Differential diagnosis of fever and rash based upon appearance of the rash

Macules, papules, nodules, or plaques

Vesicles, bullae, or pustules

Purpuric macules, purpuric papules, or purpuric vesicles

Followed widespread erythema with or without edema by desquamation

Bacterial

Arcanobacterium haemolyticum

Bacillus anthracis

Bartonella bacilliformis

Bartonella henselae (cat scratch disease)

Bartonella quintana (trench fever)

Borrelia burgdorferi (Lyme disease)*

Borrelia spp (relapsing fever)

Brucella spp (brucellosis)*

Calymmatobacterium granulomatis (donovanosis)*

Chlamydia psittaci (psittacosis)

Ehrlichiosis*

Ehrlichia chafeensis (HME)

Human granulocytic erlichiosis

Erysipelothrix rhusiopathiae (erysipeloid)

Francisella tularensis (tularemia)

Listeria monocytogenes

Leptospira spp (leptospirosis)*

Mycobacterium leprae*

Mycobacterium marinum*

Mycobacterium tuberculosis

Mycoplasma pneumoniae

Neisseria gonorrhoeae (gonorrhea)*

Neisseria meningitidis (meningococcemia)*

Pseudomonas aeruginosa

Rickettsia akari (rickettsialpox)

Rickettsia prowazekii (epidemic/louse-borne typhus)

Rickettsia rickettsii (RMSF-early lesions)*^¶

Rickettsia orientalis/tsutsugamushi (scrub typhus)

Rickettsia typhi (endemic/murine typhus)

Salmonella typhi (typhoid fever)*

Spirillum minor (rat-bite fever)

Bacillus anthracis

Ehrlichia canis

Listeria monocytogenes

Mycoplasma pneumoniae

Neisseria gonorrhoeae*

Neisseria meningitidis*

Pseudomonas aeruginosa

Rickettsia akari

Rickettsia rickettsii*

Staphylococcus aureus (TSS, SSSS)

Streptococcus group A

Treponema pallidum (secondary syphilis)

Vibrio vulnificus

Bacteremia^Δ

Borrelia spp

Clostridium spp

Infective endocarditis (many species)

Haemophilus influenzae type B

Neisseria gonorrhoeae (disseminated gonococcal infection)*^¶

Neisseria meningitidis (acute or chronic meningococcemia)*^¶

Pseudomonas aeruginosa

Rickettsia prowazekii

Rickettsia rickettsii^¶

Spirillum minor

Staphylococcus aureus (bacteremia)

Streptobacillus moniliformis

Streptococcus group A (streptococcal toxic shock syndrome, scarlet fever)

Streptococcus pneumoniae (asplenic patient)

Vibrio vulnificus

Yersinia pestis

Streptococcus group A (scarlet fever, streptococcal toxic shock syndrome)

Stapylococcus aureus (TSS, SSSS)

HME: human monocytic ehrlichiosis; RMSF: Rocky Mountain spotted fever; TSS: toxic shock syndrome. SSSS: staphylococcal scalded skin syndrome.
* Reportable disease.
¶ May have arthralgia or musculoskeletal pain.
Δ Specific therapy available.

Adapted with permission from: Sanders CV. Diagnosis of the patient with fever and rash. In: The Skin and Infection: A Color Atlas and Text, Sanders CV, Nesbitt LT (Eds), Williams & Wilkins, Baltimore, 1995. Originally modified with permission from Fitzpatrick TB, et al: Color Atlas & Synopsis of Clinical Dermatology - Common and Serious Diseases. Fitzgerald TB, et al (Eds), McGraw-Hill, New York, 1992.

Graphic 52167 Version 8.0

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Differential diagnosis of fever and rash based upon appearance of the rash