Guess that RASH!
Folliculitis -many causes, bacterial think normal flora or S. aureus, hot tub pseudomonas, candida for fungus, can be drug/irritant also
Inflammation of hair follicle with eruption of pustules and/or papillose centered on hair follicles
Mumps caused by paramyxovirus member of the rubulavirus family -can lead to orchitis, aseptic meningitis, deafness, mycocarditis
Pain tenderness and swelling in one or both of the parotid salivary glands
Murcomycosis, Fungal infection -R angle branching and ribbon-like pauci-septate -very high mortality rate
Pt with profound Neutropenia, Black eschar that looks necrotic, progressive lesion
Necrotizing fasciitis -if mono microbial is often GAS/S. aureus -if with surgery=clostridial myonecrosis and is Clostridium perfringens
Rapidly progressing, pain our of proportion to exam in the start
Measles caused by measles virus of the family paramyxovirdiae -may also see Kopliks spots in mouth, coryza, conjunctivitis, and cough
Rash that appears 3-4 days after onset of illness, on hairline forehead, behind ears, and upper neck, spreads downward and fades starting on the third day in order of appearance
R. Prowazekii causing Epidemic typhus -caused by human body louse -flying squirrel -begins abruptly with headache and fever
Rash that can be macular, petechial, and even purpuric, mostly on trunk and may spread centrifugally to involve extremities but not on face, palm, and soles, no eschars and neurologic symptoms are common including stupor confusion and even coma
Rubella caused by rubella virus in the family togavirdae -congenital infection important (PDA, cataracts and deafness) *shorter rash, longer contagious period, and NO fever (compared to measles/rubeola) ~arthralgia in adult W
maculopapular, only lasts for three days, begins on face and spreads downward and child has painful post auricular/occpital lymphadenopathy. (T normal or only mild fever), What is the triad of congenital infection?
Seborrheic dermatitis -Early signs of HIV at any CD4 count -3-5% of general population by 85-95% of people with advanced HIV infection -possibly host immune response to malassezia or its byproducts
scaly rash typically involving face, scalp, sometimes chest, Pt has risk factors for HIV
cutaneous larva migrans -caused by burrowing larvae of animal hookworms -usually ancylostoma Brazilliense
serpiginous skin eruption
Gonococcal Arthritis -presents with tenosynovitis, migratory polyarthralgia, or polyarthritis/fevers/malaise
sexually active adult/adolescent with dermatitis this can lead to what?
Infection with bacillus anthracis-->cutaneous anthrax -G+ rod that is aerobic or facilitative aerobic, Box shaped -10 unit exotoxin with PA, EF, and LF -look for widened mediastinum
A painless skin sore (ulcer) with a black center that appears after itchy small blisters or bumps there is extensive local edema
Zoster or "shingles" -VZV from the herpes family -never give aspirin -if you see multiple reoccurrences in adult start to think HIV or other IC state
An adult usually, pock lesions that are restricted to a dermatomal pattern of a DRG
Impetigo -S. Aures or Strep Pyogenes which produce an exfoliative toxin
Child <6, in the summer, forms a golden-yellow crust, painless
roseola infantum/sixth disease causes by HHV-6 (but HHV-7 can also cause)
Child in the first 3 years of life, diffuse macular lacy red rash that spares the face preceded by a high fever for the first four days so high it can lead to seizures
R. akari which causes Smallpox rickettsia -not severe
Contact with house mice, single eschar, maculo/papular/vesicular rash that does NOT involve the palms and soles pt often in city
Kaposi sarcoma caused by HHV-8 -HIV pts especially, must treat HIV can occur at any CD4 cont but typically in advanced disease -differentiate from bacillary angiomatosis -biopsy shows lymphocytic inflammation.
Dark brown or violaceous plaques on extremities and purplish red lesions are seen on bronchoscopy
Tuleremia caused by F. Tularensis -small aerobic G- cocobacili -fever, chills, myalgia, -6 forms, can cause tender ulcers
Pt probably has had contact with rashes and now has persistent painful bilateral inguinal lymphadenopathy
HME caused by ehrichia chaffeensis transmitted by lone start tick -rash in 1/3 of adults and 66% of kids -can have severe complications -note HGE caused by anaplasma phagocytophila rarely presents with rash
Involves extremities, trunk, face, and rarely palms and soles, typically later in the disease and can be maculopapular, petechial, or diffuse
plague causes by Y. pests -4 types of plague: Bubonic, pneumonic (only person to person), sylvatic, urban
Large swollen Buboes (painful swollen lymph nodes) and can progress to skin hemorrhage and black skin
R. Typhii causing Endemic typhus -transmitted by scratching contained lesions by flea bites (rat/cat exposure)
Maculo-papular rash that starts on the trunk, spreads peripherally and spares the palms and soles, can be accompanied with fever, nausea, myalgia, headache or neurologic symptoms but often mild
Molluscum Contagiosum viral inf. of epidermal keratinocytes via dsDNA of Poxviridae family; mostly pediatric, so if seen in adults -- think HIV! -5-18% of HIV infected persons
Most common in healthy kids, little round pustular lesions
Leishmaniasis (parasite) -transmitted by flea sand bite -cutaneous form caused by tropical/mexicana in middle east/S. America -mucocutanous form is brazilienis -Visceral form is is Donovani
Non-healing skin sore that is deep
Cellulitis Classically B-hemolytic strep, hard to tell what is is though, but studies have shown its save to assume its BHS and give B-lactams!
Not raised, patchy, has indistinct borders, can be patchy, fever/chills common
-HSV-1/HSV-2 -HSV-1 is more commonly oral and latent in the trigeminal nerve, is it is genital it is indistinguishable from HSV-2, transmits more easily to newborn but causes less severe effects (eye, skin infections) -HSV-2 is is latent in the sacral ganglia and often genital and more often leads to recurrence and when transmitted congenitally can lead to more severe effects (encephalitis/neurodevelopmental) -can cause eye infection (ketatits/blephratitis) or finger (whitlow) or trunk (gladiatorum) -lesions can be absent!
Painful or burning erythema, papillose, multiple vesicular or ulcerative lesions on the mouth/pharynx or genitals
Smallpox (variola) caused by pox virus in the genus orthopoxvirus' -7-17 day incubation and 2-4 day prodromal phase
Peripheral rash with lesions all in the same stage that are very deep
Varicella or "chicken pox" -VZV from the herpes family -latent in neurons -10-21 day incubation and 0-2 day prodromal phase
Pock type lesions that start in soft tissue areas and spread, all over body (mostly central distribution), lesions are in all different stages, typically children
Skin abscess (Carbuncle, a furuncle is just into sub q not fat) -I & D do not need to give antibiotics
Seeping with pus
fifth disease caused by parvovirus which can lead to: aplastic crisis, arthritis, intrauterine infection (hydrops)
Slapped check rash
bacillary angiomatosis caused by bartonella in IC -small G- rod nutritionally fastidious -cat scratch disease -->enlarged lymph nodes, azithromycin -can have visceral involvement -Lesions : Red color -biopsy shows neutrophilic inflammation
Solitary or multiple red, purple, flesh-colored, or colorless papules (hemangiomalike lesions) varying in size from 1 mm to several centimeters
R. Africae causing african tick bite fever -only 50% of pts develop this usually 1 week after bite
Southern africa travel or hunting, fever headache myalgia and rash which can be vesicular with several inoculation eschars often on legs
S. Aureus infection
Usually an area with hair, can have black eschar, see G + cocci on Gram stain
Spider bite
White area surrounding lesion that can have a black center
Erysipelas -young children and elderly often effected, predisposed by lymphedema and venous stasis -Beta-hemolytic Strep(GAS) -Tx: Pen
painful fiery red, well demarcated and raised, indurate, usually on face/lower extremity and can have fever and chills
RMSF caused by R. Rickettsii transmitted by dermacentor ticks -severe disease -no eschar
petechial rash that occurs 3-5 days after the onset of fever, often starts around the wrists and ankles then involves the palms and soles with centripetal progression pt in rural area
