The patient presented with fever, coughing, headache. He developed a rash on the 4th day, what is the probable diagnosis?
Correct Answer: Measles
Description: Measles Incubation period: 7-10 days Human beings only reservoir. Droplet infection Common in pre school age group Prodrome :lasting 4-5 days involvement of epithelial linings characteristic of measles . Koplik spots: whitish grayish spots on inner surface of cheeks opposite 2nd lower molar ,appear on 2-3 days and disappears on 2-3 day of rash. Rash appears on day 4 with increasing fever. Disappears in 4-5 days Histopathologically multinucleated giant cells in epidermis and Warthin Finkeldey cells in the reticuloendothelial system. Diseases associated with measles virus: SSPE Multiple sclerosis Crohn disease Complications: Respiratory tract :otitis media (most common complication) LAP Laryngitis Laryngotracheitis Interstitial pneumonitis resulting from measles virus takes the form of Hecht giant cell Pneumonia. Bronchopneumonia Bronchiectasis In the hemorrhagic type of measles (black measles), bleeding may occur from the mouth, nose, or bowel Neurological Encephalitis with 1 week of illness : 1/3rd die and 1/3rd left with severe neurological sequelae. SSPE: occurs 3-8 yrs after primary measles infection. Persistent measles infection or on autoimmune response. 100% fatality within 6 months of diagnosis. Presenting features include myoclonic jerks and mental deterioration. Measles virus cannot be isolated from CSF or blood. CSF ELISA for antibodies is positive. GIT: Persistent diarrhea Appendicitis Q Hepatitis Ileocolitis AGN. Malnutrition SJ syndrome DIC Treatment : Maintain hygiene Analgesics 1 age specific dose of vitamin A Fever and Rash : Mnemonic Based Approach Seven Killer Causes of Fever and Rash Mnemonic: SMARTTT Sepsis Meningococcemia Acute endocarditis Rocky mountain spotted fever Toxic erythemas Toxic epidermal necrolysis Travel-related infections Onset of Rash with "X" Days of Fever Mnemonic: Very Sick Person Must Take Double Eggs Varicella (Chicken pox): 1st day (rash is often 1st sign in children) Scarlet fever: 2nd day Pox (Small pox): 3rd day Measles (Rubeola or 14 day measles): 4th day (Remember: Koplik spots appear in pre-eruptive phase on 2nd day of fever) Typhus: 5th day Dengue: 6th day Enteric fever: 7th day Also remember, another similar mnemonic: Really Sick Children Must Take No Exercise Rubella (German measles or 3 day measles): 1st day Scarlet fever, Small pox: 2nd day Chicken pox (Varicella): 3rd day (prodromal symptoms 1-2 days before rash in adults) Measles (Rubeola or 14 day measles): 4th day Typhus: 5th day Nothing Enteric fever: 7th day Remember: Roseola infantum (Exanthem subitum, Sixth disease or 3 day fever): rash appears when fever disappears Erythema infectiosum (Slapped-cheek disease): no prodromal period and fever Drug rash: may appear anytime Exanthems - Numbered Diseases of Childhood Mnemonic: MS (Master in Surgery) and German MD (Doctor of Medicine) in ER (Emergency Room) 1st (First) disease: Measles (Rubeola, 14 day measles) Measles virus 2nd (Second) disease: Scarlet fever Streptococcus pyogenes 3rd (Third) disease: German measles (Rubella or 3 day measles) Rubella virus 4th (Fourth) disease: Duke's disease or Filatov-Duke's disease (now regarded as a variant of scarlet fever or SSSS) 5th (Fifth) disease: Erythema infectiosum or Slapped-cheek disease Erythrovirus (Parvovirus) B19 6th (Sixth) disease: Roseola infantum (Exanthem subitum, 3 day fever) Human Herpes Virus (HHV 6 more than HHV 7) Diseases Named by Numbered Days Three-day fever (3 day fever): Roseola infantum or Exanthem subitum or Sudden fever Three-day measles (3 day measles): Rubella or German measles Five-day fever (5 day fever): Trench fever or Quintana fever or Shinbone fever Seven-day fever (7 day fever): Weil's disease or Leptospirosis or Canicola fever or Nanukayami fever Fourteen-day measles (14 day measles): Measles or Rubeola or Hard measles Centripetal and Centrifugal Rash Distribution Centripetal (predominate or start on extremities) Hand, foot and mouth disease (caused by enterovirus i.e. coxsackie A16, enterovrius 71) Coxsackie A = more common but less severe Enterovirus 71 = less common but more severe Herpangina = caused by enterovirus; associated with oral enanthem but no exanthems Secondary syphilis Rocky mountain spotted fever Dengue fever Small pox Centrifugal (predominate or start on trunk) Viral exanthems: Measles, Rubella, Chicken pox, Scarlet fever Epidemic typhus Involvement of Palms and Soles Mnemonic: RED HANdS Rocky mountain spotted fever (R.rickettsi) Endocarditis Dengue (Palms and soles are spared by rash but swelling, itching and erythema is often seen) Hand-foot-mouth disease (Coxsackie) and Host vs Graft disease (GVHD) Autoimmune Kawasaki Disease (KD) Neisseria meningococcemia Stevens Johnson Syndrome and Syphilis (Secondary and Congenital) and Staphylococcal toxic shock syndrome Sparing of Face Mnemonic: SPaRES Scarlet fever (Flushing of face occurs but rash doesn't involve the face) Prowazekii caused Epidemic typhus Roseola infantum or Exanthem subitum or Sixth disease
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