Pedemy All toolsIs this fever and rash dangerous, is it contagious, and what do you do next?
This tool helps clinicians assess a child with fever and a rash in clinic, the ED or on the ward. It starts with the dangerous causes: petechiae or purpura with fever, Rocky Mountain spotted fever, SJS/TEN, toxic shock syndrome, and Kawasaki disease or MIS-C, with antibiotic doses to give now and links to the Kawasaki and MIS-C tools.
For a well-appearing child, you pick the rash pattern: blisters, a face-first rash with cough and red eyes, a sandpaper rash with sore throat, slapped cheeks, a rash after the fever breaks, or hand-foot-and-mouth. Each result gives the likely diagnosis, the isolation to start now, the test to send, treatment if any, return to school or child care, and who to notify.
Measles results include practical testing (PCR on a throat or nasopharyngeal swab plus urine, and serum IgM) and vitamin A doses by age. Doses are per kilogram with a maximum per dose. For exposed contacts, the tool points to the exposure-prophylaxis tool.
Call public health first. Send measles RT-PCR on a throat or nasopharyngeal swab and on urine, plus serum measles IgM. Keep the child in airborne isolation while you wait.
Once daily for 2 days: 50,000 IU under 6 months, 100,000 IU at 6–11 months, and 200,000 IU at 12 months and older.
Yes. Doxycycline 2.2 mg/kg (max 100 mg) twice daily is the treatment at any age. Short courses do not stain teeth. Start it on suspicion.
When all lesions are crusted. In a vaccinated child with spots that do not crust, when no new spots have appeared for 24 hours.
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