Vinnytsya National Pirogov Memorial Medical University
Department of Children Infectious Diseases
“Approved”
at sub-faculty meeting

“__”_____20__, protocol №_____
Head of Department
prof. _______I.I. Nezgoda
Study Guide for Practical Work of Students
Topic: “Differential diagnostics of the exanthema followed diseases.”
Course VI
English-speaking Students’
Medical Faculty
Duration of the class-6,6 hours.
Composed by assistant O.V. Bodnariuk
Vinnitsa
I. The theme actuality.
Measles is one of the most contagious diseases in children. In 1999, more than one million
children died from measles. With the inauguration of the Measles Initiative in 2001, there have been
dramatic decreases in childhood deaths globally. From 1 million deaths annually in 1999, fewer than
450,000 in 2004 and decreasing rapidly with more nationwide vaccination campaigns completed in 2005
and 2006.
Rubella is usually a mild illness. However it can cause serious harm to an unborn baby if a
woman gets it during early pregnancy. For this reason it is strongly recommended that all children are
immunised against rubella.
Scarlet fever (known as scarlatina in older literature references) is an exotoxin-mediated disease
arising from group A beta-hemolytic streptococcal infection. Ordinarily, scarlet fever evolves from a
tonsillar/pharyngeal focus, although the rash develops in fewer than 10% of cases of "strep throat." The
site of bacterial replication tends to be inconspicuous compared to the possible dramatic effects of
released toxins. Exotoxin-mediated streptococcal infections range from localized skin disorders (eg,
bullous impetigo) to the systemic rash of scarlet fever to the uncommon but highly lethal streptococcal
toxic shock syndrome.
Yersinia enterocolitica and Y. pseudotuberculosis are causative agents of yersiniosis in humans
and animals that have to be separated from Y. pestis, the causative agent of plague, representing a
separate clinical and epidemiological entity.
Pseudotuberculosis is an acute infectious disease of the zoonotic group, characterized by
toxemia, fever, scarlet fever-like rash, lesions of other organs and systems.
Chickenpox is an acute infectious disease, characterized by vesicular eruption with transparent
liquid on skin and mucous membranes.Herpes zoster is an infectious disease, characterized by rash in the
form of vesicles grouped closely and neuralgias in certain skin areas, innervated by separate sensitive
nerve. Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) are two species of the herpes virus family,
Herpesviridae, which cause infections in humans.
ІІ.
Primary aims of the study
A student should know:
1. Etiology of Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox .
2. Epidemiology (source of infection, ways of transmission, age-old receptivity and morbidity)
Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
3. Pathogenesis of disease, pathomorphologic changes in the skin and staggered organs Measles,
Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
4. Classification of clinical forms of Measles, Rubella, Scarlet fever, Pseudotuberculosis,
Chickenpox.
5. Clinic of typical form Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
6. Clinical manifestations of Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
7. Complications of Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
8. Methods of laboratory research.
9. Principles of therapy of Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
10. Measures of prophylaxis of Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
A student should be able:
1. To follow the basic rules of work with patient a bed sick with Measles, Rubella, Scarlet fever,
Pseudotuberculosis, Chickenpox.
2. To take anamnesis with the estimation of epidemiology information (taking into account
seasonality, origin of febricities, polymorphism of clinical signs of illness).
3. To examine a patient and reveal the basic clinical signs of illness.
4. To represent information of anamnesis and objective inspection in a hospital chart and formulate
the preliminary diagnosis.
5. To write a plan of examination.
6. To write a clinical diagnosis (form of disease, type, severity, course of disease).
7. To prescribe the treatment taking into account age, severity of illness.
8. To write out a prescription.
9. To organize disease measures in the hearth of infection (to find out the source of infection, fill an
urgent report in SES, to set a quarantine, to define the circle of contact persons).
10. To write epicrisis with the estimation of development of illness, results of inspection, efficiency
of treatment, prognosis, by recommendations for a subsequent supervision or treatment
depending on the form of Measles, Rubella, Scarlet fever, Pseudotuberculosis, Chickenpox.
III. Educational aims of the study
- forming the deontological presentations, skills of conduct with the patients
- to develop deontological presentations, be able to carry out deontology approach to the patient
- to develop the presentations of influence of ecological and socio-economic factors on the state of
health
- to develop sense of responsibility for a time illness and loyalty of professional actions
- to be able to set psychological contact with a patient and his family.
ІV. Control materials for the preliminary and final stages of the lesson
Tests and tasks
1. A 9-year-old boy has been ill for 2 days. Now he has fever up to 37,5°С, maculae,
papules, vesicles on his skin, skin of the head. Vesicles are round, situated on an unindurated
base, surrounded by erythematous corona. What is your diagnosis?
A. Smallpox
B. Scarlet fever
C. Herpetic infection
D. Streptodermia
E. Varicella
2. A 7-year-old girl was in contact with a patient with herpes zoster. Fever up to 39,3°С,
polymorphic rash (maculae, papules, crusts, vesicles) on her skin and mucous membranes of oral
cavity have occurred on the 7th day of illness. What is your diagnosis?
A. Smallpox
B. Herpes simplex
C. Herpes zoster
D. Varicella
E. Streptoderma
3. A 4-year-old girl has severe form of varicella.
What medication should be administered except one?
A. Acyclovir
B. Specific immunoglobulin
C. Recombinant interferon
D. Inductor of endogenous interferon
E. Steroid hormones
4. An 8-year-old boy is not ill with varicella. He had been in touch with the child, who
had varicellas.
He can fall ill within:
A. 28 days
B. 17 days
C. 21 days
D. 14 days
E. 11-21 days
5. A 9 -year-old boy has fever, polymorphic rash - maculae, papules, vesicles and crusts
on his face, skin of the head, trunk, limb and extremities. Severe headache, vomiting, ataxia,
slow down and discoordination of motion have occured on the 10th day of illness.
What the complication occurred?
A. Encephalitis
B. Serous meningitis
C. Neyrotoxycosis
D. Encephalitis reaction
E. Meningo- encephalitis
6. A 5-year-old boy has been ill for 5 days. The disease had abrupt ouset with fever up to 38,1
C, cough, conjunctivitis, edema of eyelids. Maculopapular rash appeared on his face, neck and behind
his ears on the 5th day of the disease. The next day the rash spread to his trunk.
What is your diagnosis?
A. Adenoviral infection
B. Measles
C. Rubella
D. Infectious mononucleosis
E. Scarlet fever
7. A 7-year-old boy has been ill for 2 days. He complains of cough, coryza, headache, fever
up to 38C. There are conjunctival hyperemia, epiphora, enanthema on the mucosa of the soft and in
part of the hard palate, whitish papulae looking like poppy-seed, surrounded by a narrow band of
hyperemia opposite of the molar teeth.
What is your diagnosis?
A. Measles
B. Rubella
C. Scarlet fever
D. Enteroviral infection
E. Adenoviral infection
8. A 2-year-old boy is not vaccinated against measles. He had been in touch with the child who
had catarrhal period of measles and took immunoglobulin.
He can fall ill within such period as:
A. 28 days
B. 17 days
C. 21 days
D. 14 days
E. 7 days
9. A 5-year-old child has low-grade fever, enanthema, enlarged post-auricular cervical
and suboccipital lymph nodes, pale red small macular rash, which localizes mainly on the
extensor surface of the extremities, back and buttocks. What is your diagnosis?
A. Infectious mononucleosis
B. Measles
C. Scarlet fever
D. Rubella
E. Enteroviral infection
10. A 2-year-old child full ill acutely: ever and rash appeared. Now it has slight malaise,
coryza and cough, enanthema on its soft palate. There is pale red small macular rash on its back
and buttocks. Post-auricular cervical and subboccipitall lymph nodes are the size of a large pea,
hard and slightly tender on palpation. What is your diagnosis?
A. Rubella
B. Measles
C. Scarlet fever
D. Infections mononucleosis
E. Entero viral infection
11. A 8- year-old girl complained of fever up to 38,6 C, sore throat, rash. In medical
examination - lacunar tonsillitis, hyperemia and enanthema of soft palate, punctiform rash which
is localized mainly on flexor surface of the extremities was discovered. Nasolabial area was pale.
What antibacterial medications should be administered?
A. Gentamycin
B. Penicillin
C. Chloramphenicol
D. Lincomycin
E. Tetracyclinl
12. A 8 - year-old boy fell ill abruptly fever up to 39 C, headache, recurrent vomiting,
sore throat. There was punctiform rash on reddened skin on his trunk, upper part of the abdomen,
and in the skin folds, especially in axillae, cubital, inquinal. The soft palate is covered with
erithematous punctiform lerions and scattered petechiae. Tonsils were enlarged, reddened with
superficial necrosis in the form of patches. Submaxillary lymph nodes were enlarged, dense and
tender. BP is 140/90; Ps is 120 per min. What is your diagnosis?
A. Adenoviral infection
B. Scarlet fever
C. Diphtheria
D. Measles
E. Leukosis
13. A 10-year-old girl complained of fever, rash, abdominal pain, artralgiae on admission.
In medical examination scarlet fever-like rash, symptoms of ,,hood", ,,gloves" and ,,socks" have
been discovered.
What is your preliminary diagnosis?
A. Measeles
B. Allergic rash
C. Rubella
D. Scarlet fewer
E. Pseudotuberculosis
14. A 5-year-old boy fell ill abruptly: fever up to 38,5, sore throat, abdominal pain.
Scarlet fever-like rash, artralgiae and frequently passed stools occurred on the 4l day f illness. In
medical examination hyperemia and edema of skin on the face, hands and feet, hyperemia of
palatal arches, soft palate, uvula back walls of pharynx, ,,raspberry tongue", pains in epigastrium
and near the umbilicus was discovered. Watery stools occured 4-6 times a day with small
admixture of mucus. Padalka's symptom was positive.
What's your preliminary diagnosis?
A. Enteroviral infection
B. Scarlet fewer
C. Abdominal typhoid
D. Pseudotuberculosis
E. Rubella
15. A 7-year-old boy has moderate form of pseudotuberculosis.
Which antibacterial medication should be administered for etiotropic therapy?
A. Penicillin
B. Ampicillin
C. Chloramphenicol
D. Erytromycin
E. Cefalosporins of the first generation
16. A 7-year-old boy fell ill abruptly: fever up to 40 C with rigor, artralgia, myalgia,
abdominal pain. Polymorphic rash with macular and scarlet fever like elements appeared
on the 4th day of illness. Ictericity of skin and sclerae occurred on the 6th day of illness. Liver and
spleen were enlarged and tender. Padalka's symptom was positive.
What's your preliminary diagnosis?
A. Measles
B. Rubella
C. Scarlet fewer
D. Pseudotuberculosis
E. Abdominal typhoid
17. A 8 - year-old boy full ill abruptly fever up to 39 C, headache, recurrent vomiting,
sore throat. There was punctiform rash on reddened skin on his trunk, upper part of the abdomen,
and in the skin folds, especially in axillae, cubital, inquinal. The soft palate is covered with
erithematous punctiform lerions and scattered petechiae. Tonsils were enlarged, reddened with
superficial necrosis in the form of patches. Submaxillary lymph nodes were enlarged, dense and
tender. BP is 140/90; Ps is 120 per min. What is your diagnosis?
A. Adenoviral infection
B. Scarlet fever
C. Diphtheria
D. Measles
E. Pseudotuberculosis
TASK 1
A child of 5 years old attends a kindergarten, he fell ill the day before yesterday when
the temperature elevated up to 39°C, repeated vomiting and a sore throat was marked. His
mother gave him paracetamol. Today in the morning the temperature is 38.5°С, he complains of
a pain in the throat, rash on the skin of the trunk. His mother called in a local physician.
On examination: there was punctiform rash on reddened skin on his trunk, upper part
of the abdomen, and in the skin folds, especially in axillae, cubital, inquinal. In medical
examination hyperemia and edema of skin on the face, hands and fee. Tonsils were enlarged,
reddened with superficial necrosis in the form of patches. Submaxillary lymph nodes were
enlarged, dense and tender. There are no changes in other organs.
In the blood analysis: Eryt- 3.5х1012/l, L - 14,3х109/l, eu - 7 %, stab neutrophils - 12 %,
s-56 %, l - 22%, m - 3 %; ESR - 23 mm/hr.
1.
Make the clinical diagnosis.
2.
What diseases should we make a differential diagnosis with?
3.
Administer treatment.
TASK 2
A 15-year-old boy fell ill abruptly: fever up to 39,5°C, sore throat, abdominal pain.
Scarlet fever-like rash, artralgiae and frequently passed stools occurred on the 4th day f illness. In
medical examination hyperemia and edema of skin on the face, hands and feet (symptoms of
,,hood", ,,gloves" and ,,socks"), ictericity of skin and sclera, hyperemia of palatal arches, soft
palate, uvula back walls of pharynx, ,,raspberry tongue", pains in epigastrium and near the
umbilicus was discovered. Submaxillary, axillae, cubital lymph nodes were enlarged. Liver and
spleen were enlarged and tender. Watery stools occured 4-6 times a day with small admixture of
mucus. Padalka's symptom was positive.
1.
Formulate the clinical diagnosis.
2.
What diseases should we make a differential diagnosis with?
3.
Administer treatment.
4.
What laboratory examinations should be administered?
5.
What complications this disease you know?
TASK 3
A child of 5 years old attends a kindergarten, he fell ill yesterday when the
temperature elevated up to 39°C, repeated vomiting and a sore throat was marked. His mother
gave him paracetamol. Today in the morning the temperature was 38.5°С, he complained of a
pain in the throat. His mother called in a local physician.
On examination: redness in the cheeks, a pale nasolabial triangle, plentiful fine dotty
rash on the skin of the trunk, extremities (mainly on the flexion surfaces) against the hyperemic
background of the skin. Bright hyperemia of the tonsils, arches, white-yellow coatings in both
tonsil lacunas are seen in the pharynx. The tongue is coated. Tonsil lymph nodes are enlarged
and painful. There are no changes in other organs.
In the blood analysis: Eryt- 3.5х1012/l, L - 14,3х109/l, eu - 3 %, stab neutrophils - 12 %,
s-59 %, l - 25 %, m - 5 %; ESR - 23 mm/hr.
1. Make the clinical diagnosis.
2. What diseases should we make a differential diagnosis with?
3. Administer treatment.
TASK 4
A child of 4 years old ill last night when the temperature rose to 37.8°С. Next morning at
the temperature of 37.5°С there was rash on the skin of the trunk, head and extremities in the
form of fine spots and papule of 0.2 х 0.3 cm in size. There were small vesicles with transparent
content in the centre of separated papules.
The general condition is satisfactory. There are no catarrhal signs. The internal organs
are without changes.
The child attends a kindergarten, there are no infectious diseases registered there.
The grandmother of the child has been ill for 10 days, she has a headache, temperature
37.5°С, there are vesicles eruptions on the face under the eye on the risht past of the cheek,
above the eyebrow, and on the forehead, local hyperemia and edema of the skin is marked here.
1.
Make the clinical diagnosis?
2.
What diseases should the child’s disease be differentiated with?
3.
Administer the treatment of the child.
TASK 5
A 5 -year-old girl has fever, vesicular rash and crusts on her face, skin of the head, trunk
and extremities. Severe headache, vomiting, ataxia, sloingw down and discoordination of motion
occurred on the 8th day of illness.
1.
Make the clinical diagnosis?
2.
What the complication occur?
3.
Administer the treatment of the child?
V. Literature
Basic literature:
№
1.
Author(s)
Mikhailova A.M.,
Minkov I., SavchukA.
Publishing
house
Year of
edition,
vol.,
issue
Number
of
pages
Odessa
2003
219
Name of source
City,
(textbook, manual, monograph,
etc.)
Infection diseases in children.
2. Robert M. Kliegman
et al.
Nelson Textbook of Pediatrics
NY,
SAUNDER
S
2007
3. Jonathan Cohan
3121
Infectious disease.
Harcourt
Publishers
limited
2004
2nd
edition
2136
4. David C Dale
Infectious diseases The clinician
guide to Diagnosis, Treatment
and Prevention.
WebMD
Corporation
2004
edition
310
5. Duker - Krugman's
Infectious Diseases of Children.
Mosby
11th
edition
1574
6. Gary R. Fleisher,
Stephen Ludwig
Textbook of Pediatric
Emergency Medicine.
Lippincott
Williams &
Wilkins
6th
edition
2052
18th
Edition
2010