Infectious Disease Emergencies: Part 1, Fever and Rash

摘要

Early recognition of potentially life-threatening infections, such as Rocky Mountain spotted fever (RMSF), meningococcemia, and necrotizing fasci-itis, is vital to ensure timely treatment. The characteristic rash of RMSF begins on the ankles and wrists and spreads both centrally and to the palms and soles; it often starts as a macular or maculopapu-lar eruption and then becomes petechial. The diagnosis is largely clinical, especially in the early stages of the disease, when there is no reliable diagnostic test. Meningococcemia typically starts with a prodrome of cough, headache, and pharyngitis, which is followed by rapid onset of fever, chills, arthralgias, and myalgias. Patients appear ill, and most have a rash. Key features that help distinguish necrotizing fasciitis from simple cellulitis are poorly defined margins of affected tissue that spread rapidly, with darkening of erythema to a reddish purple color; rapidly worsening pain that is out of proportion to the physical findings; and crepitance over the affected area.