Infectious Diseases with Xanthama

D/D of infectious diseases with exanthema. W – 20 pg-1 Exanthema are characterized by generalized eruption or rash mainly in the skin. (A) Macular papular rash Causative agent Disease Site Specific Characteristics VIRUS EBV Infectious mononucleosis Trunk May resemble measles accompanied by palatine exanthema (2)Rubeola RNA Paramyxovirus Measles Forehand going to upper body ,lower body & distal extremities after sometime. Fades in cephalocaudal direction. Red (copper(brown. (rash appears in days-DD with rubella) Palatine exanthema & koplik spots in buccal mucosa. 1mm macules (3)Rubella. RNA virus German measles frontal & retroauricular Then spreading over body & limbs. Rash appears in hours DD with rubeola (1)Chlamydia psittaci Psittacosis Trunk Faint macules occasionally erythema nodosum or erythema multiforme Bacteria (1)Listeria monocytogenes Listeriosis Trunk & legs Red macules undergoing central necrosis with formation of pustules (2) Salmonella Gr- Typhoid fever Abdomen & chest 5mm rose spots occurs in chest (3) Streptococcus pyogenes group A (B haemolytic) Gr+ Scarlet fever Exanthematous skin with accentuation in flexor regions (buttocks,axilla,groin) punctuate red papules which give sand paper like texture & blanches under pressure – circumoral pallor.Hyperpigmented transverse lines in extensor surface (antecubital fossa) tongue at first white then red strawberry Acute rheumatic fever Erythema nodosum Rapidly spreading ringed eruptions with raised margins that confluence into annular patterns Erysipelas Face, extremities Bright red edematous tender plaques Nematodes (1)Trichinella spiralis Trichinellosis Face,eyelids and conjunctiva Accompanying periorbital oedema myositis ,fever (2)Necator americanus Hookworm disease Toes,toe clefts, soles Spirochaetes (1)Treponema pallidum Secondary syphillis Trunk & proximal extremities Bilateral symmetrical macular. Papular rash alopecia,mucous patches,condyloma lata Generalized lymphadenopathy W – 20 pg - 2 (B) Vescicular or Bullous Causative agent Disease Site Specific Characteristics VIRUS (!) Herpes simplex Gingivostomatis vulvovaginitis, balanitis keratoconjunctivitis Anywhere may be sensory noninvolvement with deep pain Grouped vescicles or erythematous plate (2)Coxackie Virus Hand foot & mouth disease Margins of palms & soles. Dorsum of hands & feet (3)Varicella Zoster Herpes zoster Dermatomal distribution unilateral Painful vescicles on erythematous base(involved area hyperaesthetic,↑ pain) Chicken pox Starting from head going to trunk & extremities also in mucus of mouth & uvula Starts as pruritic macular popular rash(vescicles(fluid filled vescicles( fluid becomes cloudy(umbilication(crust Bacteria (1)strep .pyogenes (gr+) impetigo Extremities face Vescicles which becomes pustules, bullas (C) Petechial or Haemorrhagic Causative agent Disease Site Specific Characteristics Rickettsia prowazeki Epidemic typhus Sides of trunk & spreads centrifugally but spares palms, soles& face. Macules becoming haemorragic during 2nd week. Bacteria (1)N. meningitides,gr- Meningococcaemia Generalized Petechia , purpura, ecchimosis containing meningococci (2)N.gonorrheae(gr-) gonococcaemia Extremities frequently over tender joints & fingers (3)streptococci(gr+) infectious endocarditis Oropharynx,conjunctiva Petechia,splinter janeway spots clubbing , osler nodes. D)Pustules Causative agent Disease Site Specific Characteristics staph aureus Furunculosis / boils Face,neck, arms,wrists,fingers, buttocks, anogenital area. Follicular inflammatory nodule becoming pustular & painful. (2)propionobacter acne+ staph.epidermidis acne Face,upper back, chest W – 20 pg - 3 E)Ulcerations Causative agent Disease Site Specific characteristics (1)Chlamydia Lymphogranuloma venerum Penis, labia Small, usually single ulceration accompanying lymphadenopathy (2)C. diphtheria Cutaneous or wound diphtheria Extremities, face (3)T. pallidum primery syphilis chancre Penis,vulva,cervix, Rectum,lips Raised papula ulcerates into shallow based punched out well defined borders single ulcer regional lymphadenopathy (4)C, albicans Cutaneous candidosis,moniliasis,thrush, vaginitis Intertrigous area ,mouth Eythematous lesions of mucousa & skin “satellite pustules” (F)Nodules Causative agent Disease Site Specific characteristics molluscum contagiosum(viral-pox virus Cutaneous candidosis,moniliasis,thrush, vaginitis Exposed areas in children s pubic area & genitals of adults Flesh coloured to pink umbilicated papules bacteria strep. Pyogenes M.Tbc M.leprae Erythema nodosum Shin & other extensor surfaces Tender erythematous nodules 1 Macule- nonpalpable area of altered colour 2 Papule – palpable elevated small area of skin.(<0.5cm) 3 Plaque - palpable flat-topped discoid lesion(.2cm) 4Nodule – solid, palpable lesion within the skin (>0.5. 1 vescicle-small,fluid filled blister(<0.5) 2 Bulla – large fluid filled blister(.0.5) 3 Pustule- blister containing pus. 1 Wheal- elevated lesion often white with red margin due to dermal edoema. 1 Petechiae- pinsized macules of blood. 2 Purpura- larger petechiae which do not blanch on pressure. 3 Ecchymosis- large extravasation of blood in skin.(bruising) 4 Haematoma- swelling due to gross bleeding. 5 Erythema- redness of the skin. 6 Ulcer – atleast the full thickness of the epithelium lost . Healing occurs with scarring. 1 Crust- dried exudate. Report on: D/D of infectious diseases with exanthema Report prepared by 1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom.2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia.3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania. Contact: publications [at] infekcijas.eu