Exanthems and Enanthems Flashcards
aka measles
rubeola
prodrome symptoms of measles
*koplik spots, fever, severe cough, nasal congestion, conjunctivitis
how does measles start/spread to
*begins behind the ears and then trunk then extremities
tx for measles
VIT A, supportive
hand foot mouth dz cause
coxaskie virus and enterovirus
symptoms of hfmd
oral lesions -90%
3-7mm red macules that become pale, white, oval vesicles with a red areola.
Occur on the palms, soles, dorsal aspects of the fingers toes
tx for hfmd
supportive
scarlet fever cause
streptococcus toxins
where does scarlet fever originate
pahrynx (strep throat) or skin
scarlet fever PE findings
skin-sandpaper feel
pastias line
desquamation
throat- strawberry tongue
tx for scarlet fever
amoxicillin (peds), PCN, cephs, erythromycin for PCN allergy
rubella aka
german measles
most imp consequences are to who when infected w/ rubella
the unborn
rubella s/sx
soft palate petechiae (20%)
begins on neck/face then travels to trunk
rubella classic triad of clinical effects
cardiac malformation, hearing deficits, and ocular anomalies.
blueberry muffin, congenital cataract
rubella
erythema infectiosum aka
fifths, parvovirus
stages of parovirus
Stage 1: facial erythema (slapped cheeks)
Stage 2: Net pattern erythema
Stage 3: recurrent phase
can fifths disease affect a preggers women
yes-can cross placenta
roseala infatum presentation
Typically: VERY high fever, fever subsides and the rash appears
how common if roseola
80% of all children by age 1, 90% by age 2 (95% in adults)
prodrome of roseola
Sudden onset of high fever 102°F-104°F (39°C-40°C)
eruptive phase of roseola
begins when fever ends
tx for roseola
supportive
kawasaki disease etiology
acute multisystem vasculitis of unknown etiology (likely infectious cause)
main cause of morbidity for kawasaki disease
***coronary aneurysms
major criteria for kawaskie
MUST have FEVER for more than 5 DAYS
kawasakie tx
high dose ASA
IV IG
careful of reyes syndrome though
the viral rash
will not get definite dx
usually diffuse rash all over body
major complications of measles
pneumonia**, bronchitits, otitis media, sinusitis, stomatitis, encephalitis and myocarditis (high risk of getting these)
what could happen 10 yrs after a measles infection
subacute sclerosing panencephalitis (SSPE)
can measles reactivate latent TB?
yes
best dx for measles
oral swab
what is the scarlet fever look alike rash
Arcanobacterium hemolyticum
what season does scarlet fever occur
late fall, early winter, early spring
class scarlet fever presentation
abruptly with fever and sore throat, then rash appears in 1-2 days
late complications of scarlet fever
include rheumatic fever and poststreptococcal glomerulonephritis
can include rheumatic fever and poststreptococcal glomerulonephritis be prevented with early strep tx?
no
complications of scarlet fever-what are they same as
strep infection
Peritonsillar abscess, cervical lymphadenitis, retropharyngeal abscess, otitis media, bronchopneumonia, meningitis, brain abscess, intracranial venous sinus thrombosis, bacteremia and septicemia
when season does rubella infections occur
late winter early spring
prodrome of rubella
fever, headache, malaise, tender lymphadenopathy (occipital, posterior auricular and cervical) and upper respiratory symptoms lasting 1 to 5 days
when season is fifths disease most likely to occur
spring, aged 4-10
progression of Erythema Infectiosum
“slapped cheek” rash develops that progresses to involve the trunk and extremities with erythematous macules, papules and patches. Eventually the truncal eruption fades to leave behind lacy, reticular pattern, occasionally itchy.
how is the dx of Erythema Infectiosum made
clinically
when are kids considered no longer contagious w/ Erythema Infectiosum
when the rash is apparent
describe the exanthem of roseola
pink, blanchable, macule papules that are usually not pruritic
tx for roseloa
self limiting but associated w/ febrile seizures
mumps is associated with…
a virus that causes inflammation in the parotid gland
is mumps serious or benign, asymptomatic/symptomatic
majority benign and asymptomatic
complications of mumps
Hearing loss Rarely viral meningitis, encephalitis, and pancreatitis. Orchitis can occur in teens and young adults. Infertility can occur in those with orchitis. Miscarriage can occur in women with mumps in the first trimester.
can you get mumps even if you are vaccinated
yes - possibly due to waning immunity
what is varicella caused by
varicella zoster virus
when do ppl get varicella
90% <10 yrs
dew drops on rose petals
varicella
classic triad of varicella
rash, malaise, low grade fever
how does the rash present in varicella
in crops, from trunk first usually
how long are varicella pts contagious for
2 days before lesions erupt until they are all crusted
dx of varicella
clinically and confirmed by PCR
MC complication of varicella
secondary bacterial inf
tx of varicella
supportive, calamine lotion for itching
when do you need acyclovir for varicella
immunocompromised children and with VariZIG™ for highly susceptible individuals within 96 hours of exposure
what is herpes zoster caused by
reactivation of varicella zoster virus
how does zoster present
in a dermatomal pattern rarely crossing midline
tx for zoster
antiviral agents (eg, acyclovir) given early in the disease course shorten the recovery period and reduce the chance of postherpetic neuralgia
what is herpes zoster opthalmicus and is it an emergeny
herpes zoster of the opthalmic division of trigeminal nerve, EMERGENCY
what is ramsay hunt syndrome
herpes zoster oticus, is a reactivation of VZV that involves the facial nerve. Cranial nerves V, VI, VIII, and IX may also be involved.
where does HSV-1 and HSV-2 reactivate
HSV-1 reactivates predominantly in the trigeminal ganglia, called herpes labialis (shown)
HSV-2 reactivates in the lumbosacral ganglia, called herpes genitalis.
symptoms of HSV
painful ulcerating lesions
tx for HSV
typically self limiting BUT antivirals will shorten the course of symptoms and may help to prevent dissemination and transmission
herpetic whitlow
intensely painful infection of the hand caused by HSV
enterovirus season
usually summer months
GI symptoms + fever + rash
enterovirus
tx for enterovirus
usually self limiting
where is enterovirus shed and spread
via fecal oral route and shed in feces
hfmd is a variation of…
enterovirus
herpangia cause
nonpolio enteroviruses, coxsackieviruses A and B as well as echoviruses
presenting symptoms of herpangia
rapid onset of fever, vomiting, sore throat, and the appearance of numerous vesicular lesions in the region of the tonsillar fauces (anterior tonsillar pillars, tonsillar pillars, soft palate, uvula and posterior pharynx)
tx of herpangia
nonspecific, possible numbing mouth rinses
infectious mononucleosis presenting symptoms
lymphadenopathy* or pan-lyphadenopathy
splenomegaly in > 50% of patients
Could have ULQ pain
Characteristically prolonged, recovery takes 4 to 6 weeks, rarely 12 or more weeks
infectious mononucleosis is caused by
EBV
big thing to watch out for w/ mono
SPLENIC RUPTURE***
specific serology test for mono
EBV viral capsid antigen (VCA) Immunoglobulin (IgM) is the most accurate and useful tool for the diagnosis of Infectious
tx for mono
REST- NO PHYSICAL ACTIVITIES
highest rate of splenic rupture is 2-3 wks
kawasaki caused by…
vasculitis caused by unknown etiology
dx of kawasaki
DO ECHO -look for coronary aneurysms
tx to prevent coronary aneurysms in kawasaki dz
aspirin and intravenous immunoglobulin, which reduces the risk for cardiac involvement to 5%.
steven’s johnson syndrome cause…
response to triggers (infections, malignancies, medication)
more severe version of erythema multiforme
difference between SJS and erythema multiforme
SJS may involve the mucous
membranes (vs erythema multiforme that has NO muscous membrane involvement)
lymphangitis
inflammation of lymph channels
lymphangitis presentation
a red streak traveling up the arm, a raised border around the affected area, and lymphadenitis.
lymphangitis cause
is Streptococcus pyogenes
cellulitis cause
Streptococcus pyogenes and Staphylococcus aureus.
tx for cellulitis
activity against staphylococci and streptococci (eg, dicloxacillin, cephalexin, clindamycin, amoxicillin/clavulanate=augmentin
cellulitis presentation
fevers, chills, pain, swelling, tenderness, erythema, and warmth. The borders of cellulitis are NOT elevated or sharply demarcated.
lymphangitis vs cellulits
cellulitis- more diffuse, no elevations, no sharp demarcations
lymphangitis- streaking, elevated
Erysipelas
superficial bacterial skin infection that extends into the cutaneous lymphatics
Erysipelas cause
by group A streptococci, in many cases secondary to local skin trauma.
Erysipelas presentation
sharp, distinct outline, whereas cellulitis fades gradually into the surrounding skin.
impetigo cause
Staphylococcus aureus and group A beta-hemolytic streptococci (GABHS)
peak incidence of impetigo
summer and fall
tx for impetigo
topical mupirocin
H.S. purpura most serious complication
Intussusception
where does H.S. purpura usually present
below the waist
how to differentiate between idiopathic thrombocytopenic pupura and H.S purpura (lab test)
platelet count generally normal in HS
meningococal inf cause
Neisseria meningitides.
clinical presentation of miningitis
Children with meningitis are usually febrile and ill-appearing, with symptoms of lethargy, vomiting, or nuchal rigidity (doesn’t always happen)
complications of miningitis
Septic emboli cause arterial occlusion in the distal extremities, as shown in this infant.
The disease is fatal in 50 % of cases, if left untreated. Even with prompt treatment, the mortality rate is 5-10%
Septicemia leads to capillary leak, coagulopathy, profound acidosis, and myocardial failure
meninigitis tx
antibiotic treatment should be initiated without waiting for confirmatory culture testing. Initial antibiotic of choice is
Vancomycin + Ceftriaxone.
