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Viral Exanthems Flashcards

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1
Q

What is an exanthem?

A
  • rash that shows up abruptly
  • affects several areas of the skin simultaneously
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2
Q

What is an enanthema?

A

eruption on a mucous membrane

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3
Q

What are viral exanthemas commonly described as?

A

morbilliform

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4
Q

What is a mobilliform?

A

composed of erythematous macules and papules = looks like a measles rash

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5
Q

How can you differentiate viral exanthems from drug eruption rashes?

A

history taking

viral exanthem = common in kids (they have a rash s/p viral infection)

drug eruptions = common in adults

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6
Q

What is roseola infantum?

A

acute febrile illness with later onset of roseola rash

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7
Q

What is the timeline of fever in roseola infantum? What happens after this timeline?

A

3-7 days; rash appears afterwards

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8
Q

What is the prodrome of roseola infantum?

A
  • high fever (over 101)
  • palpebral edema
  • cervical lymphadenopathy
  • mild URI sxs
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9
Q

What is the clinical presentation of the exanthem in Roseola Infantum?

A

pink macules and papules surrounded by white halos

starts on trunk → neck + prox. extremities

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10
Q

How long does the rash in roseola infantum last for?

A

1-3 days

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11
Q

What is “exanthema subitum”?

A

“sudden rash” = exanthem rash appears suddenly as the fever subsides

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12
Q

What is Roseola Infantum also called?

A

Sixth disease

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13
Q

What is the etiology of Roseola Infantum?

A

HHV-6 (herpes virus)

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14
Q

What is the key symptoms of roseola infantum?

A

exanthema subitum

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15
Q

What is the epidemology of roseola infantum? (population it affects)

A

children 6mo-4yr

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16
Q

What is the most common exanthem to occur in children before the age of 2?

A

roseola infantum

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17
Q

How can someone become immune to roseola infantum?

A

no vaccine, infection = immunity

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18
Q

What are 2 complications that reactivation of HHV-6 has?

A

in immunocompromised → morbidity

reactivation w/ drug exposure → DIHS (drug induced hypersensitivity)

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19
Q

What are 3 things that HHV-6 infection in children results in?

A
  • subclinical infection
  • acute febrile illness w/o rash; risk of febrile seizure
  • exanthema subitum
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20
Q

What is the prognosis of roseola infantum?

A

benign; self-limited

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21
Q

What is the treatment for roseola infantum?

A

supportive = treat fever w/ antipyretics (NSAIDs)

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22
Q

What is Erythema Infectiosum also called? What is the etiology of this disease?

A

Fifth disease; Parvovirus B19

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23
Q

What is the mode of transmission for Erythema Infectiosum?

A
  • respiratory tract secretions
  • inoculation with blood products
  • vertical transmission = mom to fetus
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24
Q

What is the incubation period for Erythema Infectiosum prior to onset of rash?

A

1-2 wks

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25
When are individuals sick with erythema infectiosum most infectious?
before onset of rash = (when they have the rash = less infectious)
26
What is the epidemiology for erythema infectiosum?
- kids 4-10 y/o (can affect all ages) - happens w/ epidemics (ie: flu); school outbreaks in late winter-early spring - common secondary spread in household (kids are petri dishes)
27
What is the pattern with antibodies in erythema infectiosum?
increasing prevalence of antibodies with age = the older you are, the more antibodies are built against Fifth Disease
28
What are the symptoms of Erythema Infectiosum?
- erythematous "slapped cheek" rash → reticular erythema on body - low-grade fever
29
How do you diagnose Erythema Infectiosum?
detection of serum Parvo-B19 specific IgM Ab is preferred = indicates infection occurred w/in last 2-4 mos.
30
What is Papular Purpuric Gloves and Socks Syndrome?
rare Parvo-B19 related disease
31
What are the symptoms of Papular Purpuric Gloves and Socks Syndrome?
- painful, pruritic papules - petechiae - purpura on hands and feet - fever - enanthem
32
How is Papular Purpuric Gloves and Socks Syndrome different from Erythema Infectiosum?
Gloves and Socks syndrome = viremic and contagious
33
What is a general note about Parvo-B19 infections symptomatically?
most infections are asymptomatic and unrecognized
34
What is the treatment for Parvo-B19 infections?
supportive care = treat the symptoms
35
What is the prognosis for Parvo-B19 infections?
resolves after 5-10 days; can recur
36
What are the triggers that can reactivate Parvo-B19?
sun; hot temp; exercise; bathing; stress
37
What are the complications with Parvo-B19 infections?
immunodeficiency → chronic erythroid hypoplasia w/ severe anemia chronic hemolytic anemias (ie: Sickle Cell patients) → transient aplastic crisis
38
What is a special consideration in pregnancy when it comes to pregnant mothers infected with Parvo-B19?
- hydrops fetalis (accumulation of fluid in 2 fetal compartments) - intrauterine growth retardation - pleural and pericardial effusion - death 2%-6.5% (lowish)
39
What is the prodrome for Hand-Foot-and-Mouth disease?
1-2 days = fever, sore throat, malaise
40
What are the symptoms after a prodrome in Hand-Foot-and-Mouth disease?
- enanthem & exanthems - rash starts at mouth → hands and feet (sometimes w/ buttocks and elbow involvement)
41
What is the characteristic of the exanthem in Hand-Foot-and-Mouth disease?
bright pink macules and papules → painful vesicles w/ erythematous halos; erosions w/ surrounding erythema
42
What is characteristic of the enanthem in Hand-Foot-and-Mouth disease?
resembles aphthae (canker sores)
43
What is the etiology of Hand-Foot-and-Mouth disease?
Coxsackievirus
44
What is the epidemiology of Hand-Foot-and-Mouth disease?
commonly children - during late summer, early fall
45
What is the incubation period of Coxsackievirus with Hand-Foot-and-Mouth disease?
4-6 days
46
What is the prognosis of Hand-Foot-and-Mouth disease?
benign, self-limited, resolves w/in 10 days very contagious
47
What is the treatment for Hand-Foot-and-Mouth disease?
supportive = treat sxs (ie: fever)
48
What will be the majority of the exanthems that we will encounter?
nonspecific viral exanthems = nonspecific and difficult to categorize = this is their category lol
49
What is the prodrome for Nonspecific Viral Exanthems?
- no indicative symptom complex - Nonspecific associated sxs: fever; headache; fatigue; myalgias; respiratory or GI complaints
50
What is noteable about the exanthems in Nonspecific Viral Exanthems?
no unique lesion morphology or distribution
51
What is the prognosis for Nonspecific Viral Exanthems?
resolve over 1wk w/o treatment
52
What is the etiology for Nonspecific Viral Exanthems?
- nonPolio enteroviruses = common in summer - Respiratory viruses (ie: adeno, rhino, etc) = common in winter
53
What must you do when you diagnose Measles or Rubella via serology?
cases must be reported to local or state health departments
54
Which Classical Viral Exanthems are uncommon in the USA and why?
Measles and Rubella because of routine vaccinations
55
What are the symptoms for Measles?
Prodrome: - 4D's + 3C's = 4 days Cough, Coryza (head cold), Conjunctivitis - fever - malaise Other sxs: - exanthema and enanthema
56
What is the characteristic of the exanthema of Measles?
- erythematous macules and papules - starts at face - head to toe distribution
57
What is the characteristic of the enanthema of Measles?
Koplik spots = blue/white dots on mucosa
58
What is the recovery period for Measles?
starts 2 days after rash onset; 6-7 days for full recovery
59
What is another name for Measles?
Rubeola
60
What is the mode of transmission for Measles?
respiratory droplets
61
What is the incubation period for Measles?
8-12 days from exposure to onset of symptoms
62
When are patients infected with Measles contagious?
1-2 days before onset of sxs (3-5 days before onset of rash) *Immunocomp pts. contagious throughout
63
Epidemiology for Measles?
- unvaccinated - foreign-born - immunocomp - pediatrics (common)
64
How is Measles diagnosed?
clinically; confirm w/ serology
65
What are the 2 testing options for Measles?
Serology anti-measles IgM and IgG; isolation of virus or identification of measles RNA Histological eval skin lesions or respiratory secretions = syncytial keratinocytic giant cells
66
What is the prognosis of Measles?
self-limiting; 10-12 days
67
What is the treatment of Measles?
supportive = treat the symptoms
68
What risk factors can worsen the prognosis of Measles?
- malnutrition - immunosuppression - poor health - inadequate supportive care = can lead to infant death
69
Which supplement has been shown to help treat Measles?
Vitamin A
70
What are the common complications of a Measles infection?
- otitis media - Croup (laryngotracheobronchitis) - diarrhea - pneumonia
71
What are the less common but notable complications of Measles?
- Hepatitis - thrombocytopenia - encephalitis
72
What is the most common fatal complication with Measles infection?
pneumonia
73
What is the clinical presentation of Rubella?
- LOW-grade fever - headache, sore throat, rhinorrhea, cough - conjunctivitis - lymphadenopathy - exanthema and enanthema
74
What is the exanthema characteristic in Rubella?
- pruritic - pink/red macules and papules - starts on face → neck, trunk, extremities w/in 24hrs
75
What is the enanthema characteristic in Rubella?
petechial lesions on soft palate and uvula = Forchheimer's sign
76
What is the treatment for Rubella?
supportive = treat symptoms
77
What is the complication with Rubella infections?
infected pregnant women → miscarriage, fetal death, congenital rubella syndrome

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