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  • Print publication year: 2008
  • Online publication date: December 2009

4 - Systemic Diseases Causing Fever and Rash

from Part I - Systems

Summary

INTRODUCTION – AGENTS

The clinical picture of fever and rash may be caused by a variety of agents, including bacterial, viral, rickettsial, or fungal infections, immunocompromised states, autoimmune conditions, and other systemic diseases. Knowledge of the epidemiology, pathophysiology, clinical presentations, and management of these conditions is essential for the acute care physician, as some of these conditions have significant time-dependent morbidity and mortality.

HISTORY AND PHYSICAL EXAMINATION

Crucial elements of the history and physical in the patient presenting with fever and rash are listed in Table 4.1.

SYSTEMIC BACTERIAL INFECTIONS

Secondary Syphilis

Syphilis is caused by the spirochete Treponema pallidum, which typically enters the body through mucous membranes or nonintact skin (Table 4.2). Syphilis is the third most common reportable sexually transmitted disease in the United States (after chlamydia and gonorrhea) and is spread almost exclusively through sexual contact, with some rare cases of transplacental transmission. Syphilis affects all ethnicities equally but has a male predilection. The incubation period is 2–90 days from exposure.

Primary syphilis presents as a painless genital chancre. (See Chapter 17, Ulcerative Sexually Transmitted Diseases.) Medical care is often delayed or not sought because the lesion is painless and usually resolves spontaneously though latent disease persists.

REFERENCES
American College of Physicians. Guidelines for laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med 1997;127:1106.
Banatvala, J E, Brown, D W. Rubella. Lancet 2004 Apr 3;363(9415):1127–37.
Brady, W J, DeBehnke, D, Crosby, D L. Dermatological emergencies. Am J Emerg Med 1994;12:217–37.
Brady W J, Perron A D, DeBehnke D J. Serious generalized skin disorders. In: Tintinalli, J E, Kelen, G D, Stapdzynski, J S, eds, Emergency medicine: A comprehensive study guide, 6th ed. New York: McGraw-Hill Medical Publishing Division, 2004.
Centers for Disease Control and Prevention (CDC). Lyme disease – US 2001–02. MMWR 2004;53:365.
Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease. MMWR 2005;54(RR07):1–21.
Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines 2006. MMWR 2006;55.
Cunha, B A. Rocky Mountain spotted fever revisited. Arch Intern Med 2004;164:221–3.
Dourmishev, L A, Dourmishev, A L. Syphilis: uncommon presentations in adults. Clin Dermatol 2005;23:555–64.
Duke, T, Mgone, C S. Measles: not just another viral exanthem. Lancet 2003 March 1;36(9359):763–73.
Fleischer, A B, Feldman, S R, McConnell, C F, et al. Emergency dermatology: A rapid treatment guide. New York: McGraw-Hill, 2002.
Gardner, P. Clinical practice: prevention of meningococcal disease. N Engl J Med 2006;355:1466–73.
Hajjeh, R A, Reingold, A, Weil, A, et al. Toxic shock syndrome in the United States: surveillance update, 1979–1996. Emerg Infect Dis J 1999;5(6):807–10.
Hazelzet, J A. Diagnosing meningococcemia as a cause of sepsis. Pediatr Crit Care Med 2005;6:S50–4.
Hernandez-Salazar, A, Rosales, S P, Rangel-Frausto, S, et al. Epidemiology of adverse cutaneous drug reactions. A prospective study in hospitalized patients. Arch Med Res 2006;37:899–902.
Lamoreux, M R, Sternbach, M R, Hsu, W T. Erythema multiforme. Am Fam Physician 2006;74:1883–8.
Masters, E JOlson, G S, Weiner, S J, et al. Rocky Mountain spotted fever: a clinician's dilemma. Arch Intern Med 2003;163:769–74.
McCann, D J, Nadel, E S, Brown, D F. Rash and fever. J Emerg Med 2006;31:293–7.
Pitambe, H V, Schulz, E J. Life-threatening dermatoses due to metabolic and endocrine disorders. Clin Dermatol 2005;23:258–66.
Quagliarello, V, Scheld, M. Treatment of bacterial meningitis. N Engl J Med 1997;336:708.
Reidner, G, Rusizoka, M, Todd, J, et al. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med 2005;353:1236–44.
Robson, K J, Piette, W W. Cutaneous manifestations of systemic disease. Med Clin North Am 1998;82:1359–79.
Rosenstein, N E, Perkins, B A, Stephens, D S, et al. Meningococcal disease. N Engl J Med 2001;344:1378–88.
Singh-Behl, D, Rosa, S P, Tomecki, K J. Tick-borne infections. Dermatol Clin 2003; 21:237–44.
Steere, A. Lyme disease. N Engl J Med 2001;345:115.
Young, N, Brown, K. Mechanisms of disease: parvovirus B19. N Engl J Med 2004;350:586–97.