Chicken Pox and Viral Rashes

Question 1

Coxsackie A vs. Coxsackie B

Answer 1

A - hand foot mouth disease- fever and rash with bubbles on hands and wet

B - myocarditis

Question 2

What is chicken pox?

Answer 2

Highly contagious generalised vesicular rash due to primary infection with varicella zoster virus

Question 3

What is shingles?

Answer 3

Reactivation of the dormant varicella zoster virus in dorsal root ganglion

Question 4

How is chicken pox spread?

Answer 4

Via respiratory route

Question 5

What is the infectivity and incubation period of chicken pox?

Answer 5

Infectivity = 4 days before rash, until 5 days after the rash first appeared

Incubation period = 10-21 days

Question 6

Clinical features of chicken pox

Answer 6

Tend to be more severe in older children/adults

Fever initially

Itchy, rash starting on head/trunk before spreading

Initially macular, then papular, then vesicular

Systemic upset is usually mild

Question 7

Management of chicken pox

Answer 7

Supportive

Keep cool, trim nails

Calamine lotion

School exclusion until all lesions are dry and crusted over

Question 8

Management of immunocompromised patients/newborns with chicken pox

Answer 8

Should receive varicella zoster immunoglobulin (VZIG)

If chickenpox develops IV aciclovir should be considered

Question 9

Common complications of chicken pox

Answer 9

Secondary bacterial infection of the lesions

NSAIDs may increase this risk

May manifest as single infected lesion/small area of cellulitis

Question 10

Rare complications of chicken pox

Answer 10

Pneumonia

Encephalitis (cerebellar involvement may be seen)

Disseminated haemorrhagic chickenpox

Arthritis, nephritis and pancreatitis very rarely

Question 11

What is measles?

Answer 11

Infection caused by measles paramyxovirus

Question 12

Clinical features of measles

Answer 12

Prodromal phase: irritable, conjunctivitis, fever

Koplik spots (white spots on buccal mucosa)

Maculopapular rash (starts behind ears then to the whole body)

Diarrhoea occurs in around 10% of patients

Question 13

Investigations in measles

Answer 13

IgM antibodies detected within a few days of rash onset

Question 14

Management of measles

Answer 14

Mainly supportive

Admission may be considered in immunocompromised

Inform public health

Question 15

Complications of measles

Answer 15

Otitis media

Pneumonia

Encephalitis

Subacute sclerosing panencephalitis (very rare, may present 5-10 years following the illness)

Febrile convulsions

Keratoconjunctivitis, corneal ulceration

Diarrhoea

Increased incidence of appendicitis

Myocarditis

Question 16

Aetiology of infectious mononucleosis

Answer 16

Virus found in saliva

May be spread by kissing, sharing cups, toothbrushes etc

Question 17

Clinical features of EBV infection

Answer 17

Fever

Sore throat

Fatigue

Lymphadenopathy(swollen lymph nodes)

Tonsillar enlargement

Splenomegalyand in rare casessplenic rupture

Classic picture is adolescent with sore throat who develops itchy rash after taking amoxicillin

Question 18

Management of EBV infection

Answer 18

Usually self limiting

Acute illness lasts ~2-3 weeks

Advise to avoid alcohol as EBV impacts the ability of the liver to process it

Advise to avoid contact sports due to risk of splenic rupture

Question 19

Complications of EBV

Answer 19

Splenic rupture

Glomerulonephritis

Haemolytic anaemia

Thrombocytopenia

Chronic fatigue

Associated with certain cancers, notable Burkitt’s lymphoma

Question 20

Slapped cheek syndrome presentation

Answer 20

Rash on both cheeks + fever

Rash may extend to body and usually presents un context of another illness (usually cold)

Question 21

Slapped cheek syndrome cause

Answer 21

Parvovirus B19

Question 22

Hand, foot and mouth disease presentation

Answer 22

Presents with blisters on hands and feet, ulcerations on tongue and fever

Usually presents in the context of another illness, usually the common cold

Question 23

Most common cause of hand, foot and mouth disease

Answer 23

Coxsackie virus A16

Question 24

Scarlet fever presentation

Answer 24

Coarse red rash

Sore throat

Headache

Fever

Characteristic ‘sandpaper’ texture and the tongue appears bright red

Question 25

Management of scarlet fever

Answer 25

Antibiotics (usually 10 days of phenoxymethylpenicillin)

Question 26

Roseola cause

Answer 26

Human herpes virus 6

Question 27

Roseola presentation

Answer 27

Lace-like red rash across the whole body with a high fever

Question 28

Rubella presentation

Answer 28

Postauricular lymphadenopathy and a rash that starts on the head and spreads down to the trunk