In children, the presentation of a rash and a fever as in the case with this 24-month old patient is not normally a cause for concern and the early arrival at the clinic helps limit the spread of these symptoms to serious cases (Jarvis, 2015). In such instances, there are three major classifications; on in which the patient presents with a serious illness and may require immediate treatment, second where the viral syndromes are easily recognizable and manageable and third where there occurs an undifferentiated rash. In this patient, the rash and fever can be classified within the second group where the symptoms are recognizable and can be related to a particular illness or condition (Langlois & Andreae, 2011).
In the differential diagnosis, this condition could have been scarlet fever. It is usually caused by the streptococcus pyogenes and it is mainly characterized by the emergence of fever as the first indication which is followed by the rashes within the next few hours or 2-3 days after the emergence of the fever. In most cases the scarlet fever begins in the trunk and spreads fast to the extremities upon which it becomes confluent. A flushed face accompanied by perioaral pallor are the other distinguishing features for this condition (Langlois & Andreae, 2011). On the other hand, there are some signs that indicate that the condition could be Erythema infectiosum which is usually caused by the human parvovirus (B19) which is common for children between the ages of 2 and 12 years. It is usually characterized by a facial rash that can be described as classic bright-red facial rash which may also spread to the extremities and the trunk but in a less dominant way as it is on the face. It is accompanied by abdominal pains, a fever and a sore throat. In most cases, the rash appears 24 hours after the emergence of the symptoms (Jarvis, 2015).
For this patient, the condition is scarlet fever. The fact that the rash begins at the trunk and spreads to the extremities and this is few hours after the fever emergence gives all credence to the symptoms of a scarlet fever. While Erythema infectiosum is a possibility, the fact that the facial rash is dominant than in the extremities as well as the non-indication of abdominal pain all point to the reality that it could not be Erythema infectiosum. In examining the patient for scarlet fever, the physician will focus on a physical examination of the tongue, tonsils and throat to indicate any cases of abnormalities. The indication of enlarged lymph nodes could also be an indication and this is combined with the laboratory tests commonly the rapid strep test or a throat/wound culture (Warshaw et al., 2011).
The patient can be placed on a ten day medication plan for oral penicillin or the alternative single penicillin-G benzathine injection if they child may not be suitably capable of completing the dosage (Caubet et al., 2011). The mother should however focus on feeding the child with warm soup and moderate quantities of ice cream. Ibuprofen 50mg/1.25 mL will also be part of the medication list to help reduce the fever as well as manage the pain that may appear once a sore throat develops since there is such a possibility (Jarvis, 2015).
References
Caubet, J. C., Kaiser, L., Lemaître, B., Fellay, B., Gervaix, A., & Eigenmann, P. A. (2011). The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. Journal of Allergy and Clinical Immunology, 127(1), 218-222.
Jarvis, C. (2015). Physical examination & health assessment (7th ed.). St. Louis, MO: Saunders Elsevier.
Langlois, D. M., & Andreae, M. (2011). Group A streptococcal infections.Pediatrics in Review-Elk Grove, 32(10), 423.
Warshaw, E. M., Hillman, Y. J., Greer, N. L., Hagel, E. M., MacDonald, R., Rutks, I. R., & Wilt, T. J. (2011). Teledermatology for diagnosis and management of skin conditions: a systematic review. Journal of the American Academy of Dermatology, 64(4), 759-772.
