patients with mononucleosis caused by Epstein-Barr virus develop rash when taking ampicillin.
Diseases caused by rickettsii should be considered when assessing individuals with centrally distributed maculopapular eruptions. The usual context for epidemic typhus is an area of war or natural disaster, where people are exposed to lice.
Endemic typhus or leptospirosis (caused by a spirocheta) can be found in urban environments, where rodents multiply. Some centrally distributed maculopapular eruptions have distinctive characteristics.
Chronic migrating erythema (ECM), the rash of Lyme disease, typically manifests as single or multiple ring plates. Untreated lesions of ECM usually disappear within a month, but may persist for more than a year. The bordered erythema, the rash of acute articular rheumatism has a distinctive evolution with the enlargement and displacement of transient ring lesions.
Vascular collagen diseases can cause fever and rash. Patients with lupus erythematosus typically develop an erythematous rash, well contoured with a butterfly distribution on the cheeks (rash malar), as well as many skin manifestations. Still's disease manifests itself as a passing pink-orange rash on the thorax, coinciding with the febrile peaks.
Peripheral eruptions are more prominent in the periphery or begin in peripheral (sacral) areas before expanding centripetally. The rash of secondary syphilis, which may be diffuse but prominent on palms and plants, should be considered as a differential diagnosis with pinkish pitiriazis, especially in sexually active patients.
Atypical measles is observed in measles individuals who have received the dead virus vaccine. Classical target lesions of multiform erythema appear symmetrically on the elbows, knees, palms and plants. In relatively severe cases, these lesions may spread diffusely and may involve mucous surfaces. Injuries can occur on the hands and feet in endocarditis.
Confluent descuamative erythema consists of diffuse erythema, commonly followed by descuamation. Eruptions caused by Streptoccous group A or Staphylococcus aureus are mediated by toxins. Certain features of the disease may be suggestive for diagnosis. Scarlatine usually follows pharyngitis, patients have red face, raspberry tongue and spots accentuated in body envelopes (Pastia lines).
Kawasaki disease is present in the pediatric population with tongue cracks, raspberry tongue, conjunctivitis, adenopathy and sometimes cardiac abnormalities. Streptococcal toxic shock syndrome is manifested with hypotension, multi-organic failure and, frequently, with a severe streptococcal group A infection (e.g. necrotizing fasceitis).
Staphylococcal toxic shock syndrome also presents with hypotension and multi-organic failure, but only colonization with Streptoccocus aureus and not with a severe infection is usually recorded. Staphylococcal syndrome of scalded skin is observed primarily in children and immunocompromised adults.
Generalized erythema is often evident during the prodrom of fever and malaise, the deep sensitivity of the skin is preserved. In the exfoliative stage, the formation of bubbles by light lateral pressure (Nikolski sign) may be introduced to the skin.
In a mild form, a scarlet rash mimics scarlet fever, but the patient does not exhibit raspberry tongue or perioral pallor. In contrast to the staphylococcal syndrome of the stopped skin, in which the plane of cleavage is superficial in the epidermis, toxic epidermal necrolysis involves the peeling of the entire epidermis, resulting in a severe disease.
This disease is unusual among children and relatively common among HIV-infected patients. Exfoliative erythrodermic syndrome is a serious reaction associated with systemic toxicity, which is often caused by eczema, psoriasis, fungoid mycosis or a severe drug reaction.
It follows the vesicular eruptions. Chickenpox is highly contagious, frequently occurring in winter or spring. Injuries of chickenpox are at different stages of development, at a certain time, in a certain region of the body. In immunodepressed hosts, chickenpox vesicles may lack characteristic erythematous base or may appear hemorrhagic.
The eruption of rickettsii is commonly found in urban settlements and is characterized by blisters and pustules. It can be distinguished from chickenpox by an escar at the site of the mouse tick bite. Disseminated infection with Vibrio vulnificus or egtima gangrenosum caused by Pseudomonas aeruginosa should be considered in immunodepressed individuals with sepsis and hemorrhagic bubbles.
Urticaria eruptions, in the presence of fever, are usually due to urticaria vasculitis (individuals with classical, mild urticaria, usually having a hypersensitivity reaction without associated fever, which disappear within 48 hours), lesions that can last up to 5 days.
Etiologies include serum disease (commonly induced by drugs such as penicillins, sulphates, salicylates or barbiturates), connective tissue diseases (e.g. lupus erythematosus or Sjogren's syndrome) and infections (e.g. hepatitis B virus, parasites, etc.). Malignant conditions may be associated with fever and chronic hives.
Nodular rashes are frequently a disseminated infection in immunodepressed individuals. Patients with disseminated candidiasis (commonly caused by Candida tropicalis) may have a triad with fever, myalgia and eruptive nodules. And other examples can be given.
Purple rashes such as acute meningococcal rash are classically present in children as a petesial rash, but initial lesions can occur in the form of whitish maculates or hives. Large echimotic areas of purpura fulminants reflect severe intravascular disseminated coagulation, which may be due to infectious or non-infectious causes. Thrombocytopenic thrombotic purpura is a non-infectious cause of fever and spots.
And the examples can go on... But I think it's good to stop here...
Hold on! Many of you (those who have gone through my posts) are asking me to move to concrete elements of the new medicine but it is necessary to understand the mechanisms that I will describe later precisely on the basis of the "cutting-edge" discoveries of current, classical, allopathic medicine.
In the main, everything I present here you will see is directly related and supports everything I insert. Offf, for those who are not interested in all this medical data, please come back in to read my posts in April, after
I'm
done with all this classic medicine!
Goodfaith
and understanding in everything you do!
Dorin, Merticaru