McKinnon H D, Howard T
Dewitt Army Community Hospital, Fort Belvoir, Virginia 22060, USA.
Am Fam Physician. 2000 Aug 15;62(4):804-16.
The differential diagnosis for febrile patients with a rash is extensive. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion. Rashes can be categorized as maculopapular (centrally and peripherally distributed), petechial, diffusely erythematous with desquamation, vesiculobullous-pustular and nodular. Potential causes include viruses, bacteria, spirochetes, rickettsiae, medications and rheumatologic diseases. A thorough history and a careful physical examination are essential to making a correct diagnosis. Although laboratory studies can be useful in confirming the diagnosis, test results often are not available immediately. Because the severity of these illnesses can vary from minor (roseola) to life-threatening (meningococcemia), the family physician must make prompt management decisions regarding empiric therapy. Hospitalization, isolation and antimicrobial therapy often must be considered when a patient presents with fever and a rash.
发热伴皮疹患者的鉴别诊断范围很广。伴有发热和皮疹的疾病通常根据原发性皮损的形态进行分类。皮疹可分为斑丘疹（中央和周边分布）、瘀点、弥漫性红斑伴脱屑、水疱脓疱性和结节性。潜在病因包括病毒、细菌、螺旋体、立克次体、药物和风湿性疾病。详尽的病史和仔细的体格检查对于做出正确诊断至关重要。虽然实验室检查有助于确诊，但检查结果往往不能立即获得。由于这些疾病的严重程度差异很大，从轻微的（幼儿急疹）到危及生命的（脑膜炎球菌血症），家庭医生必须就经验性治疗迅速做出管理决策。当患者出现发热和皮疹时，通常必须考虑住院、隔离和抗菌治疗。
