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What viral infection is suggested by a rash and fever in a 15-month-old with a history of delayed immunization past 10 months?

  1. Rubeola

  2. Varicella

  3. Rubella

  4. Roseola

The correct answer is: Varicella

The situation described fits well with roseola, which is characterized by a high fever followed by a distinct rash. In infants and toddlers, roseola, or sixth disease, is commonly caused by human herpesvirus 6 or 7. The rash typically occurs after the fever subsides, featuring small, pink, raised spots that start on the trunk and then spread to the extremities. The delayed immunization past the age of 10 months is significant because children who have not been immunized against certain illnesses are at increased risk. Rubeola (measles) typically presents with a prodrome of fever, cough, coryza, and conjunctivitis, followed by a morbilliform rash, and usually occurs in older children or those who are not vaccinated. Varicella (chickenpox) is marked by an itchy vesicular rash that appears in crops, often accompanied by flu-like symptoms. Rubella (German measles) features a mild rash and is less commonly associated with a high fever in this age group. Thus, the combination of high fever followed by a rash in a child with delayed immunization points primarily to roseola as the most likely diagnosis.