1. Department of Pediatric, Corse of Children Infectious Diseases
Sumy State University
Medical Institute
Department of Pediatric,
Corse of Children Infectious Diseases
Differential diagnosis infectious diseases with exanthemas Lecturer
Bynda Tatiana P.

2. Professional motivation
Exanthema – rashes on the skin, which occurs in many infectious diseases.
Some rashes are typical only for one disease; other may be present in several diseases.
They differ by the rash morphology, localization, time of appearing, and dynamics of development.
That’s why it is very important to differentiate them and perform right diagnosis for adequate etiological and pathogenetical treatment.

3. The exanthema - rashes on the skin
The enanthema - rashes on the mucosa.

4. Depending on the cause the rash is divided into infectious and non-infectious
Connection with infectious diseases
Acute onset
Fever
Symptoms of intoxication
Other symptoms of infectious diseases
Cyclical course
The appearance of the disease in children after contact with sick
Noninfectious
Gradual onset
Without an increase in body temperature

5. Depending on the morphology the rash is divided into 2 groups: hemorrhagic and inflammatory.
In addition inflammatory rash is divided into rash with cavity and without cavity
Exanthema
Inflammatory
Haemorrhagic
Macula-
papular
Vesicular

7. Characteristic of the rash
When occurs the first elements of the rash? (Time the rash appears after the onset of the diseases)
Where the first elements of the rash appeared?
The order of the spreading of the rash.
Where is the rash more?
Where no rash?
The presence of temperature, itching, catarrhal symptoms.

8. Characteristic of the rash
Character (petechiae, spot, papule, vesicle)
Polymorphism of the rash
Size
Form
Color
Edge (clear, unclear)
Symmetry
The ability to confluence
The presence of pruritus
Background of the skin

9. Characteristic of the rash
The duration of the rash
The order of the fading rash
Secondary morphological elements of the rash (pigmentation, crust, desquamation )

10. Causes of acute maculopapular rash
1 мм – punctiform rash (Scarlet fever,
Pseudotuberculosis)
2-5 mm- roseola (typhoid fever)
5-10 mm – micromacula (rubella, sudden disease (sixth disease)
10-20 mm – macromacula (measles, urticaria, drug allergy, enterovirus exanthema)   > 20 mm – erythema (erysipelas)

11. Causes of acute vesicle rash
- chickenpox - herpes - herpes zoster - drug allergy

12. Causes of hemorrhagic rash:
Meningococcal disease Haemorrhagic fever Leptospirosis Toxic Flu

13. Diseases that are accompanied by vesicles

14. Chickenpox
Chickenpox is an acute infectious disease, characterized by vesicular eruption with transparent liquid on skin and mucous membrane.

15. Chickenpox (Varicella)
Susceptibility to chickenpox is very high, practically universal.
In most cases it occurs in children 2-5 years age.
The incubation period ranges from 11 to 21 days (most cases days).
The prodromal period consists of 1 to 2 days of fever, headache, malaise and anorexia.

16. Chickenpox (Varicella)
The temperature
The vesicle

17. Chickenpox
The rise of temperature in chickenpox usually coincides with appearance of the rash.
It usually goes up to 38°C, and may become high (39 °C or 40 °C).
The temperature curve is irregular, each peak reflecting the dynamics of the eruption.
The elevation of temperature is accompanied with aggravation of the child’s general condition

18. Chickenpox (Varicella)
At first the spots appear on the face or trunk and, at the height of the illness, are more numerous centrally than distally.
The rashes, often pruritic, begin as a maculae and progresses rapidly through the stages of papule, vesicle, and crusted lesion.

19. Chickenpox (Varicella)
False polymorphism
The lesions erupt in crops for 3 to 4 days and it is characteristic of the rashes that lesions in different stages of development may be found on one area (polymorphism).

20. Chickenpox (Varicella)

21. Varicella rash is always on the scalp

22. http://intranet. tdmu. edu

23. Chickenpox (Varicella)
The vesicle is a 2 to 5 mm oval filled with clear fluid surrounded by an erythematous base.
The fluid clouds and a crust forms appear within 1 day.

24. Chickenpox
In some patients eruption is often seen on the mucous membranes of the mouth, nasopharynx, larynx, genital organs.
The vesicles are rapidly converted into superficial erosions with a yellowish-grey floor, which are rather tender but heal in a few days.

25. Chickenpox
Lesions occurring on the mucous membranes do not crust but form a shallow ulcer.

28. Chickenpox (Varicella)

29. Chickenpox (Varicella)

30. Chickenpox (Varicella)

31. Chickenpox (Varicella)
ВІТРЯНА ВІСПА

32. Chickenpox (Varicella)

33. Chickenpox (Varicella)

34. Atypical forms of the disease
Atypical forms of the disease may occur:
bullous,
pustule,
hemorrhagic,
gangrenous,
abortive.

35. The pustular eruptions

36. The pustular eruptions

37. In the bullous form of chickenpox (varicella bullosa) large flabby bullae develop (up to two or three centimetres in diameter, with turbid contents) in addition to the typical vesicular rash. The bullae may burst leaving an extensive moist surface. The outcome in the overwhelming majority of cases is favorable.
This form, the same as the pustular, is related
to concomitant
secondary coccal
infection.

39. The hemorrhagic form

40. The hemorrhagic form (varicella hemorrhagica)

41. The hemorrhagic form (varicella hemorrhagica)

42. The gangrenous form (varicella gangrenosa)

43. Chickenpox (Varicella)
The chief blood findings in the eruptive stage are slight leukopenia, neutropenia, and a relative lymphocytosis.
Postinfectious immunity is stable lifelong.
After the disease subsides, the virus may remain dormant for decades and may then reappear as herpes zoster

44. Herpes Simplex
Herpes simplex is a viral disease, manifested by vesicular rash on the skin and mucous membrane.

45. An incubative period is from 2 to 14 days (an average 4-5 days).
Herpes Simplex
An incubative period is from 2 to 14 days (an average 4-5 days).
There are some clinical forms of herpes viral infection depending on the process localization.

46. Herpes Simplex
Nose and lip herpes is characterized by appearance of small vesicles with thin fragile wall between the skin and mucous membranes of nose and lips.
The vesicles appear in groups and are surrounded by an area of hyperemia.

47. Herpes Simplex
Subjective sensations are itch, pain and burning pain.
The vesicles contain clear fluid, which gradually then becomes turbid The vesicles dry up and crusts appear in 3-4 days.

48. Herpes Simplex
Constitutional symptoms of the disease are absent, body temperature is normal.
Crusts fall off in 5-7 days and the affected skin is again covered with epithelium.

50. Herpes Simplex

51. Herpes zoster
Herpes zoster is an infectious disease, characterized by rash in the form of vesicles grouped closely and neuralgias in certain skin areas, innervated by separate sensitive nerve.

52. Herpes zoster
The disease affects older children and adults.
It is characterized by sporadic cases.
Epidemic outbreaks are absent.

53. Herpes zoster
The disease has an acute onset with low–grade fever and severe pain along the nerves, connected with the affected ganglion.
Reddening, burning pain and itch appears on the corresponding area of sensory innervation.

54. Herpes zoster
At the end of the first day after the onset of the disease or in at beginning of the second one groups of vesicles, containing clear fluid, appear on the affected area of the skin.

55. The elements of rash may fuse.
Herpes zoster
The elements of rash may fuse.
In the end of the first week after the onset of the disease or during the second one the vesicles dry up and crusts appear.
Mild pigmentation remains after them.

56. The process is unilateral.
Herpes zoster
The areas of the skin, which are innervated by trigeminal or intercostal nerves, are affected most frequently.
The process is unilateral.
Recurrent waves of eruption occur frequently, that is why general background of rash seems polymorphous.

57. Herpes zoster Regional lymph nodes are enlarged.
Pain syndrome may remain for several months after disappearance of local lesions.
Atypical forms of the disease may occur (bullous, hemorrhagic, gangrenous, abortive).
In herpes zoster lesions of CNS have the form of serous meningitis.