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EXANTHEM OF INFECTIOUS ORIGIN Exanthem = acute eruption of skin efflorescenses in multiple sites, due to the systemic effects of a microorganism on the skin. Enanthem = eruption of similar etiology on the mucous membranes. Exanthematic infections – infectious diseases with exanthem as an obligatory, prominent and characteristic symptom: (Czech – Latin – English name) spála - scarlatina - scarlet fever spalničky - morbilli - measles, rubeola zarděnky - rubeola - German measles, rubella pátá nemoc - megalerythema infectiosum - Fifth disease, erythema infectiosum šestá nemoc - exanthema subitum – Sixth disease, exanthem subitum, roseola infantum plané neštovice – varicella - chickenpox pravé neštovice – variola – smallpox In many other infections (viral, bacterial, fungal, parasitic) exanthem occurs facultatively. Diagnostic procedure: history, physical findings, laboratory tests History: Personal history: age, vaccination, previous diseases, allergy Epidemiological data: season, contacts, travelling History of current illness: prodromes, progression, administered drugs Physical findings: exanthem - morphologic types of skin lesions (macula, papula, urticaria, vesicle, bulla, pustula, nodus... (see in dermatology), their colour and presence or abscence of haemorrhage (purpuric lesions) - development of the rash (onset, progression, distribution, fading, hyperpigmentation, peeling...) other symptoms – fever, lymphadenopathy, catarrhal symptoms, arthralgias, hepatomegaly, spleenomegaly, meningeal syndrom... Laboratory tests: blood count + differential count of leukocytes throat swab culture serology liver tests others – X-ray, lumbar puncture, biopsy The noninfectious processes often include skin rash and fever and should be considered in the initial evaluation, as well as drug reactions. Morphologic classification of exanthems: 1. Macular and/or papular exanthem scarlet fever measles rubella Fifth disease Sixth disease Arcanobacterium haemolyticum infection staphylococcal toxic shock syndrom Kawasaki syndrom infections of adenovirus, enterovirus (Coxsackie, ECHO, enteroviruses 68-71), EBV – infectious mononucleosis initially meningococcus infection, rickettsioses Dengue fever, typhoid fever parasitic infections – scabies, cercaria dermatitis STD – HIV primary infection, secondary syphilis 2. Vesiculobullous exanthem chickenpox + herpes zoster smallpox herpes simplex virus infection + eczema herpeticum Kaposi impetigo ECHOvirus, Coxsackievirus infection – „hand-foot-mouth disease“ (erythema multiforme) 3. Difusse erythema scarlet fever? scalded skin syndromes toxic shock syndrom 4. Nodular lesions disseminated fungal infections, nocardiosis, atypical mycobacterium infections (erythema nodosum) 5. Petechial purpuric eruptions DIC – meningococcus infection, severe sepsis, viral hemorrhagic fevers, tropical malaria ricketsioses, ECHOvirus, Coxsackievirus infections, atypical measles