Exanthems and Enanthems Lecture Powerpoint Flashcards
Exanthem vs enanthem
Exanthem is breaking out on the surface of skin, an enanthem is an internal rash involving mucus membranes
Koplik spots
Small intraoral lesions most often on the inner cheek against the molars that appear like tiny white grains of sand surrounded by a red ring pathonomonic of measles infection (rubeola)
Triad of measles presentation
Cough
coryza (inflammation of mucus membranes of nose)
conjunctivitis
Measles infection course
- highly contageous with 90% secondary infection rate in susceptible contacts (pneumonia or sinusitis)
- incubation 10-14 days
- rash (exanthem) apears over 2-4 days, nonpruritic**, erythematous macules and papules spreading from face down to trunk and extremities
Rare delayed secondary condition following measles infection
Subacute sclerosing panecephalitis (SSPE)
Measles diagnosis (1) and treatment (2)
-Swab for serologic identification or PCR
- supportive
- prophylactic treatment for exposure to unvaccinated contact or immune globulin can prevent or modify or abort measles infection
4 common findings of scarlett fever
- pastia lines (red lines on the anticubital fossa of elbow creases
- sandpaper appearing red erythematous rash diffusely
- red strawberry tongue with enlarged papilla
- desquamation of palms
Scarlet fever definition
Infection caused by exotoxins produced by GABHS, only evolves in about <10% of streptococcal tonsillopharyngitis cases, affecting mostly patients 5-12 resulting in fever and sore throat followed by rash and exudative tonsopharyngitis with petachiae and punctate red macules on the hard and soft palate
Scarlet fever rash look alike in adolescent patients who have a neg rapid antigen test and culture
Arcanobacterium hemolyticum
Scarlet fever infection course
- incubates 1-4 days
- spread via airborne droplets
- yellowish white coat initially covers tongue against red papillae
- rash appears at base of neck then down rest of body, palms and soles remain clear
- fades in 5-7 days
Scarlet fever diagnosis (1) and treatment (1) and complications (2)
- Rapid antigen test and culture
- oral penicillin or amoxicillin, injectible PCN is curative
- peritonsillar abscess
- rheumatic fever
Blueberry muffin rash and congenital cataracts are characteristic of what infection?
Rubella
Clinical manifestations of rubella infection in children and adults
- mild maculopapular rash in children
- arthalgias, arthritis, and thrombocytopenic purpura
Rubella infection course
- Prodrome of fever, headache, malaise, tender lymphadenopathy lasting 1-5 days
- enanthem and nonspecific exanthems that are pruritic spread in cephalocaudal fashion and fade in 2-3 days
Complications of rubella infection
Congenital rubella syndrome (sensorineural deafness, cataracts, congenital heart disease, CNS anomalies)
Fifth disease (erythema infectiosum, human parvovirus b19) clinical manifestation (3) and diagnosis (2) and treatment (1)
- lacy, reticular erythematous patches and plaques on lower extremeties and feet
- characteristic slapped cheeks appearance
- general malaise and fevers
- clinical
- IgM assay
-supportive
Fifth disease (erythema infectiosum, human parvovirus b19) infection course
- self limiting illness of childhood
- transmitted via droplets
- often seasonal
- incubated 4-15 days
- NO longer infectious once rash is apparent
- concern in pregnancy
Roseola (Herpes virus 6 and 7) infection characteristics (2) and treatment (1)
- HIGH grade fever that lasts 3-4 days and as it subsides the nonpruritic erythematous rash appears
- leading cause of fever induced seizures in age groups 6-24 months
-supportive
Mumps presentation (2)
- swelling one side of face and pain while chewing
- high fever
Complications of mumps (5)
- hearing loss
- viral meningitis or encephalitis
- pancreatitis
- orchitis and potential infertility
- miscarriage
Varicella infection course
- Mostly occur in chidlren younger than 10
- incubate 10-21 days from time of exposure
- spread by respiratory droplets or contact with vesicles
Varicella is caused by this virus
Varicella zoster virus
Varicella zoster manifestations
- varicella (chickenpox)
- herpes zoster (normally reactivation later in life, shingles)
- ramsay hunt syndrome (zoster on the ear causing facial paralysis and hearing difficulties)
- herpes opthalmicus (medical emergency)
Varicella zoster virus diagnostic studies (3) and treatment (1)
- clinical suspicion
- tzanck smear (this is Tav thoughts here, idk if that’s true)
- PCR
-acyclovir
Herpes zoster presentation (2) and complication (1) and treatment (1)
- prodrome of pain or anesthesia along the dermatome following stress or failure of immune system
- herpetiform vesicles develop unilaterally
- post herpatic neuralgia which can last for years
- normally none but acyclovir in early disease course shortens recovery period and reduces chance of postherpatic neuralgia
Anything above waist is typically HSV __, while below is ___
I, II
HSV characteristics (2) and treatment (1)
- groups of vesicles on erythematous base, PAINFUL***
- recurrent outbreaks will occur for life due to stress, trauma, etc
- symptomatic treatment using acyclovir
Herpeti whitlow
Intensely painful infection of the hand involving one or more fingers typically affecting the terminal phalanx caused by HSV1 typically
Hand foot and mouth diesase (coxsackie virus A16) infection course (4)
- spread fecal oral
- incubation 3-10 days
- highly contageous
- prodrome is 3-5 days low grade fever and malaise
Hand foot and mouth disease (coxsackie virus A16) presentation (2) and treatment (1)
- reticulated confluent red papules and plaques symmetric and most prominant on the trunk
- papulovesicular ulceration on palm, sole, and orally
-supportive
Rare complications of hand foot and mouth disease (3)
- myocarditis
- pneumonia
- aseptic meningitis
Herpangina
Usually seen in children of all ages caused by nonpolio enteroviruses and coxssackie, characterized by rapid onset fever, vomiting, sore throat, etc, most mild and resolve within a week, no specific treatment except analgesics
Pityriasis rosea
Common benign papulosquamous disease considered a viral exanthem but has no single viral cause, begins as a solitary patch that resolves within 6 weeks, treatment is entirely suppportive
Infectious mononucleosis (epstein barr) presenting symptoms (4)
- prodrome of headache, fever, debilitating fatigue
- exudative pharyngitis (often mistaken for strep pharyngitis, which is more erythematous!!)
- hepatomegaly and splenomegaly
- rubella like rash
Not all exudative pharyngitis is streptococcal in origin, it can also be…
….infectious mononucleosis
Infectious mononucleosis infection course
- primarily teenagers and young adults
- spread via contact with oral secretions
- high incident of splenic rupture
Inectious mononucleosis diagnostic tests (3)
- leukocytosis with atypical lymphocytes
- monospot test (appears within first 2 weeks and may need retesting)
- EBV viral capsid antigen and immunoglobin most accurate for diagnosis
Infectious mononucleosis treatment options
-self limiting, rest, avoid contact sports
Kawasaki disease
Acute febrile vasculitis of unknown etiology that frequently occurs in young children and has 3 distinct phases that requires intervention early on to prevent complication
3 stages of kawasaki disease
- Acute (1-11 days) HIGH fever and sometimes strawberry tongue or lymphadenopathy
- subacute stage with persistent anorexia, conjunctivia, thrombocytosis, aneurysmal formation
- late stage with cardiac abnormalities that predominate coronary aneurysms (need CXR), leading cause of acquired heart disease in US with many complications
Treatment of kawasaki disease (2)
- aspirin
- intravenous immunoglobulin
(these 2 reduce risk of cardiac involvement from 25 to 5% best in the first 10 days of sickness)
Steven johnson syndrome
Severe erythema multiforme rxn that can be due to infection, medication, and malignancy but may be idiopathic, morbidity and mortality correlated with percent body surface area involved
Most common cause of lymphangitis
Strep pyogenes
Lymphangitis definition
Inflammation of lymphatic channels caused by distal infection, can be quite toxic and febrile, typically presents with red streak traveling up arm with a raised border around affected area, and lymphadenitis
Cellulitis definition and treatment (1)
- Nonnecrotizing infection of the derrmis and hypodermis, patients report fevers, chills, pain, tenderness, etc,
- outpatient with oral antibiotics (cephalexin, amoxicillin/clauvinate)
Most common 2 organisms involved in cellulitis
Strep pyogenes and staph aureus
Erysipelas definition and treatment (1)
Superficial bacterial skin infection that extends into the cutaneous lymphatics, usually involves superficial lymph vessel with sharp distinct outline while celllulitis fades into surrounding skin
-10-20 days penecillin, cephalosporin, or macrolide in PCN allergic
Impetigo
Highly contageous bacterial infection of epidermis, typically from staph A and GABHS (remember individuals can be carriers in their nose), usually occurs from skin breakage and poor hygeine, presents with honey colored crust and either bullous or nonbullous lesions with pruritis
Impetigo treatment
Topical antibiotic such as mupirocen
Impetigo is theorized to contribute to what complication?
Poststrep glomerulonephritis
Scalded skin syndrome
A staph toxin mediated type of exfoliative dermatitis often in children
Most serious complication of HS purpura and how is it diagnosed?
Intusucception, diagnosed via ultrasound
How is HS purpura differentiated from idiopathic thrombocytopenic purpura?
Platelet count is normal in HSP
HS purpura
Vasculitis affecting skin with purpuric lesions, joints, GI and kidneys, in a well appearing child can be managed outpatient but is helpful to manage BP, urine, and electrolytes for glomerulonephritis
Meningitis infection presentation
Variable presentation with some developing septicemia alongside this, usually ill appearing with lethargy, vomiting, and nuchal rigidity, as well as capillary leak, coagulopathy, and myocardial failure. If untreated properly 50% mortality, with prompt treatment drops to 10%
Meningococcemia treatment (1)
-vanco + ceftriaxone without waiting for confirmatory culture
