Chicken Pox and Viral Rashes Flashcards
Coxsackie A vs. Coxsackie B
A - hand foot mouth disease- fever and rash with bubbles on hands and wet
B - myocarditis
What is chicken pox?
Highly contagious generalised vesicular rash due to primary infection with varicella zoster virus
What is shingles?
Reactivation of the dormant varicella zoster virus in dorsal root ganglion
How is chicken pox spread?
Via respiratory route
What is the infectivity and incubation period of chicken pox?
Infectivity = 4 days before rash, until 5 days after the rash first appeared
Incubation period = 10-21 days
Clinical features of chicken pox
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
Management of chicken pox
Supportive
Keep cool, trim nails
Calamine lotion
School exclusion until all lesions are dry and crusted over
Management of immunocompromised patients/newborns with chicken pox
Should receive varicella zoster immunoglobulin (VZIG)
If chickenpox develops IV aciclovir should be considered
Common complications of chicken pox
Secondary bacterial infection of the lesions
NSAIDs may increase this risk
May manifest as single infected lesion/small area of cellulitis
Rare complications of chicken pox
Pneumonia
Encephalitis (cerebellar involvement may be seen)
Disseminated haemorrhagic chickenpox
Arthritis, nephritis and pancreatitis very rarely
What is measles?
Infection caused by measles paramyxovirus
Clinical features of measles
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
Investigations in measles
IgM antibodies detected within a few days of rash onset
Management of measles
Mainly supportive
Admission may be considered in immunocompromised
Inform public health
Complications of measles
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
Aetiology of infectious mononucleosis
Virus found in saliva
May be spread by kissing, sharing cups, toothbrushes etc
Clinical features of EBV infection
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
Management of EBV infection
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
Complications of EBV
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
Associated with certain cancers, notable Burkitt’s lymphoma
Slapped cheek syndrome presentation
Rash on both cheeks + fever
Rash may extend to body and usually presents un context of another illness (usually cold)
Slapped cheek syndrome cause
Parvovirus B19
Hand, foot and mouth disease presentation
Presents with blisters on hands and feet, ulcerations on tongue and fever
Usually presents in the context of another illness, usually the common cold
Most common cause of hand, foot and mouth disease
Coxsackie virus A16
Scarlet fever presentation
Coarse red rash
Sore throat
Headache
Fever
Characteristic ‘sandpaper’ texture and the tongue appears bright red
