Viral Exanthems

Question 1

What are the viral exanthems?

Answer 1

First disease - measles
Second - scarlet fever
Third - rubella
Fourth - Dukes
Fifth - Parvovirus B19
Sixth - Roseola Infantum

Question 2

What are the symptoms of measles?

Answer 2

10-12 days after exposure
Fever, coryzal, conjunctivitis

Koplik grey white spots on mucosa, 2 days after fever

Question 3

What is the measles rash?

Answer 3

Starts on face
Behind ears
3-5 days after fever

Erythematous macular rash with flat lesions

Question 4

What is the treatment for measles?

Answer 4

Self resolving 7-10 days
Isolate until 4 days after symptoms
Notifiable disease

Question 5

What are some of the complications of measles?

Answer 5

Pneumonia
Diarrhoea
Encephalitis
Meningitis
Hearing, vision loss

Question 6

What is scarlet fever associated with?

Answer 6

Group A strep infection
Usually tonsilitis
Not caused by a virus

Due to exotoxin from strep pyogenes bacteria

Question 7

What is the rash in scarlet fever?

Answer 7

Red-pink blotchy macular rash
Rough sandpaper skin
Starts on trunk, spreads outwards

Question 8

What are other symptoms of scarlet fever?

Answer 8

Red flushed cheeks
Fever
Lethargy
Sore throat
Strawberry tongue
Cervical lymphadenopathy

Question 9

What is the treatment for scarlet fever?

Answer 9

Abx for underlying strep infection

Phenoxymethylpenicillin for 10 days

Keep off school for 24 hours following starting abx

Report to public health

Question 10

What are some other conditions associated with group A strep infection which can occur with scarlet fever?

Answer 10

Post strep glomerulonephritis

Acute rheumatic fever

Question 11

What is the rash seen in rubella?

Answer 11

Milder erythematous macular rash, compared to measles

Starts on face, spreads to rest of the body

Rash lasts for 3 days

Associated with mild fever, joint pain, sore throat, lymphadenopathy

Question 12

What is the management of rubella?

Answer 12

Supportive
Condition is self limiting
Notifiable disease

Avoid pregnant women
Stay off school for at least 5 days after rash appears

Question 13

What are the features of congenital rubella syndrome?

Answer 13

Deafness, blindness

Congenital heart disease

Question 14

What are the features of parvovirus b19?

Answer 14

Mild fever
Coryza
Non specific viral symptoms like muscle aches, lethargy

Question 15

What is the rash in parvovirus b19?

Answer 15

Appears 2-5 days after symptoms
Diffuse bright rash on both cheeks

A few days later - reticular mildly erythematous rash

Question 16

What is the management of parvovirus b19?

Answer 16

Self limiting
Symptoms fade over 1-2 weeks
Stay off school until rash forms, then no longer infectious

Patients at risk - immunocompromised, pregnant, sickle cell etc - need serology testing, FBC, reticulocyte count for aplastic anaemia

Question 17

What are complications of parvovirus b19?

Answer 17

Aplastic anaemia
Encephalitis, meningitis
Pregnancy complications

Question 18

What are the causes of roseola infantum?

Answer 18

Human herpesvirus 6 HHV-6

HHV-7 less frequently

Question 19

What is the presentation of roseola and the rash?

Answer 19

High fever comes on suddenly, 1-2 weeks after infection
Lasts for 3-5 days then suddenly disappears
Coryzal symptoms

Rash appears for 1-2 days when fever has settled
Mild erythematous macular rash
Not itchy

Question 20

What are the complications of roseola?

Answer 20

Febrile convulsion due to the high temperature

Immunocompromised at risk of myocarditis, thrombocytopenia, GBS

Question 21

What is the chickenpox rash and symptoms?

Answer 21

Varicella zoster virus

High contagious
Widespread, erythematous, raised, vesicular (fluid filled) blistering rash

Starts on trunk or face and spreads outwards

Lesions scab over then stop being infectious

Fever, itch, general fatigue

Question 22

What is the infectivity of chickenpox?

Answer 22

Direct contact with lesions or infected droplets from cough/sneeze

Symptomatic 10 days-3 weeks after exposure

Question 23

What are the complications of chickenpox?

Answer 23

Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis

Question 24

What is the management of chickenpox?

Answer 24

Mild self limiting
Aciclovir if immunocompromised
Admission for complications e.g. encephalitis

Itching - calamine or chlorphenamine

Kept off school
Avoid pregnant women and immunocompromised
Until lesions dry and crusted - around 5 days after rash

Question 25

What is the presentation of hand foot and mouth disease?

Answer 25

Coxsackie A virus
Incubation 3-5 days

Viral URTI symptoms
Tiredness, sore dry throat, temperature

Small mouth ulcers appear after 1-2 days, painful mouth ulcers on tongue

Blistering red spots - hands, feet, around mouth
Rash itchy

Question 26

What is the management of hand foot and mouth?

Answer 26

Supportive
Adequate fluids
Simple analgesia
Avoid sharing towels, bedding

Question 27

What are the differentials for a non blanching rash?

Answer 27

Meningococcal septicaemia
Other sepsis
Henoch Schonlein Purpura
Idiopathic thrombocytopenic purpura
Acute leukaemia
Haemolytic uraemic syndrome
Mechanical e.g. vomiting or breath holding
Traumatic - NAI tight pressure on skin
Viral illness - influenza, enterovirus

Question 28

What is impetigo and the treatment?

Answer 28

Superficial bacterial infection - staph aureus
Golden crust
Bullous or non bullous

Topical fusidic acid
Flucloxacillin if widespread

Off school until all lesions healed, or treated with abx for at least 48 hours