1. Department of Pediatric, Corse of Children Infectious Diseases
Sumy State University
Medical Institute
Department of Pediatric,
Corse of Children Infectious Diseases
Differential diagnosis infectious diseases with exanthemas
Part Lecturer
Bynda Tetiana P.

3. Scarlet fever
Scarlet fever is an acute infectious disease, characterized by lesions of oropharynx with submaxillary lymphadenitis, fever, toxemia, punctiform rash and then desquamation.

4. Scarlet fever
Due nonspecific prevention, antibacterial therapy of scarlet fever during last years – the number of patient with hard forms of this disease had decreased. But total morbidity is still high. Number of patients with light scarlet fever, repeated cases of it has increased. That is why it is hard to put the diagnose in time. This lead to widely spreading of streptococcal infection. That’s why it is necessary for future doctors to know peculiarities of clinical features, treatment, and prevention of scarlet fever.

5. Epidemiology
Susceptibility to scarlet fever depends on absence of antitoxic immunity against erythrogenous exotoxin of hemolytic streptococcus.
Susceptible organism – children 3-10 years old.
The contagious index is about 40 %.

6. Incubation period
The incubation period for scarlet fever is 1 to 7 days.

7. The initial period - from of the appearance of the first symptoms to the appearance of the rash.
The disease is accompanied in abruptly by fever, vomiting, sore throat and constitutional symptoms such as headache, chills and malaise.
Within 12 to 36 hours after the onset, the typical rash appears.

8. The rash period The significant findings are Fever Tonsillitis
Enanthem
Exanthema

9. Tonsillitis Tonsillitis is a typical sign of scarlet fever.
Tonsillitis may be:
catarrhal,
follicular,
lacunar or
necrotic,
which occurs on the 2nd - 4th day of the disease.

10. Local hyperemia of soft palate - "flaming fauces"
Local hyperemia of soft palate - "flaming fauces". The upper border of hyperemia is on the anterior palatal arches and on the base of the uvula (delimited hyperemia)

11. The palate and uvula may be edematous, reddened, and covered with petechiae. Note inflammation of the oropharynx with petechiae on the soft palate, small red spots caused by group A streptococcal pharyngitis.

12. Necrosis may be superficial in the form of patches - Follicular tonsillitis

13. Depending on severity of the disease necrosis may be deep, continious, locating on the tonsils - Lacunar tonsillitis
Necrosis has a dirty-grey or greenish color

14. Lacunar tonsillitis disappears slowly in 7-10 days.
Catarrhal and folicular tonsillitis disappears in 4-5 days.

15. Tonsillitis is accompanied by lymphadenitis.
Regional lymph nodes become enlarged, dense, tender.

16. If adipose tissue, surrounding the lymph nodes is affected, periadenitis, adenophlegmon will occur.

17. Dryness of the skin. White dermographism.

18. The rash usually appears within 12 hours after onset of the illness; occasionally it may be delayed for 2 days.
The rash is an erythematous punctiform eruption that blanches on pressure.

19. Elements of rash are dusky red, minute roseolas (may be tiny papules) of 1–2 mm diameter, closely situated with each other.
The eruption have a rough texture.

20. The eruption
Papules are usually absent on the face, palms, and soles, but the face characteristically shows flushing with circumoral pallor (Filatov’s sign).

21. On the body, the rashes are intensified in skin folds and at sites of pressure.

22. In the antecubital and axillary fosses, linear petechiae are seen with accentuation of the erythema (Pastia’s lines).

23. The exanthema usually lasts 4 to 5 days and then begins to desquamate, first on the face last on the palms and soles.

24. Desquamation is one of the most characteristic features of scarlet fever Desquamation begins on the face in fine flakes toward the end of the 1st wk. and proceeds over the trunk and finally to the hands and feet. The duration and extent of desquamation vary with the intensity of the rash; it may continue for as long as 6 wk.

25. Tongue is white coated, from 2 to 4-5 days, bright-raspberry colour and enlarged papillae of the tongue are observed ("raspberry tongue", "papillae tongue").

27. Blood test
There is leukocytosis, neutrophilia, increased ESR.

28. Pseudotuberculosis
is an acute infectious disease of the zoonotic group,
characterized by
fever, toxemia,
scarlet fever-like rash,
lesions of other organs and systems.

29. Incubation period is 3-18 days.
Pseudotuberculosis
Incubation period is 3-18 days.
Beginning is acute with high temperature, intoxication.
Polymorphism of complaints: malaise, fatigue, headache, sleepless, anorexia, arthralgias, muscle pain, sore throat, nausea, abdominal pain, dyspepsia.

30. Rush
Rash localization is like the one in scarlet fever (on the lateral parts of the trunk, the internal and the back parts of crura and thighs, on the skin of the lower abdomen, in skin folds).
Besides rash may appear on the external surfaces of arms and forearms, on the knee and radiocarpal joints.

31. maculopapulous (like in scarlet fever), may be erythematous;
Pseudotuberculosis
Rush:
maculopapulous (like in scarlet fever), may be erythematous;
the eruption is characterized by dusky red, tiny papules.

32. on the neck, hyperemia and edema of skin on the face (“hood” symptom);
Pseudotuberculosis
The rush in present on face, intensified periorbitally (“glasses” symptom),
on the neck, hyperemia and edema of skin on the face (“hood” symptom);
hyperemia and edema of skin on hands (“gloves” symptom) and
feet (“socks” symptom).

33. Pseudotuberculosis
on the body the rush is intensified in skin folds, at the sites of pressure, round the joints.
The exanthema usually lasts 4 to 5 days and then begins to desquamate, first on the face and last on the palms and soles.
Red dermographysm.

34. “Strawberry” tongue also simulates the scarlet fever.
Pseudotuberculosis
Catharral syndrome (pharyngeal and tonsilar erythema without the exudate, erythema of the soft palate, conjunctivitis, corryza.
“Strawberry” tongue also simulates the scarlet fever.
Abdominal syndrome; tenderness during the palpation of abdomen, may be acute appendicitis.
Dyspepsia: nausea, vomiting, liquid feces.

35. Hepatomegaly, rare – splenomegaly, lymphadenopathy.
Pseudotuberculosis
Hepatomegaly, rare – splenomegaly, lymphadenopathy.
Arthritis of knees, elbows, foot and hand small joints or arthralgia.
Hepatitis with or without the jaundice.
Toxic myocarditis.
Toxic nephritis, pyelonephritis.
Bronchitis or pneumonia may also develop.