12.3 Viral Skin Infections

Question 1

Erythema Infectiosum (Fifth Disease)

Answer 1

• Caused by HPV
• Transmitted through droplet and blood
• Incubation period of 14 days
• HIGHLY CONTAGIOUS
• Starts off with low grade fever, headache, runny nose, flu like symptoms
• Once flu symptoms disappear a rash starts to form

Exanthem
Stage 1 - Bright red rash over cheek (slapped cheeks) - HALLMARK SIGN
Stage 2 - Lacy reticular rash on trunks and limbs
Stage 3 - Rash will fade and return with bathing, exercise, sun exposure and stress

Treatment
- Supportive treatment (because it is viral)
- Antipyretics

Complications
- Hydrops Fatalis (can cause women to miscarry)
- Aplastic crisis in patients with immunodeficiency

Question 2

Hand, Foot and Mouth Disease

Answer 2

• Caused by Coxsackie Virus A16
• Transmitted via contact with skin lesions or oral-fecal route
• Incubation period 3-6 days
• Communicability 2 days before and 2 days after rash

Prodromal Phase
- Sore throat, malaise, low grade fever

Exanthem
- Painful vesicles on buccal mucosa, tongue, or hard palate
- Within 48 hours grayish-white vesicle lesions with erythema base appear on palmer and plantar surfaces.

Treatment
- Supportive (antipyretics)
- Educate parents about how contagious this is (hand hygiene)

Complications
- Lesions in mouth can cause dehydrations because they do not want to eat or drink.
- Recommend soft diet to encourage eating/drinking

Question 3

Rubella (German Measles)

Answer 3

• Caused by Rubella Virus
• Transmission through nasopharyngeal secretions, blood, urine, stool
• Incubation 2-3 weeks
• Communicability 7 days before and after rash

Prodromal Period
- Fever, Lymphadenopathy

Exanthem
- Forchheimer spots (pinpoint red macules and petechiae over soft palate and uvula)
- Discrete pink/red macules/papules that appear on the face then spread to the trunk and extremities

Treatment
- Supportive (antipyretics)

Complications
- Congenital Rubella Syndrome (when women contract rubella during first trimester which can lead to deafness, eye abnormalities, congenital heart disease)

Prevention
- MMR Vaccine (live vaccine) - Given at 12-15 months then again at 4-6 years.
- MMR Vaccine is teratogenic so do not administer during pregnancy due to causing congenital rubella syndrome.

Question 4

Measles (Rubeola)

Answer 4

• Caused by Morbillivirus
• Transmitted through droplets, blood, urine
• Incubation period 10-20 days
• Communicable 4 days prior and 5 days after rash

Prodromal Period
- Fever and 3 C’s
- Coryza (acute rhinitis), cough, conjunctivitis,
- Koplick Spots (HALLMARK) - Greyish white lesions on the inside of the cheek then pinpoint white red papules (occur 48 hours before the rash)

Exanthem (2 days after koplick spots)
- Red rash that begins on face, behind ears, then goes to trunk and extremities

Treatment
- Hydration (due to koplick spots)
- Vitamin A Supplements

Complications
- Otitis Media
- Pneumonia

Prevention
- MMR Vaccine

Question 5

MUMPS (Parotitis)

Answer 5

• Caused by paramyxovirus
• Transmitted through respiratory secretions and saliva
• Communicable 24 hours before and after parotid swelling

Prodromal Period
- Fever, headache
- Sour foods can cause pain in parotid area
- Earache from chewing food

Disease
- Inflammation of salivary (parotid) gland
- Swelling of gland peaks at 1-3 days and lasts up to 3-7 days

Treatment
- Analgesics and hydration
- Soft Food
- Warm/Cold Compresses

Complications
- Sensorineural deafness

Prevention
- MMR Vaccine

Question 6

Varicella (Chicken Pox)

Answer 6

• Caused by Varicella Roster
  Risk Factors
• Steroid therapy, chemotherapy, immunocompromised state, pregnancy
• Transmitted through respiratory secretions, direct contact, airborne
• Incubation 10-21 days
• Communicability 24 hours before onset until all lesions are crusted

Prodromal
- Fever, malaise, intense itching

Exanthem
- Begin as a macule, turns to papule, turns to superficial vesicular lesion (dewdrops), red base develops then lesions crust over (5-7 days after onset).

Treatment
- Antipruritic lotion
- Antipyretics
- Acyclovir and antihistamines (to prevent secondary infection from scratching)

Complications
- Viral Pneumonia
- Secondary bacterial infection
- Fetal Growth Retardation
- Herpes Zoster

Prevention
- Varicella Vaccine (Live Vaccine)
- Given at 12-15 months and 4-6 years

Question 7

Herpes Zoster

Answer 7

• Caused by Varicella Zoster Virus
• Re-activation of varicella that can occur years after primary varicella infection

Risk Factors
- Stressful states to body (cancer, immunocompromised)

• Transmission - Reactivation of virus in dorsal root ganglia

Prodrome
- Headache, fever, malaise
- Unilateral pain, hyperesthesia’s, and dermatome (tingling/itching) along dermatome of spine (typically on 1 side of the body)

Exanthem
- Crops of vesicles usually confined to a dermatome following the course of an affected nerve

Treatment
- Topical antipruritic
- Analgesics (extremely painful)
- Oral Antivirals

Complications
- Meningoencephalitis

Prevention
- Varicella Zoster Vaccine

Question 8

Herpes Simplex

Answer 8

• Caused by Herpes Virus

Type 1 - Oral Lesions
Type 2 - Genital Lesions

Transmission - Saliva/Viral Shedding
Incubation - 2-12 days
Communicability - Can occur when asymptomatic

Prodromal
- Itching, Stinging, Burning, Tingling
- Fever, Malaise, Pain
- Dysuria with Type 2

Exanthem
- Grouped vesicles on erythematous base that evolve into pustules and crusts

Reactivation
Type 1 - Once per year
Type 2 - 2-5 times a year

Treatment
- Analgesics
- Oral Antivirals

Complications
- Ocular Infections
- Encephalitis

Question 9

Molluscum Contagiosum

Answer 9

• Caused by Poxvirus
• Transmitted through direct or indirect skin contact.
• Incubation Period 2-6 Weeks

Exanthem
- Skin colored, red, or translucent papules with central depression typically on face, eyelids, neck, chest, axillae, and genitals
- Anywhere between 1-20 lesions

Treatment
- Resolves on its own within 18 months
- Can also be removed surgically
- Educate parents this may be long term for over a year.

Question 10

Conjunctivitis

Answer 10

• Inflammation of conjunctiva in the eye
• Can be caused by Chlamydia, Gonorrhea, or HSV in newborns
• Chemical conjunctivitis can appear 24 hours after instillation of newborn ophthalmic eye prophylaxis

S/S (Inflamed conjunctiva and swollen eyelids)

Bacterial - Pink Eye (extremely contagious)
- Purulent drainage
- Crusting of eyelids

Viral
- Seen with upper respiratory infections
- Watery drainage

Foreign Body
- Unilateral (only pain in the affected eye)
- Pain, tearing

Allergic
- Itchy, watery eye

Treatment
- Depends on cause
- Bacterial drops
- Antihistamines for allergic reactions

Education for Parents
- Extremely contagious so handwashing and keeping towels separate is important.
- Parents can remove secretions as long as they wipe from inner to outer campus.