Viral Exanthemas Flashcards
Asymptomatic, discrete papular, waxy lesions gradually develop on surface of skin. Each has an umbilicated appearance. Generally only a few are present (2 - 20), but in a generalized location
Molluscom Contagiosum
A small growth begins on surface of skin and gradually enlarges over a long period. Relatively few symptoms are experienced, although when on foot, some pain may be experienced. Frequently, small black dots are seen centrally. Surface exhibits hyperkeritinazation
Warts, Common, Plantar, Flat (juvinile), genital, condylomata (genital)
Human Papilloma Virus (HPV)
Use Acetic Acid to Diagnose (blanches)
A vesiculated rash spreading from distal distribution to central begins to develop in a toxic appearing individual. Symptoms consist of headache, fever to 102-5 degrees, extreme malaise, and muscular pains preceding the rash. Rash develops with same stages present in local crops and becomes encrusted during its development. Illness lasts for two weeks and resolves with significant scarring. A hemorrhagic form is highly fatal
Variola (Smallpox)
Direct Contact w/ 12 day incubation period
Immediate isolation and Active Immunization w/in 24Hr
A Montana sheep herder, who has just finished the spring shearing marathon, notices a small pimple on his finger. He has no other symptoms
Ecthyma Contagiosum
Orf Virus (Poxvirus)
Transmitted from working with sheep, usually seen in spring (sheering season), incubation 4 to 7 days
Usually a solitary lesion on hand developing into a vesicle
Resolves in 30-40 days with symptomatic care
Symptoms begin with a general malaise, mild fever (101 - 102 degrees) and pruritic rash beginning centrally on head and trunk and then extending peripherally. Rash rapidly develops from macule and papule to a vesicle in 24 hours. Local crops have various stages of development. Rash clears over a week to ten days. A latent infection may ensue and Reye syndrome seen in individuals treated with aspirin
Varicella (chickenpox)
VZV - Varacella Zoster Virus
Direct/Air transmission, incubation 14-16 days
Contageous for first 5 days, about 1-2 days before rash crusts…
Strict isolation, Vitamin A, AVOID aspirin (Reyes Syndrome - rash, vomiting, liver damage, hypoglycemia)
Smallpox vs Chickenpox
Symptoms begin with a general malaise, mild fever (101 - 102 degrees) and pruritic rash beginning centrally on head and trunk and then extending peripherally. Rash rapidly develops from macule and papule to a vesicle in 24 hours. Local crops have various stages of development. Rash clears over a week to ten days.
The same virus produces this disease later in life. It occurs in linear regions following dermatomes.
Shingles
Herpes Zoster (VZV)
Stinging erythematous lesion develops at junction of skin and lip. Proceeds to a crusted sore over a few days but lasts up to 10 to 12 days. No systemic symptoms are noted.
Also lesions of oral cavity - gingiva and tongue and genital region may be found.
Cold Sore, Herpetic Gingivostomatitis, Genital Herpes
Herpes Simplex Virus 1 and 2
Direct Contact, Incubation period is 2d to 2w, Stress activates
Acyclovir, famcicilovir, valaciclovir, penciclovir
Precautions for outbreak during birth…
Six month old infant develops a high fever (102 - 105 degrees) with minimal respiratory symptoms preceding. Infant seems playful in spite of fever. After about 3 days the fever breaks and a fine maculopapular rash develops on neck and trunk, then to disappear in two days.
Exanthem Subitum, Roseola
Herpes Virus 6 & 7
Airborne droplet transmission, incubation 9d
Communicable during febrile stage
Rash developes just as fever clears - infant playful*
Antipyretics
Adolescent develops sore throat, mild fever, enlarged lymph nodes and extreme tiredness over three to four days. The tiredness lingers a week or more after the other symptoms resolve. A maculopapular rash may be noted on the trunk. Occasionally, jaundice may appear.
Infections Mono, Kissing Disease
Herpes Virus - Epstein-Barr Virus (EBV)
Close contact, pharyngeal secretions with incubation period of 30-50 days
Underterminded communicability period
Posterior Cervial lymphadopathy, splenomegaly, rapid mono test, heterophile antibody
Manage symptoms
A young child develops malaise and mild fever. Complaints of sore throat and lesions in mouth and on extremities. Enanthem occurs within one or two days after onset of symptoms and exanthem occurs shortly thereafter. Lesions clear within a week.
Also a possible ulcerative rash may develop in the posterior pharynx.
Hand Foot Mouth Disease, Herpangina
Coxackie Virus
Droplet, saliva, fecal transmission with incubation period of 3-6d
Communicable for several weeks
Treat symptoms, protect newborns
If only in posterior pharynx, if not mono, suspect herpangina
Child develops a flu-like process with mild fever, malaise, abdominal cramping, diarrhea and a non-specific maculopapular rash of trunk. Rash fades over a five day period, after other symptoms have resolved
Non-Specific Viral Exanthem
Echo Virus
Fecal to Oral, incubation is 3-6d
Communicable for several weeks
Treat symptoms
Grade school child develops a very mild upper respiratory illness; then a very red, slapped-cheeks rash appears on face. Over a few days this fades and a lacy rash is noted on the upper extremities. This may fade only to return in a couple of weeks. There may be some vague joint complaints
Erythema Infectiosum, Fifths Disease
Human Parvovirus B19
Droplet, blood, incubation 4-14 days
Communicable until rash appears
Treat Symptoms
*NO need to keep from school once rash appears…
Young unvaccinated boy returns from Switzerland. A week after arriving home he develops upper respiratory symptoms with rhinitis and cough followed by conjunctivitis. The day after going back to school, he develops a discrete red rash gradually becoming confluent as spreading from central to distal body sites. He is seen by his pediatrician and then makes a trip to the ER with a fever of 104°. An oral lesion of Koplik spots develops on the buccal mucosa. Total illness may last for one week
Rubeola, Measles
Paramyxovirus
Droplet, direct contact (peaks in winter and spring, 2-5y cycles) Incubation period is 8-12 days
Communicable 1-2d prior to Sx. 3-5d prior to rash and 4 days after onset of rash
Isolate, treat symptoms, vitamin A
School age child develops mild upper respiratory symptoms and malaise with low grade fever. Shortly thereafter, a fine maculopapular rash develops on upper body and spreads to lower body. It rapidly clears in same fashion over three days. An enanthem, Forchheimer spots, may appear on the soft palate/uvula. Some joint pain and cervical lymph nodes may be present.
A significant congenital form may develop in fetuses exposed in early pregnancy
Rubella, German Measles (Bastard Scarlatina)
Toga Virus
Droplet, direct contact, Peaks in winter and spring (6-9m cycles) Incubation 16-18 days
Communicable 7d prior to 5 days post onset of rash
Suboccipital and posterior auricular lymphadopathy
Isolation and treat Sxs
A high grade fever develops suddenly, lasting for 1-5 days in an individual returning from the Caribbean. Some joint pains, a sore throat and a cough along with significant general malaise and vomiting follow. Following resolution of the fever, a non-descript, generalized rash then develops, sparing the soles and palms. The individual appears ill and toxic. There is a fatal hemorrhagic form
Dengue Fever
Denge Virus (arbovirus)
Mosquito Borne, not seen in winter, w/in 26 degrees N/S of equator
Incubation 2-8 days
Communicable over lifetime of mosquito… 70 days
biphasic fever, pharyngitis, cough, arthralgias, generalized maculopapular rash, but not on palms or soles, serology
Treat Symptoms
