Exanthems

Question 1

exanthems

Answer 1

generalized skin eruption secondary to systemic infxn

Question 2

most common cause of EX

Answer 2

viral, but can be caused by bacteria (GAS, S. aureus, meningococcus)

Question 3

the exanthem (or rash) is precede?

Answer 3

yes, by a prodrome, think fever, malaise, sore throat, Nv, abdominal pain

Question 4

enanthems

Answer 4

oral lesion

Question 5

most common viral exanthems

Answer 5

rubeola (measles), rubella (german measles), varicella, roseola (6th dz), Erythema infectiosum (fifth dz)

Question 6

scarlatiniform

Answer 6

generalized erythema, worse in body creases

Question 7

morbilliform

Answer 7

maculopapular

Question 8

vesicular

Answer 8

intially vesicles, may evolve to papules then pustules, then erosions

Question 9

rubeola

Answer 9

aka first dz, measels

SS RNA paramyxovirus

Question 10

4 pahses of rubeola

Answer 10

incubation (8-12 days), prodromal (catarrhal), exanthematous (rash), recovery

Question 11

prodromal phase

Answer 11

 cough, coryza, conjunctivitis, Koplik’s spots (gray-white oral lesions on the buccal mucosa opposite the lower molar

Question 12

rash

Answer 12

 Conjunctiva may reveal a Stimson line (transverse line of inflammation along eyelid margin) may last 12-14 hours

o Maculopapular rash in hairline & spreads to trunk, extremities (cephalad to caudal pattern). May also note cervical lymphadenitis, splenomegaly, and mesenteric LAD with abdominal pain. Otitis media, pneumonia, and diarrhea are common in infants

Question 13

tx for rubeola

Answer 13

• Self-limiting 7-10 days

- Rx  symptomatic (hydration and antipyretics). Vitamin A supplements if at high risk for complications

Question 14

most common complication of rubeola?

Answer 14

otitis media

Question 15

• SSPE (Subacute Sclerosing Panencephalitis)

Answer 15

rare fatal encephalitis years after initial infection – behavioral and intellectual deterioration with eventual death

Question 16

prevention for rubeola?

Answer 16

 MMR vaccine at 12-15 months and 4-6 years

Question 17

rubella

Answer 17

• German Measles, 3 day measles. Third disease. Caused by a single-stranded RNA. Humans are the only natural host.
• Virus invades the respiratory epithelium and disseminated via a primary viremia
• Usually occurs in spring (but rare due to vaccination). Incubation period 14-23 days

Question 18

signs of rubella

Answer 18

retroauricular, posterior cervical, and posterior occipital LAD accompanied by an erythematous, maculopapular, discrete rash that starts on the face and then spreads – it resolves in 3 days (rash is less prominent than with measles)
o Rose-colored spots on the soft palate are called Forchheimer spots may develop before the rash
o Other manifestations – mild pharyngitis, conjunctivitis, anorexia, headache, malaise, low-grade fever (on the first day of rash only)

Question 19

• Congenital rubella syndrome

Answer 19

 significant morbidity from infection in utero. Maternal infection during the first trimester results in fetal infection and generalized vasculitis

Question 20

common complciations

Answer 20

arthralgias

Question 21

roseola

Answer 21

• Exanthem subitum. Sixth disease. HHV6, HHV7

- Peaks between 6 months and 2 years old

Question 22

roseola CF

Answer 22

• 3-7 days of high fever > 39.0°C (103.0°F). Rash occurs after the fever has resolved
• Defervescence precedes rash (initially appears on trunk

Question 23

Varicella

Answer 23

• Primary infection with VZV. Incubation 10-20 days
• Starts on trunk, then face, head, extremities less so. Also mucous membranes
• Lesions appear in crops over 3-4 days; up to 500. Crust in 3-5 days

Question 24

varicella prodrome

Answer 24

• Prodrome of fever, malaise, anorexia, and occasionally a scarlatiniform or morbilliform rash
  o Characteristic pruritic rash begins the next day – starts on trunk and spreads peripherally
  o Rash starts as red papules that rapidly develop into clear vesicles 1-2 mm (dew-drop on rose petal). Vesicles then become cloudy, rupture, and then crust
• Intensely pruritic, fever can reach 105°F
• Contagious from 24 hours before rash until all lesions have crusted (usually 1 week)

Question 25

complications of varicella

Answer 25

pneumonia, encephalitis; can be fatal

Question 26

varicella dx

Answer 26

Tzanck smear for multinucleated giant cells

Question 27

varicella tx

Answer 27

symptomatic, no ASA (increased risk of streptococcal cellulitis, also risk of Reye’s syndrome) o Can give oral antihistamines for pruritus Tz o Consider acyclovir in teens o If immunocompromised and exposed, give IVIG within 96 hours of exposure o Administration of varicella vaccine within 72 hours of exposure can prevent or lessen severity

Question 28

Zoster

Answer 28

reactivation of VZV | o Varicella dormant in dorsal root ganglia

Question 29

prodrome of VZV

Answer 29

 pain, tingling, dermatome distribution, fever, malaise o Usually clears in 7-14 days, but can last a while with persistent pain (postherpetic neuralgia) o Lesions are typical of herpes – grouped vesicles on an erythematous base

Question 30

tx for zoster

Answer 30

 symptomatic; pain meds in older, acyclovir in compromised children

Question 31

Erythema infectiosum

Answer 31

- Fifth disease. Caused by human parvovirus B19 (affinity for infecting RBCs) o In a child with hemoglobinopathy, a transient aplastic crisis precedes the onset of “slapped cheeks” - Epidemics in spring

Question 32

ER CF

Answer 32

- Mild flu-like illness - Rash at 10-17 days (not contagious with rash) – starts as facial erythema and spreads to extremities in a reticular pattern - Low-grade or no fever.

Question 33

Erytema Infectiosum rashes

Answer 33

o Slapped cheeks (and circumoral pallor) first rash o Maculopapular  second rash o Lacy arms & legs  third rash

Question 34

complications

Answer 34

arthritis, mroe common in older women

Question 35

mumps

Answer 35

2-3 wk intubation, paramyoxovirus

Question 36

mumps CF

Answer 36

- Parotitis; bilateral in 70% - The mandibular angle is obliterated - Stenson’s duct may be erythematous with yellow discharge

Question 37

mumps complications

Answer 37

orchitis, pancreatitis, oophoritis, aseptic meningitis

Question 38

dx mumps

Answer 38

clinical (no rash); paired sera

Question 39

H-F-M dz

Answer 39

- Coxsackie A-16. Usually in summer | - Highly contagious

Question 40

HFM dz CF

Answer 40

- Vesicles on tongue, oral mucosa, hands & feet | - May also have generalized scarlatiniform rash

Question 41

HFM prodrome

Answer 41

of low grade fever, anorexia, oral pain. Followed by crops of ulcers on the tongue and oral mucosa and a vesicular rash on the hands and feet (occasionally buttock and thighs) o Individual vesicles have a “football” shape with surrounding erythema

Question 42

complications of HFM

Answer 42

myocarditis, substernal chest pain, dyspnes

Question 43

herpangina

Answer 43

if HFM limited to mouth