Ok, now we will talk about fever and rash in kids. We will begin with measles. Measles is but a moxivirus, species measles virus, RNA virus. The human is the natural host, common communicability, highly infection during the prodromal period and at time of eruption, immunity, life-long immunity, incubation period 8-12 days, infective material, respiratory tract droplet, malnutrition, malnourished children are susceptible, pathophysiology, inoculation, then will be local replication in respiratory tract, and then lymphatic spread causing viremia and wide dissemination, conjunctiva, respiratory tract, urine tract, small blood vessels, lymphatic system, and CNS, all inflamed, virus-induced endothelial cell plus immature T-cells causing rash. There is four outcomes, maybe there is recovery life-long, or maybe there will be post-infectious encephalitis, immunopathologic etiology, or there will be subacute sclerosing, defective measles virus, infection of CNS, no resolution of acute infection caused by defective CMI, frequently fatal outcomes, this is rare outcomes, mechanisms of separation of the measles virus within body, and pathogenesis of measles, CMI, cell-mediated immunity, CNS, central venous system, measles clinical features, measles is a rare serious infection characterized by high fever, enantheme, cough, carousel, conjuctivitis, and prominent exantheme. After an inoculation period of 8-12 days, the prodromal phase began with a mild fever followed by the onset of conjuctivitis with photophobia, carousel, prominent cough, and increasing fever, 3C of measles are carousel, cough, and conjuctivitis. After 4-12 days, these symptoms develop and are followed by characteristic erythematous and maculopapular rash, typically on day 14 after exposure, which spreads from head to feet. The rash is described as merdily formed because it has both macular and papular features. Coplic spots also represent the enantheme and are the pathognomonic sign of measles, appearing 1-4 days prior to the onset of the rash. They first appear as desecrate red lesions with bluish-white spots in the center of the inner aspect of the cheeks at the level of the premolars. They may spread to involve the lips, hard palate, and gingiva. They also may occur in the conjuctival folds and in the vaginal mucosa. Coplic spots have been reported in 15-70% of measles cases, but probably occur in the great majority. Skin rash symptoms increase in intensity for 2-4 days. The rash begins on the forehead, around the hairline, behind the ears, and on the upper neck of a red maculopapular ruption. It then spreads downward to the torso and extremities, reaching the palms and soles in up to 50% of cases. The enantheme frequently becomes queer-confluent on the face and upper trunk. No measles without rash unless there are immunity modifications. Desacomitation with the onset of the rash symptoms begin to subside. The rash fades over about 7 days in the same progression as it evolved, often leaving a fine desacomitation of skin in its wake. Of the major symptoms of measles, the cough lasts the longest, often up to 10 days. In more severe cases, generalized lymphadenopathy may be present, with cervical and occipital lymph nodes especially prominent. Transmission. It's transmitted by respiratory tract or conjuctiva following contact with large droplets or small droplet aerosols in which the virus is suspended. Patients are infectious from day 3 before to up to 4-6 days after the onset of the rash. Approximately 90% of exposed susceptible individuals experience measles face-to-face contact. It's not necessarily necessary because viable variants may be suspended in the air for as long as one hour after the patient with the source case leaves the room. Secondary cases due to spread of aerosolized virus has been reported. In brief, incubation period 10-14 days the virus enters the body. Prodromal period lasts for 3 days and the period of exantheme lasts for 4 days. Recovery takes 10-14 days with persistent cough. Anantheme begins in the middle of the prodromal phase and high fever begins at the beginning of the prodromal phase with the 3C cough, conjuctiva and carousel. Diagnosis is by clinical and epidemiological findings. Laboratory findings in the acute phase include reduction in total blood white cells count with lymphocytes, decreases more than neutrophils. Absolute neutropenia has been known to occur in measles not complicated by bacterial infection. The ESR and C-reactive of protein level are normal. Differential diagnosis. It is maybe rubella adenovirus, enterovirus and Ibishtin-Barr virus. Exanthemes, sebacea, mycoplasma pneumonia, Kawasaki syndrome and drug eruption....arrange all without deleting