Table 4 Fever and Rash: Physical Examination
- Vital signs
a. Temperature
b. Pulse
c. Respiration
d. Blood pressure - General appearance
a. Alert
b. Acutely ill
c. Chronically ill - Signs of toxicity
- Adenopathy/location of adenopathy
- Presence of mucosal, conjunctival, or genital lesions
- Hepatosplenomegaly
- Arthritis
- Nuchal rigidity/neurological dysfunction
- Features of rash
a. Type of primary rash lesion (Table 5)
b. Presence of secondary lesions
c. Presence of desquamation
d. Presence of excoriations
e. Configuration of individual lesions
f. Arrangement of lesions
g. Distribution pattern: exposed areas; centripetal versus centrifugal
Source: Adapted from Refs. 5 and 8.
Table 3 Fever and Rash: History
Age of patient
Season of the year
Type of prodrome associated with current illness
History of drug or antibiotic allergies
Medications taken within the past 30 days (prescription or nonprescription)
Drug ingestion
Exposure to febrile or ill persons within the recent past
Prior illness
Occupational exposures
Sun exposures
Recent travel
Exposure to wild or rural habitats
Exposure to insects, arthropods, or wild animals
Exposure to pets
Immunizations
Exposure to sexually transmitted diseases
HIV risk factors (intravenous drug use, unprotected sex, sexual orientation)
Site of rash onset
Factors effecting immunological status (chemotherapy, steroid use,
hematological malignancy, solid organ or bone marrow transplant,
asplenia)
Valvular heart disease
Rate of rash development (slow versus fast)
Direction of rash spread (centrifugal versus centripetal)
Evolution of rash (has the appearance of the rash changed)
Relationship between rash and fever
Presence or absence of pruritus
Previous treatment of the rash (topical or oral therapies)
Source: Adapted from Refs. 5 and 8.
22 Engel et al.