Dukes' disease, named after Clement Dukes,
also known as fourth disease
or Filatov-Dukes' disease (after
Nil Filatov),
is an
exanthem
An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease.
The term exanthem is from the Greek ...
. It is distinguished from
measles
Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
or forms of
rubella
Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...
, though it was considered as a form of
viral rash
An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease.
The term exanthem is from the Greek ...
.
Although Dukes identified it as a separate entity, it is thought not to be different from
scarlet fever
Scarlet fever, also known as Scarlatina, is an infectious disease caused by ''Streptococcus pyogenes'' a Group A streptococcus (GAS). The infection is a type of Group A streptococcal infection (Group A strep). It most commonly affects childr ...
caused by exotoxin-producing ''
Streptococcus pyogenes'' after Keith Powell proposed equating it with the condition currently known as
staphylococcal scalded skin syndrome in 1979.
It was never associated with a specific pathogen,
and the terminology is no longer in use.
However, a mysterious rash of unknown cause in school children often gives rise to the question of whether it could be Dukes' disease.
Signs and symptoms
Signs and symptoms may include
fever,
nausea,
vomiting, and
diarrhea, along with typical viral symptoms of
sensitivity to light,
enlarged lymph nodes,
sore throat, and possibly
brain inflammation
Encephalitis is inflammation of the brain. The severity can be variable with symptoms including reduction or alteration in consciousness, headache, fever, confusion, a stiff neck, and vomiting. Complications may include seizures, hallucinations ...
. The rash may appear at any time during the illness. It is usually generalised. The rash consists of
erythematous maculopapules
A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...
with areas of
confluence
In geography, a confluence (also: ''conflux'') occurs where two or more flowing bodies of water join to form a single channel. A confluence can occur in several configurations: at the point where a tributary joins a larger river (main stem); o ...
. They may be
urticarial,
vesicular, or sometimes
petechial
A petechia () is a small red or purple spot (≤4 mm in diameter) that can appear on the skin, conjunctiva, retina, and mucous membranes which is caused by haemorrhage of capillaries. The word is derived from Italian , 'freckle,' of obscure origin ...
. The palms and soles may be involved. The eruptions are more common in children than in adults. Usually, the
rash fades without
pigmentation or scaling.
Diagnosis
References
External links
{{Numbered Diseases of Childhood
Pediatrics
Scarlet fever