Professional Documents
Culture Documents
Differentials: Less Common Infections
Differentials: Less Common Infections
DIFFERENTIALS
LESS COMMON INFECTIONS
Rocky Mountain spotted fever and leptospirosis are occasionally confused with KD
distinguishing features include pronounced myalgias and headache at onset, centripedal rash,
and petechiae on the palms and soles.
Leptospirosis
Risk factors include exposure to water contaminated with urine from infected animals.
classic description of leptospirosis is of a biphasic illness with a few asymptomatic days between
an initial period of fever and headache and a late phase with renal and hepatic failure.
In contrast, patients with KD have consecutive days of fever at diagnosis and rarely have renal or
hepatic failure Children with KD and pronounced myocarditis may demonstrate hypotension with
a clinical picture similar to that of toxic shock syndrome.
1ST
SJS KD
s/sx: s/sx
periorbital edema, oral ulcerations, and Fever is characteristically high (≥38.3°C
a normal or minimally elevated ESR are [101°F]), unremitting, and unresponsive
not seen in KD. to antibiotics.
dysphagia and ocular pruritus, followed conjunctivitis
by high fever, respiratory symptoms and erythema of the oral and pharyngeal
rashes with blisters or lesions causing mucosa with strawberry tongue and red,
mucosal inflammations. cracked lips; edema and erythema of the
Skin lesions are usually preceded by a hands and feet;
few days by inflammation and dryness of rash of various forms (maculopapular,
the mouth and genitalia. erythema multiforme, or scarlatiniform);
The oral, ocular and genital mucous and nonsuppurative cervical
membranes are gradually affected by lymphadenopathy, usually unilateral,
erythema, erosion, and with node size >1.5 cm
pseudomembranes. Perineal desquamation is common in the
Patients are severely ill and bullous acute phase.
lesions develop fast both on skin and Periungual desquamation of the fngers
mucous membranes (10), often within and toes begins 2-3 wk afer the onset of
12 hours illness and may progress to involve the
entire hand and foot
Measles is transmitted via droplets from the nose, mouth or throat of infected persons.
Patients are infectious from 3 days before to up to 4-6 days after the onset of rash.
Initial symptoms, which usually appear 8–12 days after infection, include high fever, cough,
coryza, conjunctivitis and Koplik spots or tiny white spots on the inside of the mouth, which is a
pathognomonic sign of measles, appearing 1-4 days prior to the onset of the rash. Several days
later, a rash develops, starting on the forehead (around the hairline), behind the ears, and on
the upper neck as a red maculopapular eruption. It then spreads downward to the torso and
extremities, reaching the palms and soles in up to 50% of cases. The exanthem frequently
becomes confluent on the face and upper trunk.
This was ruled-in due to the presence of fever, maculopapular rash and erythematous
conjunctivae in the patient.
However, this can be ruled-out since the distribution of rash on this patient started on the trunk
and abdomen(while in the case of measles, it would start in the forehead down to the trunk
and extremities), cough and coryza or runny nose were absent which are classic symptoms of
measles along with conjunctivitis, no Koplik spots which is a pathognomonic sign (seen in 50-
70% of measles patients), also in this patient, the fever persisted for several days, while in
measles usually, symptoms would subside with the onset of rash.
Rule in
Fever
Skin lesion
Swollen neck glands
Rule out
Fever unresponsive to antipyretics
no tonsillopharyngeal congestion
unremarkable tongue on pe
no erythema on axilla, elbow and groins
PATHOGENESIS
Human herpesvirus 6 replicates most commonly in the leukocytes and the salivary glands
during the primary infection and will, therefore, be present in saliva. Early invasion of the
central nervous system (CNS) has also been shown.
CLINICAL MANIFESTATIONS
lower mean numbers of total white blood cells (8,900/μL), lymphocytes (3,400/μL), and
neutrophils (4,500/μL)
Thrombocytopenia, elevated serum transaminase values, and atypical lymphocytes have
also been noted sporadically in children with primary HHV-6B infection
CSF analyses reported in patients with encephalitis thought to be caused by HHV-6 have
been normal or demonstrated only minimal CSF pleocytosis with mild elevations of
protein
DIAGNOSIS
Fever
Rash: maculopapular lesions on trunk and abdomen
Irritability
RULE OUT