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TABLE 2
Diseases Presenting with Fever and Rash
Lyme disease Borrelia Macule or papule All ages at risk for History of tick Clinical
burgdorferi at site of tick tick exposure in exposure; findings,
bite, progressing endemic areas secondary serology,
to erythematous, polymerase
pathognomonic macular lesions; chain reaction
erythema Borrelia test
migrans lymphocytoma;
highest incidence:
May through
September
Meningococcemia Neisseria Variety of lesions Highest incidence in Acutely ill patient; Often, clinical
(acute) meningitidis but, children 6 months to high fever, findings; blood
characteristically, 1 year of age tachypnea, cultures
petechial lesions tachycardia, mild
distributed on hypotension;
the trunk and leukocytosis;
extremities meningitis
(although the develops in more
lesions can be than 50 percent of
located patients
anywhere);
petechiae on
mucous
membranes
Meningococcemia N. meningitidis Intermittent Same as for acute Fever, myalgias, Blood cultures
(chronic) maculopapular form arthralgias,
lesions, often on headache,
a painful joint or anorexia; may
pressure point; recur for weeks or
may have months, with
nodules on average duration
calves of 8 weeks; may
progress to acute
meningococcemia,
meningitis or
endocarditis
DESCRIPTION OF DIAGNOSTIC BASIS FOR
DISEASE ETIOLOGY EPIDEMIOLOGY
RASH CLUES DIAGNOSIS
Rocky Mountain Rickettsia Rash evolving Young adults with Onset typically Clinical
spotted fever rickettsii from pink tick exposure; men abrupt; fever, findings,
macules to red affected more often severe headache serology
papules and than women and myalgias are
finally to prominent; rash
petechiae; rash appearing around
beginning on fourth day of
wrists and illness; may have
ankles and relative
spreading bradycardia and
centripetally; leukopenia
involvement of
palms and soles
late in disease
Toxic shock Staphylococcus Diffuse “sunburn“ All ages, but most High fever, Clinical criteria,
syndrome aureus rash that common in hypotension and vaginal and
desquamates menstruating involvement of wound cultures
over 1 to 2 females three or more
weeks organ systems;
about 50 percent
of cases occurring
in menstruating
women around
onset of menses;
postoperative
patients at
increased risk;
condition out of
proportion to
wound
appearance
DESCRIPTION OF DIAGNOSTIC BASIS FOR
DISEASE ETIOLOGY EPIDEMIOLOGY
RASH CLUES DIAGNOSIS
Kawasaki's Idiopathic Erythematous Children less than 8 Winter and spring; Specific
disease rash on hands years of age, with high fevers, clinical criteria
and feet; peak incidence at 1 cervical
morbilliform, year; boys affected lymphadenopathy,
scarlatiniform more often than arthritis,
rash on trunk girls arthralgias,
and perineum; cardiac
hyperemic lips involvement,
mucous
membrane
involvement; can
be complicated by
coronary artery
abnormalities in
20 to 25 percent of
cases
Rickettsialpox Rickettsia akari Generalized All ages; urban Transmitted from Serology
maculopapular- settings mice to humans
vesicular via mites;
exanthem; formation of
possible papules 7 to 10
involvement of days after initial
mucous bite; typically,
membranes; no formation of a
involvement of black eschar over
palms or soles healing lesion;
febrile phase
occurring 3 to 7
days after initial
lesion and lasting
up to a week; self-
limited, usually
mild course