Exanthems and Enanthems Lecture Powerpoint

Question 1

Exanthem vs enanthem

Answer 1

Exanthem is breaking out on the surface of skin, an enanthem is an internal rash involving mucus membranes

Question 2

Koplik spots

Answer 2

Small intraoral lesions most often on the inner cheek against the molars that appear like tiny white grains of sand surrounded by a red ring pathonomonic of measles infection (rubeola)

Question 3

Triad of measles presentation

Answer 3

Cough
coryza (inflammation of mucus membranes of nose)
conjunctivitis

Question 4

Measles infection course

Answer 4

• highly contageous with 90% secondary infection rate in susceptible contacts (pneumonia or sinusitis)
• incubation 10-14 days
• rash (exanthem) apears over 2-4 days, nonpruritic**, erythematous macules and papules spreading from face down to trunk and extremities

Question 5

Rare delayed secondary condition following measles infection

Answer 5

Subacute sclerosing panecephalitis (SSPE)

Question 6

Measles diagnosis (1) and treatment (2)

Answer 6

-Swab for serologic identification or PCR

• supportive
• prophylactic treatment for exposure to unvaccinated contact or immune globulin can prevent or modify or abort measles infection

Question 7

4 common findings of scarlett fever

Answer 7

• pastia lines (red lines on the anticubital fossa of elbow creases
• sandpaper appearing red erythematous rash diffusely
• red strawberry tongue with enlarged papilla
• desquamation of palms

Question 8

Scarlet fever definition

Answer 8

Infection caused by exotoxins produced by GABHS, only evolves in about <10% of streptococcal tonsillopharyngitis cases, affecting mostly patients 5-12 resulting in fever and sore throat followed by rash and exudative tonsopharyngitis with petachiae and punctate red macules on the hard and soft palate

Question 9

Scarlet fever rash look alike in adolescent patients who have a neg rapid antigen test and culture

Answer 9

Arcanobacterium hemolyticum

Question 10

Scarlet fever infection course

Answer 10

• incubates 1-4 days
• spread via airborne droplets
• yellowish white coat initially covers tongue against red papillae
• rash appears at base of neck then down rest of body, palms and soles remain clear
• fades in 5-7 days

Question 11

Scarlet fever diagnosis (1) and treatment (1) and complications (2)

Answer 11

• Rapid antigen test and culture
• oral penicillin or amoxicillin, injectible PCN is curative
• peritonsillar abscess
• rheumatic fever

Question 12

Blueberry muffin rash and congenital cataracts are characteristic of what infection?

Answer 12

Rubella

Question 13

Clinical manifestations of rubella infection in children and adults

Answer 13

• mild maculopapular rash in children

- arthalgias, arthritis, and thrombocytopenic purpura

Question 14

Rubella infection course

Answer 14

• Prodrome of fever, headache, malaise, tender lymphadenopathy lasting 1-5 days
• enanthem and nonspecific exanthems that are pruritic spread in cephalocaudal fashion and fade in 2-3 days

Question 15

Complications of rubella infection

Answer 15

Congenital rubella syndrome (sensorineural deafness, cataracts, congenital heart disease, CNS anomalies)

Question 16

Fifth disease (erythema infectiosum, human parvovirus b19) clinical manifestation (3) and diagnosis (2) and treatment (1)

Answer 16

• lacy, reticular erythematous patches and plaques on lower extremeties and feet
• characteristic slapped cheeks appearance
• general malaise and fevers
• clinical
• IgM assay

-supportive

Question 17

Fifth disease (erythema infectiosum, human parvovirus b19) infection course

Answer 17

• self limiting illness of childhood
• transmitted via droplets
• often seasonal
• incubated 4-15 days
• NO longer infectious once rash is apparent
• concern in pregnancy

Question 18

Roseola (Herpes virus 6 and 7) infection characteristics (2) and treatment (1)

Answer 18

• HIGH grade fever that lasts 3-4 days and as it subsides the nonpruritic erythematous rash appears
• leading cause of fever induced seizures in age groups 6-24 months

-supportive

Question 19

Mumps presentation (2)

Answer 19

• swelling one side of face and pain while chewing

- high fever

Question 20

Complications of mumps (5)

Answer 20

• hearing loss
• viral meningitis or encephalitis
• pancreatitis
• orchitis and potential infertility
• miscarriage

Question 21

Varicella infection course

Answer 21

• Mostly occur in chidlren younger than 10
• incubate 10-21 days from time of exposure
• spread by respiratory droplets or contact with vesicles

Question 22

Varicella is caused by this virus

Answer 22

Varicella zoster virus

Question 23

Varicella zoster manifestations

Answer 23

• varicella (chickenpox)
• herpes zoster (normally reactivation later in life, shingles)
• ramsay hunt syndrome (zoster on the ear causing facial paralysis and hearing difficulties)
• herpes opthalmicus (medical emergency)

Question 24

Varicella zoster virus diagnostic studies (3) and treatment (1)

Answer 24

• clinical suspicion
• tzanck smear (this is Tav thoughts here, idk if that’s true)
• PCR

-acyclovir

Question 25

Herpes zoster presentation (2) and complication (1) and treatment (1)

Answer 25

- prodrome of pain or anesthesia along the dermatome following stress or failure of immune system - herpetiform vesicles develop unilaterally - post herpatic neuralgia which can last for years - normally none but acyclovir in early disease course shortens recovery period and reduces chance of postherpatic neuralgia

Question 26

Anything above waist is typically HSV __, while below is ___

Answer 26

I, II

Question 27

HSV characteristics (2) and treatment (1)

Answer 27

- groups of vesicles on erythematous base, PAINFUL*** - recurrent outbreaks will occur for life due to stress, trauma, etc - symptomatic treatment using acyclovir

Question 28

Herpeti whitlow

Answer 28

Intensely painful infection of the hand involving one or more fingers typically affecting the terminal phalanx caused by HSV1 typically

Question 29

Hand foot and mouth diesase (coxsackie virus A16) infection course (4)

Answer 29

- spread fecal oral - incubation 3-10 days - highly contageous - prodrome is 3-5 days low grade fever and malaise

Question 30

Hand foot and mouth disease (coxsackie virus A16) presentation (2) and treatment (1)

Answer 30

- reticulated confluent red papules and plaques symmetric and most prominant on the trunk - papulovesicular ulceration on palm, sole, and orally -supportive

Question 31

Rare complications of hand foot and mouth disease (3)

Answer 31

- myocarditis - pneumonia - aseptic meningitis

Question 32

Herpangina

Answer 32

Usually seen in children of all ages caused by nonpolio enteroviruses and coxssackie, characterized by rapid onset fever, vomiting, sore throat, etc, most mild and resolve within a week, no specific treatment except analgesics

Question 33

Pityriasis rosea

Answer 33

Common benign papulosquamous disease considered a viral exanthem but has no single viral cause, begins as a solitary patch that resolves within 6 weeks, treatment is entirely suppportive

Question 34

Infectious mononucleosis (epstein barr) presenting symptoms (4)

Answer 34

- prodrome of headache, fever, debilitating fatigue - exudative pharyngitis (often mistaken for strep pharyngitis, which is more erythematous!!) - hepatomegaly and splenomegaly - rubella like rash

Question 35

Not all exudative pharyngitis is streptococcal in origin, it can also be...

Answer 35

....infectious mononucleosis

Question 36

Infectious mononucleosis infection course

Answer 36

- primarily teenagers and young adults - spread via contact with oral secretions - high incident of splenic rupture

Question 37

Inectious mononucleosis diagnostic tests (3)

Answer 37

- leukocytosis with atypical lymphocytes - monospot test (appears within first 2 weeks and may need retesting) - EBV viral capsid antigen and immunoglobin most accurate for diagnosis

Question 38

Infectious mononucleosis treatment options

Answer 38

-self limiting, rest, avoid contact sports

Question 39

Kawasaki disease

Answer 39

Acute febrile vasculitis of unknown etiology that frequently occurs in young children and has 3 distinct phases that requires intervention early on to prevent complication

Question 40

3 stages of kawasaki disease

Answer 40

- Acute (1-11 days) HIGH fever and sometimes strawberry tongue or lymphadenopathy - subacute stage with persistent anorexia, conjunctivia, thrombocytosis, aneurysmal formation - late stage with cardiac abnormalities that predominate coronary aneurysms (need CXR), leading cause of acquired heart disease in US with many complications

Question 41

Treatment of kawasaki disease (2)

Answer 41

- aspirin - intravenous immunoglobulin (these 2 reduce risk of cardiac involvement from 25 to 5% best in the first 10 days of sickness)

Question 42

Steven johnson syndrome

Answer 42

Severe erythema multiforme rxn that can be due to infection, medication, and malignancy but may be idiopathic, morbidity and mortality correlated with percent body surface area involved

Question 43

Most common cause of lymphangitis

Answer 43

Strep pyogenes

Question 44

Lymphangitis definition

Answer 44

Inflammation of lymphatic channels caused by distal infection, can be quite toxic and febrile, typically presents with red streak traveling up arm with a raised border around affected area, and lymphadenitis

Question 45

Cellulitis definition and treatment (1)

Answer 45

- Nonnecrotizing infection of the derrmis and hypodermis, patients report fevers, chills, pain, tenderness, etc, - outpatient with oral antibiotics (cephalexin, amoxicillin/clauvinate)

Question 46

Most common 2 organisms involved in cellulitis

Answer 46

Strep pyogenes and staph aureus

Question 47

Erysipelas definition and treatment (1)

Answer 47

Superficial bacterial skin infection that extends into the cutaneous lymphatics, usually involves superficial lymph vessel with sharp distinct outline while celllulitis fades into surrounding skin -10-20 days penecillin, cephalosporin, or macrolide in PCN allergic

Question 48

Impetigo

Answer 48

Highly contageous bacterial infection of epidermis, typically from staph A and GABHS (remember individuals can be carriers in their nose), usually occurs from skin breakage and poor hygeine, presents with honey colored crust and either bullous or nonbullous lesions with pruritis

Question 49

Impetigo treatment

Answer 49

Topical antibiotic such as mupirocen

Question 50

Impetigo is theorized to contribute to what complication?

Answer 50

Poststrep glomerulonephritis

Question 51

Scalded skin syndrome

Answer 51

A staph toxin mediated type of exfoliative dermatitis often in children

Question 52

Most serious complication of HS purpura and how is it diagnosed?

Answer 52

Intusucception, diagnosed via ultrasound

Question 53

How is HS purpura differentiated from idiopathic thrombocytopenic purpura?

Answer 53

Platelet count is normal in HSP

Question 54

HS purpura

Answer 54

Vasculitis affecting skin with purpuric lesions, joints, GI and kidneys, in a well appearing child can be managed outpatient but is helpful to manage BP, urine, and electrolytes for glomerulonephritis

Question 55

Meningitis infection presentation

Answer 55

Variable presentation with some developing septicemia alongside this, usually ill appearing with lethargy, vomiting, and nuchal rigidity, as well as capillary leak, coagulopathy, and myocardial failure. If untreated properly 50% mortality, with prompt treatment drops to 10%

Question 56

Meningococcemia treatment (1)

Answer 56

-vanco + ceftriaxone without waiting for confirmatory culture