Sepsis with Skin Manifestations (See also Chap. 18) Maculopapular rashes may reflect early meningococcal or rickettsial disease but are usually associated with nonemergent infections. Exanthems are usually viral. Primary HIV infection commonly presents with a rash that is typically maculopapular and involves the upper part of the body but can spread to the palms and soles. The patient is usually febrile and can have lymphadenopathy, severe headache, dysphagia, diarrhea, myalgias, and arthralgias. Recognition of this syndrome provides an opportunity to prevent transmission and to institute treatment and monitoring early on. Petechial rashes caused by viruses are seldom associated with hypotension or. | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient Part 4 Sepsis with Skin Manifestations See also Chap. 18 Maculopapular rashes may reflect early meningococcal or rickettsial disease but are usually associated with nonemergent infections. Exanthems are usually viral. Primary HIV infection commonly presents with a rash that is typically maculopapular and involves the upper part of the body but can spread to the palms and soles. The patient is usually febrile and can have lymphadenopathy severe headache dysphagia diarrhea myalgias and arthralgias. Recognition of this syndrome provides an opportunity to prevent transmission and to institute treatment and monitoring early on. Petechial rashes caused by viruses are seldom associated with hypotension or a toxic appearance although severe measles can be an exception. In other settings petechial rashes require more urgent attention. Meningococcemia See also Chap. 136 Almost three-quarters of patients with bacteremic N. meningitidis infection have a rash. Meningococcemia most often affects young children . those 6 months to 5 years old . In sub-Saharan Africa the high prevalence of serogroup A meningococcal disease has been a threat to public health for more than a century. In addition epidemic outbreaks occur every 8-12 years. In the United States sporadic cases and outbreaks occur in day-care centers schools grade school through college and army barracks. Household members of index cases are at 400-800 times greater risk of disease than the general population. Patients may exhibit fever headache nausea vomiting myalgias changes in mental status and meningismus. However the rapidly progressive form of disease is not usually associated with meningitis. The rash is initially pink blanching and maculopapular appearing on the trunk and extremities but then becomes hemorrhagic forming petechiae. Petechiae are first seen at the ankles wrists axillae mucosal surfaces and palpebral and bulbar conjunctiva with .
