Infectious Exanthems Flashcards Preview

Skin MS: Week 4 > Infectious Exanthems > Flashcards

Flashcards in Infectious Exanthems Deck (93):
1

DNA viruses

HPV - warts
Pox virus - MC, smallpox (Variola)
Orf virus - Exanthem contagiosum
Herpes (varicella, HSV1/2, HHV 6/7, EBV)
Parvovirus - erythema infectiosum (Fifth disease)

2

RNA viruses

Enterovirus (Coxsackievirus - HFM, Echo virus - non-specific, EV D68 - severe respiratory)
Paramyxovirus - measles (rubeola)
Togavirus - rubella
arbovirus - dengue virus, chikungunya
Filoviridae - ebola

3

exanthem

expressed on cutaneous surfaces

4

enanthem

expressed on mucosal surfaces

5

HPV -->

common warts, plantar warts, flat warts, genital warts, condylomata

6

HPV transmission

person to person by contact or through fomites
non-seasonal

7

HPV incubation

3 months to many years

8

HPV management

liquid N2, various acids, laser, surgical, laser
prevention

9

Small growth on surface of skin and gradually enlarges over long period. Relatively few sxs (maybe pain on foot). Small black dots seen centrally. Surface exhibits hyperkeratinization.

HPV - wart

10

Asymptomatic discrete papular waxy lesions gradually develop on surface of skin. Umbilicated appearance. 2-20 in generalized location

Molluscum contagiosum (poxvirus)

11

Molluscum contagiosum spread

humans - direct contact/fomites
non-seasonal
infectivity low

12

MC incubation

2-7weeks to 6 months

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MC management

mechanical removal
liquid N2, acids

14

Vesiculated rash from distal distribution to central
HA, fever, malaise, muscular pains before rash
Rash develops in same stages w/ local crops and becomes encrusted. Illness lasts 2 weeks and resolves w/ significant scarring. Hemorrhagic form is highly fatal

Variola (smallpox) - poxvirus

15

Variola transmission

direct contact w/ skin lesions, mucous membranes
human transmission
animals in winter/spring

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incubation smallpox

12 days

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communicability of smallpox

onset of rash - clearing of crusts

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dx of smallpox

culture of lesions, serology

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smallpox management

strict isolation, symptomatic tx, active immunization

20

eczema vaccinatum

skin reaction - underlying skin disease + smallpox vaccine

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Sheep herder (spring) notices small pimple on finger. No other sxs.

Ecthyma contagiosum, orf (poxvirus)

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orf virus transmission

working with sheep - zoonosis usually seen in spring
directly from infected animal

23

incubation orf virus

4-7days

24

dx of orf

solitary lesion on hand, beginning as erythematous papule and developing into a vesicle

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management of orf

duration is usually 30-40 days
spontaneously resolves w/ only symptomatic care
wear gloves

26

General malaise - fever - pruritic rash beginning centrally on head and trunk and extending peripherally.
Macule --> papule in 24 hrs
Local areas have various stages of development
Clears over week to 10 days
Latent infection, do not treat w/ aspirin (Reye's)

varicella (chickenpox)
Herpes virus - VZV

27

VZV transmission

exposure to nasopharyngeal droplet, skin lesion contact, easily air spread
Peaks in late winter/spring

28

VZV incubations

14-16 days

29

VZV communicability

1-2 days before rash to when rash begins to crust (5 days)

30

VZV dx

clinical inspection of rash, spreading from macule to vesicles in 24 hours, hx of contact, immunofluorescence stain of lesion, serology

31

vzv management

strict isolation, avoid use of aspirin, avoid hospitalization, vitamin a, immunization
oral acyclovir w/in 24 hrs

32

smallpox vs chickenpox

smallpox
ill 7-17 days after contact
has fever/malaise 2-4 days before rash
Pocks mostly on face/arms/legs
Present on palms/soles
Scabs 10-14 days after rash appears
Fall off 14-28 days after rash appears

Chickenpox
ill 14-21 days after contact
no sxs before rash
pocks most numerous on body, not on palms/soles usually
Scabs 4-7 days after rash appears
scabs fall off w'/in 14 days after rash begins

33

Stinging erythematous lesion at junction skin/lip
Proceeds to crusted sore over few days but lasts up to 10-12 days. no systemic sxs noted.
Lesions of oral cavity (gingiva and tongue) and genital region may be found

Herpes simplex 1 and 2

34

HSV1/2 transmission

direct contact - sexual and birthing contacts
non-seasonal but associated w/ stress

35

HSV1/2 incubation

varies from 2d-2w, becomes latent and recurs

36

HSV1/2 communicability

not well defined, 1 to several weeks

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dx of HSV1/2

clinical picture, recovery from lesion for cell culture, fluorescent antibody

38

HSV1/2 management

drying agents, acyclovir oint, oral/IV acyclovir/famciclovir/valacyclovir/penciclovir
protect newborns from exposure - pregnancy precautions

39

six mo old infact w/ high fever w/ minimal respiratory sxs preceeding. Infant seems playful in spite of fever. After about 3 days, fever breaks and fine maculopapular rash develops on neck and trunk then disappears in two days

HHV 6/7 roseola
exanthem subitum (sixth disease)

40

HHV6/7 transmission

probably nasopharyngeal droplet
yearround

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incubation HHV6/7

9 days

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HHV6/7 communicability

early, during febrile stage

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HHV6/7 dx

clinical course, non-toxic, but febrile infant (3mo to 3 yrs) w/ high fever, possible febrile convulsion, virus isolation possible

Fever clears when rash devleops

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management sixth disease

antipyretics, ?ganciclovir, no isolation
observe for febrile convulsion
*frequently mislabel as penicillin allergy

45

Adolescent w/ sore throat, mild fever, enlarged lymph nodes, extreme tiredness over 3-4 days. Tiredness lingers a week or more as other sxs resolve. Maculopapular rash may be noted on trunk, possible jaundice.

Infectious mono "Kissing Disease"
Epstein-Barr Virus (herpesvirus 4)

46

EBV transmission

close contact
pharyngeal secretions
non-seasonal

47

EBV incubation

30-50 days

48

EBV communicability

indeterminate, but virus recovery for months after recovery

49

EBV dx

increased posterior cervical lymph nodes, tender and enlarged spleen, atypical lymphocytes, rapid mono test, heterophile Ab

50

EBV management

symptomatic tx, avoid contact sports, possible steroids, observe for jaundice, avoid tx w/ ampicillin

51

Young child w/ malaise, mild fever
sore throat, lesions in mouth and on extremities. Enanthem w/in 1-2 days after onset of sxs and exanthem shortly thereafter. Lesions clear within 1 week. Possibly ulcerative rash in posterior phalanx

Hand, Food and Mouth Disease
herpangina
coxsackievirus (enterovirus)

52

Coxsackievirus transmission

nasopharyngeal droplet, saliva, fecal
peaks in summer, early fall

53

incubation coxsackievirus

2-6 days

54

communicability coxsackievirus

possible for several weeks

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coxsackievirus dx

clinical appearance, virus isolation from mucous membranes, feces, serology

56

management coxsackievirus

symptomatic medications, protect newborns, good handwashing, personal hygiene

57

Child w/ flu-like process w/ mild fever, malaise, abdominal cramping, diarrhea, and non-specific maculopapular rash on trunk. Rash fades over 5 days, after other sxs gone.

Non-specific viral exanthem
Echo virus (enterovirus)

58

Echovirus transmission

fecal to oral route
peaks in summer and early fall

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incubation echovirus

3-6 days

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Echovirus communicability

several weeks during fecal viral shedding

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echovirus dx

clinical course, viral isolation from feces, serology

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echovirus mngmnt

symptomatic meds, personal hygiene, care w/ diaper changing

63

Non-specific respiratory virus w/ possible exanthem - causative agent

Enterovirus D-68

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Enterovirus D-68 transmission

respiratory secretions, most serious in asthma, may be found in fecal excretions
peaked last year in mid-August

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Incubation enterovirus D68

1-5days

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communicability D68

1 day prior to 5 days after onset

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Dx D68

clinical course, PCR serology
episodes of paralysis of arms and legs?

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D68 management

symptomatic meds, personal hygiene, admission if asthma or serious respiratory sxs

69

Gradeschool child w/ very mild upper respiratory illness, then very red slapped-cheeks rash on face. OVer few days, fades and lacy rash noted on upper extremities. This may fade only to return in couple of weeks, maybe some vague joint complaints

Erythema infectiosum, fifth disease
Human parvovirus B19

70

Parvovirus B19 transmission

nasopharyngeal droplet, possible via blood
peaks in spring

71

B19 incubation

4-14 d

72

B19 communicability

from before onset of rash to shortly after rash appears
once rash - no need to keep out of school

73

B19 dx

clinical appearance, serology

74

B19 management

symptomatic meds, personal hyg. protect pregnant women from exposure.

75

Young unvaccinated from travel - week later, upper resp sxs w/ rhinitis and cough, conjuctivitis. Discrete red rash gradually becoming confluent as spreading from central to distal body sites. High fever. Koplik spots on buccal mucosa. Total illness lasts 1 week.

Rubeola (measles)
Paramyxovirus

76

Measles transmission

nasopharyngeal droplets, direct contact
peaks in winter, spring in 2-5 year cycles

77

measles incubation

8-12 days

78

measles communicability

1-2 days before onset of sxs (3-5 days before rash) to 4 days after onset of rash

79

dx measles

clinical appearance, serology for acute/convalescent sera, possible SSPe

80

management measles

isolation, symptomatic medications, vit A
active immunization, immunoglobulin if exposed IC

81

School age child w/ mild upper resp sxs and malaise, low grade fever. Shortly thereafter, fine maculopapular rash on upper body and spreads to lower body. Clears in same fashion over 3 days. Enanthem (forchheimer spots) may appear on soft palate/uvula. Some joint pain and cervical lymph nodes may be present.
Significant congential form may develop in fetuses exposed in early pregnancy.

Rubella = German measles
Togavirus

82

Rubella transmission

nasopharyngeal droplet, direct contact, maybe stool/urine
peaks winter/spring, occurs in 6-9 year cycle

83

rubella incubation

16-18 d

84

rubella communicability

7d before to 5 days after onset of rash

85

rubella dx

clinical course and appearance of rash, suboccipital and posterior auricular nodes, serology on acute and convalescent sera

86

rubella management

isolation, symptomatic meds
active immunization
consider globulin in susceptible/pregnant women

87

High grade fever suddlenly, lasting 1-5 days, hx of travel
some joint pains, sore throat, cough w/ significant general malaise and vomiting. After fever, non-descript generalized rash, sparing soles and palms. Individual appears ill and toxic. There is a fatal hemorrhagic form.

Dengue fever
Dengue virus (arbovirus) and no chikungunya virus

88

Dengue fever transmission

mosquitoborne
not present about or below 25degrees N/S
Not seen in winter months

89

Dengue fever incubation

3-8 days

90

Dengue fever communicability

Over lifetime of infected mosquito- up to70 days

91

Dengue fever dx

biphasic fever, pharyngitis, arthralgias, generalized maculopapular rash, not on pals/soles, serology

92

dengue fever management

symptomatic meds
use of screened windows, insect repellant

93

Big differential dx of other conditions w/ rash

scarlet fever, pityriasis rosea, impetigo, meningococcemia