Continued information gathering
Continued information gathering
A good understanding of how the likely conditions present is needed (see below). This will allow you to think about which questions will be helpful in differentiating between them.
The fact that Jake presents with fever followed by a rash is not particularly helpful in narrowing down the cause of his symptoms as the conditions first being considered have this in common.You could look to the fact that he had prodromal symptoms before the rash (sore throat) to shape your thinking. Erythema infectiosum and HFM can present with viral-like symptoms, including sore throat, whereas roseola does not.
It is worth remembering that certain more unlikely causes (e.g. German measles and scarlet fever) can also have sore throat. Based on this information your questioning should now determine if the cause is HFM disease or erythema infectiosum, and should focus on the distribution of the rash and changes over time.
Jake’s parents say they first noticed the rash on his belly but that it is now also over his chest. This does not fit with either condition being considered and casts doubt on your thinking. You may need to consider other possible causes.
| Table 1: Causes of maculopapular rash in young children that are common or critical/notifiable | ||||||
| Critical/notifiable | Common conditions | |||||
| Measles (rubeola) | German measles (rubella) | Scarlet fever | Erythema infectiosum | Roseola | Hand, foot and mouth | |
| Fever | Yes | Yes | Yes | Yes | Yes | Yes |
| Swollen glands | No | Yes | Sometimes | No | No | No |
| Prodomal symptoms | Cold-like symptoms, conjunctivitis, cough. Koplik's spots appear 24-48 hours before rash | Sore throat, coryza, malaise, mucosal petechiae | Usually follows a sore throat or skin infection such as impetigo | Non-specific viral symptoms | None | Loss of appetite, malaise. Possibly sore throat, cough and abdominal pain |
| Other signs and associated symptoms | Pain and swelling in joints | 'Strawberry tongue' | ||||
| Location | Ears & face, progressing to trunk & limbs | Face, moving quickly to the neck, trunk and extremities | Almost always originates from the groin and spread bilaterally up the trunk to the axilla | Face before moving to arms and legs | Neck, trunk and spreads to limbs | Sides of fingers, hands, and feet. Small, sometimes painful ulcers can appear in and around the mouth |
| Nature of rash | Blanching | Blanching and 'sandpaper'-like quality | 'Slapped' cheeks, burning hot. Limb rash 'lace-like' | Blanching | Small greyish lesions on hands that peel off within a week | |