Cutaneous Exanthems Flashcards
Rubeola is AKA?
Measles
Rubella is AKA?
German measles
Roseola is AKA?
6th disease (fever before rash) Exanthem subitum
5th Dz is AKA?
Erythema infectiosum
Varicella is AKA?
Chicken pox
6 different cutaneous exanthems?
Rubeola Rubella Roseola 5th Dz Varicella Hand/foot/mouth disease
Rubeola etiology/epidemiology?
Highly contagious
RNA paramyxovirus
URI and regional lymph nodes
Systemic spread
Rubeola incubation time?
8-14d
Rubeola is infectious when?
5d before RASH and 4 days after
Rubeola is transmitted via?
Respiratory secretions,
Blood,
Urine
Rare in young infants <1yr due to?
Maternal antibodies
Rubeola presents as?
Rash-exanthem
High fever 104-105
Classic S/S ( Cough, Coryza, Conjunctivitis)
Koplik spots (lower molars - gray-white spots)
Cervical/Mesenteric LAD
Splenomegaly
Rubeola Rash-exanthem begins when/where/how?
2-5d after fever
On head > most of body over 24hrs
(rash fades same way - Rash extent = severity)
Rubeola Rash appearance?
Macular rash - petechial or hemorrhagic
Infants w/ Rubeola w/ have what presentation also?
AOM, Pneumonia, Diarrhea
WBC level of rubeola pt is?
Leukopenia
Dx of rubeola?
Clinical
PCR or IgM ABs
PEDs MC complication of measles is?
AOM
TXT of rubeola?
Supportive - fluids/APAP
Vit A for 2days
TXT complications
Rubeola Prevention?
Vaccine (MMR)
Rubeola prophylaxis available? If so when?
Measles vaccine w/in 72hr of exposure
Immunoglobin w/in 6d of exposure
Rubella etiology/epidemiology?
Togavirus - Single strand RNA
Unvaccinated populations in spring
Maternal antibodies protect infant for how long against Rubella?
6mo
Rubella incubation period?
14-21d
Rubella transmitted via?
Direct contact or droplets from nasopharyngeal secretions
Rubella pahtophys?
Invades respiratory epithelium >
Virus spreads through blood
Rubella most infectious when?
2d before RASH 5-7 after
- virus will be present 7d before RASH 14d after
Rubella presents as?
Rash Low fever, HA LAD - post auricular/cervical/occipital Mild sore throat, Conjunctivitis Anorexia, malaise, Polyarthritis (hands) Forschheimer spots
Rubella Rash-exanthem begins when/where/how?
Begins on face and spreads to the body that lasts 3 days.
Rubella rash appearance?
Red, maculopapular, discrete rash
Forschheimer spots are?
Rose-colored spots on palate indicting Rubella
Complications of Rubella typically occur when/where/what?
In-utero
- Blueberry muffin baby
- Deaf, Cataracts, CHD
- Sheds virus in NP secretion up to >12mo after birth
PVT of Rubella include?
Vaccine
Erythema infectiosum (5th) etiology/epidemiology?
Parvovirus B19 (single strand DNA)
High affinity for RBC stem cells
Spring time epidemics
Erythema infectiosum transmitted via?
Respiratory secretions
Blood products during transfusions
Erythema infectiosum pathophys?
Invades RBC progenitors and divides >
Cell death of RBC progenitors >
Erythroid aplasia
Erythema infectiosum during pregnancy complication to baby?
Fetal anemia or hydrops fetalis
Erythema infectiosum ass/w SCA, spherocytosis, thalassemia will cause?
Hemolytic anemias + 5th dz = Aplastic crisis
Erythema infectiosum incubation?
4-14d (rare 21d)
Erythema infectiosum presents as?
Mild nonspecific illness - fever, malaise, myalgia, HA
Rash
(Adolescent may have pharyngitis, coryza, GI upset.)
Erythema infectiosum rash process?
- Slapped cheek w/ circumoral pallor around mouth
- Red, Symmetric, maculopapular truncal rash (1-4d)
- Rash fades > lacy/reticular lasting 2-40d and is pruritic, no desquamination.
Erythema infectiosum rash stage 3 reoccurs if?
Exercise, bath, rubbing, stress
Dx of Erythema infectiosum occurs?
Clinically
IgM ABs
PCR
TXT of Erythema infectiosum?
Supportive - fluids/APAP
IV IG for - x-imm or severe anemia/chronic infection
Erythema infectiosum greatest risk is to?
Pregnant women
Exanthem subitem 6th dz (rose) etiology/epidemiology?
HHV 6 and 7
LRG double strand DNA
Maternal antibodies protect child from Exanthem subitem for how long?
6mo
Exanthem subitem presents as?
Rash Sudden onset High fever lasting 3-5d URI S/S - congestion, Red TMs, cough GI symptoms 33% febrile seizures
Rash lasts how long?
1-3d
Dx of Exanthem subitem?
Clinical
Sudden high fever 3-5d followed by rash then defervescence
Hand, foot, mouth dz is due to
Coxsackie A virus via A2M transmission
Hand, foot, mouth dz incubation?
3-5d
Hand, foot, mouth dz presents w/
Rash Mouth pain Sore throat Refuse to eat/drink > anorexia \+- fever, fussy, abd pain, N/V/D
Hand, foot, mouth dz rash presents as?
Oral ulcers
Vesiculopustular rash on hands/feet (+- diaper/thigh)
- palms/soles too
When can Hand, foot, mouth dz pts go back to school?
2-3d after fever resolves
TXT of Hand, foot, mouth dz?
Supportive
Hand, foot, mouth dz can last how long?
10-14d
Hand, foot, mouth dz is infectious how long?
Sheds 6w - 3mo after infection
Varicella etiology and epidemiology?
Varicella-zoster virus (Double strand icosahedral DNA)
Primary infection = Chickenpox (Varicella)
2ndy infection = Shingles (Zoster) - latent
Highly infectious
Late/winter spring
Varicella is infectious until?
2 days before RASH onset 7 days after onset
Varicella is contagious until?
All lesions are crusted
Peak age range of Varicella?
10-14yo - vaccinated
Varicella transmits via?
Direct contact, droplet, airborne into conjunctivae or respiratory tract
Varicella incubation is?
14-16d
Varicella presents as?
Prodrome (Fever, malaise, anorexia) - 1 day before rash
Varicella rash spreads how?
Begins on trunk and spreads to head, face, extremities
W/ all lesion stages present
Varicella rash characteristics?
Pruritic - +- in mucosa membranes
SML red papules - non-umbilicated, oval, teardrop vesicles on red base.
Fluid progresses clear to cloudy
Varicella rash progression?
Small red papules >
Vesicles ulcerate, crust, heal
Cycle of varicella New Lesion crops occurs how often?
Q/3-4d
Varicella TXT?
Symptomatic - (antipyretics, cool bath, hygiene)
NO Rx unless severe
Severe Varicella may be TXT w/?
Acyclovir or Valacyclovir
Varicella complications?
MC = 2ndy infection of skin lesions (staph/strep)
Pneumonia
Reye syndrome
Neuro/Cardiac/Arthritis etc.
Neonatal Varicella is?
Mothers w/ varicella (not shingles) can pass to infant.
When does neonatal Varicella occur?
5d before to 2d after delivery
How to TXT neonatal Varicella?
VZIG (Varicella-zoster IG)
Varicella and Zoster are not SL diseases T/F?
False
Varicella OR Zoster leads to more scarring?
Zoster (deeper in tissue)
When should PEDs return to school if they have Zoster?
After ALL vesicles crusted
Admitted PED w/ Varicella requires what?
Negative pressure room to PVT transmission
Varicella vaccinations req?
Live attenuated virus (x2 doses)
Varicella prophylaxis?
VZIG w/in 96h
V-Zoster is what?
Recurrence of latent VZV
V-Zoster presents as?
Unilateral Dermatomal distro Rash (trunk)
- Regional LAD
- Acute neuritis (pain/TTP)
Fever/Malaise
V-Zoster rash appearance?
Group of lesions for 1-7d > crusts
What nerve branch can be involved w/ V-Zoster?
CN V - Corneal/intraoral lesions
CN VII - Facial paralysis/ear canal vesicles
CN VII V-Zoster is AKA?
Ramsay Hunt syndrome
Complication of V-Zoster w/ pain persisting longer than 1 month is called?
Post-herpetic neuralgia