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Skin MS: Week 4 > Infectious Exanthems > Flashcards

Infectious Exanthems Flashcards

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1
Q

DNA viruses

A 
HPV - warts
Pox virus - MC, smallpox (Variola)
Orf virus - Exanthem contagiosum
Herpes (varicella, HSV1/2, HHV 6/7, EBV)
Parvovirus - erythema infectiosum (Fifth disease)
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2
Q

RNA viruses

A 
Enterovirus (Coxsackievirus - HFM, Echo virus - non-specific, EV D68 - severe respiratory)
Paramyxovirus - measles (rubeola)
Togavirus - rubella
arbovirus - dengue virus, chikungunya
Filoviridae - ebola
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3
Q

exanthem

A

expressed on cutaneous surfaces

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4
Q

enanthem

A

expressed on mucosal surfaces

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5
Q

HPV –>

A

common warts, plantar warts, flat warts, genital warts, condylomata

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6
Q

HPV transmission

A

person to person by contact or through fomites

non-seasonal

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7
Q

HPV incubation

A

3 months to many years

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8
Q

HPV management

A

liquid N2, various acids, laser, surgical, laser

prevention

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9
Q

Small growth on surface of skin and gradually enlarges over long period. Relatively few sxs (maybe pain on foot). Small black dots seen centrally. Surface exhibits hyperkeratinization.

A

HPV - wart

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10
Q

Asymptomatic discrete papular waxy lesions gradually develop on surface of skin. Umbilicated appearance. 2-20 in generalized location

A

Molluscum contagiosum (poxvirus)

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11
Q

Molluscum contagiosum spread

A

humans - direct contact/fomites
non-seasonal
infectivity low

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12
Q

MC incubation

A

2-7weeks to 6 months

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13
Q

MC management

A

mechanical removal

liquid N2, acids

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14
Q

Vesiculated rash from distal distribution to central
HA, fever, malaise, muscular pains before rash
Rash develops in same stages w/ local crops and becomes encrusted. Illness lasts 2 weeks and resolves w/ significant scarring. Hemorrhagic form is highly fatal

A

Variola (smallpox) - poxvirus

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15
Q

Variola transmission

A

direct contact w/ skin lesions, mucous membranes
human transmission
animals in winter/spring

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16
Q

incubation smallpox

A

12 days

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17
Q

communicability of smallpox

A

onset of rash - clearing of crusts

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18
Q

dx of smallpox

A

culture of lesions, serology

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19
Q

smallpox management

A

strict isolation, symptomatic tx, active immunization

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20
Q

eczema vaccinatum

A

skin reaction - underlying skin disease + smallpox vaccine

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21
Q

Sheep herder (spring) notices small pimple on finger. No other sxs.

A

Ecthyma contagiosum, orf (poxvirus)

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22
Q

orf virus transmission

A

working with sheep - zoonosis usually seen in spring

directly from infected animal

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23
Q

incubation orf virus

A

4-7days

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24
Q

dx of orf

A

solitary lesion on hand, beginning as erythematous papule and developing into a vesicle

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25
Q

management of orf

A

duration is usually 30-40 days
spontaneously resolves w/ only symptomatic care
wear gloves

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26
Q

General malaise - fever - pruritic rash beginning centrally on head and trunk and extending peripherally.
Macule –> papule in 24 hrs
Local areas have various stages of development
Clears over week to 10 days
Latent infection, do not treat w/ aspirin (Reye’s)

A

varicella (chickenpox)

Herpes virus - VZV

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27
Q

VZV transmission

A

exposure to nasopharyngeal droplet, skin lesion contact, easily air spread
Peaks in late winter/spring

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28
Q

VZV incubations

A

14-16 days

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29
Q

VZV communicability

A

1-2 days before rash to when rash begins to crust (5 days)

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30
Q

VZV dx

A

clinical inspection of rash, spreading from macule to vesicles in 24 hours, hx of contact, immunofluorescence stain of lesion, serology

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31
Q

vzv management

A

strict isolation, avoid use of aspirin, avoid hospitalization, vitamin a, immunization
oral acyclovir w/in 24 hrs

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32
Q

smallpox vs chickenpox

A 
smallpox
ill 7-17 days after contact
has fever/malaise 2-4 days before rash
Pocks mostly on face/arms/legs
Present on palms/soles
Scabs 10-14 days after rash appears
Fall off 14-28 days after rash appears

Chickenpox
ill 14-21 days after contact
no sxs before rash
pocks most numerous on body, not on palms/soles usually
Scabs 4-7 days after rash appears
scabs fall off w’/in 14 days after rash begins

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33
Q

Stinging erythematous lesion at junction skin/lip
Proceeds to crusted sore over few days but lasts up to 10-12 days. no systemic sxs noted.
Lesions of oral cavity (gingiva and tongue) and genital region may be found

A

Herpes simplex 1 and 2

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34
Q

HSV1/2 transmission

A

direct contact - sexual and birthing contacts

non-seasonal but associated w/ stress

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35
Q

HSV1/2 incubation

A

varies from 2d-2w, becomes latent and recurs

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36
Q

HSV1/2 communicability

A

not well defined, 1 to several weeks

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37
Q

dx of HSV1/2

A

clinical picture, recovery from lesion for cell culture, fluorescent antibody

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38
Q

HSV1/2 management

A

drying agents, acyclovir oint, oral/IV acyclovir/famciclovir/valacyclovir/penciclovir
protect newborns from exposure - pregnancy precautions

39
Q

six mo old infact w/ high fever w/ minimal respiratory sxs preceeding. Infant seems playful in spite of fever. After about 3 days, fever breaks and fine maculopapular rash develops on neck and trunk then disappears in two days

A 
HHV 6/7 roseola 
exanthem subitum (sixth disease)
40
Q

HHV6/7 transmission

A

probably nasopharyngeal droplet

yearround

41
Q

incubation HHV6/7

A

9 days

42
Q

HHV6/7 communicability

A

early, during febrile stage

43
Q

HHV6/7 dx

A

clinical course, non-toxic, but febrile infant (3mo to 3 yrs) w/ high fever, possible febrile convulsion, virus isolation possible

Fever clears when rash devleops

44
Q

management sixth disease

A

antipyretics, ?ganciclovir, no isolation
observe for febrile convulsion
*frequently mislabel as penicillin allergy

45
Q

Adolescent w/ sore throat, mild fever, enlarged lymph nodes, extreme tiredness over 3-4 days. Tiredness lingers a week or more as other sxs resolve. Maculopapular rash may be noted on trunk, possible jaundice.

A

Infectious mono “Kissing Disease”

Epstein-Barr Virus (herpesvirus 4)

46
Q

EBV transmission

A

close contact
pharyngeal secretions
non-seasonal

47
Q

EBV incubation

A

30-50 days

48
Q

EBV communicability

A

indeterminate, but virus recovery for months after recovery

49
Q

EBV dx

A

increased posterior cervical lymph nodes, tender and enlarged spleen, atypical lymphocytes, rapid mono test, heterophile Ab

50
Q

EBV management

A

symptomatic tx, avoid contact sports, possible steroids, observe for jaundice, avoid tx w/ ampicillin

51
Q

Young child w/ malaise, mild fever
sore throat, lesions in mouth and on extremities. Enanthem w/in 1-2 days after onset of sxs and exanthem shortly thereafter. Lesions clear within 1 week. Possibly ulcerative rash in posterior phalanx

A

Hand, Food and Mouth Disease
herpangina
coxsackievirus (enterovirus)

52
Q

Coxsackievirus transmission

A

nasopharyngeal droplet, saliva, fecal

peaks in summer, early fall

53
Q

incubation coxsackievirus

A

2-6 days

54
Q

communicability coxsackievirus

A

possible for several weeks

55
Q

coxsackievirus dx

A

clinical appearance, virus isolation from mucous membranes, feces, serology

56
Q

management coxsackievirus

A

symptomatic medications, protect newborns, good handwashing, personal hygiene

57
Q

Child w/ flu-like process w/ mild fever, malaise, abdominal cramping, diarrhea, and non-specific maculopapular rash on trunk. Rash fades over 5 days, after other sxs gone.

A 
Non-specific viral exanthem
Echo virus (enterovirus)
58
Q

Echovirus transmission

A

fecal to oral route

peaks in summer and early fall

59
Q

incubation echovirus

A

3-6 days

60
Q

Echovirus communicability

A

several weeks during fecal viral shedding

61
Q

echovirus dx

A

clinical course, viral isolation from feces, serology

62
Q

echovirus mngmnt

A

symptomatic meds, personal hygiene, care w/ diaper changing

63
Q

Non-specific respiratory virus w/ possible exanthem - causative agent

A

Enterovirus D-68

64
Q

Enterovirus D-68 transmission

A

respiratory secretions, most serious in asthma, may be found in fecal excretions
peaked last year in mid-August

65
Q

Incubation enterovirus D68

A

1-5days

66
Q

communicability D68

A

1 day prior to 5 days after onset

67
Q

Dx D68

A

clinical course, PCR serology

episodes of paralysis of arms and legs?

68
Q

D68 management

A

symptomatic meds, personal hygiene, admission if asthma or serious respiratory sxs

69
Q

Gradeschool child w/ very mild upper respiratory illness, then very red slapped-cheeks rash on face. OVer few days, fades and lacy rash noted on upper extremities. This may fade only to return in couple of weeks, maybe some vague joint complaints

A

Erythema infectiosum, fifth disease

Human parvovirus B19

70
Q

Parvovirus B19 transmission

A

nasopharyngeal droplet, possible via blood

peaks in spring

71
Q

B19 incubation

A

4-14 d

72
Q

B19 communicability

A

from before onset of rash to shortly after rash appears

once rash - no need to keep out of school

73
Q

B19 dx

A

clinical appearance, serology

74
Q

B19 management

A

symptomatic meds, personal hyg. protect pregnant women from exposure.

75
Q

Young unvaccinated from travel - week later, upper resp sxs w/ rhinitis and cough, conjuctivitis. Discrete red rash gradually becoming confluent as spreading from central to distal body sites. High fever. Koplik spots on buccal mucosa. Total illness lasts 1 week.

A

Rubeola (measles)

Paramyxovirus

76
Q

Measles transmission

A

nasopharyngeal droplets, direct contact

peaks in winter, spring in 2-5 year cycles

77
Q

measles incubation

A

8-12 days

78
Q

measles communicability

A

1-2 days before onset of sxs (3-5 days before rash) to 4 days after onset of rash

79
Q

dx measles

A

clinical appearance, serology for acute/convalescent sera, possible SSPe

80
Q

management measles

A

isolation, symptomatic medications, vit A

active immunization, immunoglobulin if exposed IC

81
Q

School age child w/ mild upper resp sxs and malaise, low grade fever. Shortly thereafter, fine maculopapular rash on upper body and spreads to lower body. Clears in same fashion over 3 days. Enanthem (forchheimer spots) may appear on soft palate/uvula. Some joint pain and cervical lymph nodes may be present.
Significant congential form may develop in fetuses exposed in early pregnancy.

A

Rubella = German measles

Togavirus

82
Q

Rubella transmission

A

nasopharyngeal droplet, direct contact, maybe stool/urine

peaks winter/spring, occurs in 6-9 year cycle

83
Q

rubella incubation

A

16-18 d

84
Q

rubella communicability

A

7d before to 5 days after onset of rash

85
Q

rubella dx

A

clinical course and appearance of rash, suboccipital and posterior auricular nodes, serology on acute and convalescent sera

86
Q

rubella management

A

isolation, symptomatic meds
active immunization
consider globulin in susceptible/pregnant women

87
Q

High grade fever suddlenly, lasting 1-5 days, hx of travel
some joint pains, sore throat, cough w/ significant general malaise and vomiting. After fever, non-descript generalized rash, sparing soles and palms. Individual appears ill and toxic. There is a fatal hemorrhagic form.

A 
Dengue fever
Dengue virus (arbovirus) and no chikungunya virus
88
Q

Dengue fever transmission

A

mosquitoborne
not present about or below 25degrees N/S
Not seen in winter months

89
Q

Dengue fever incubation

A

3-8 days

90
Q

Dengue fever communicability

A

Over lifetime of infected mosquito- up to70 days

91
Q

Dengue fever dx

A

biphasic fever, pharyngitis, arthralgias, generalized maculopapular rash, not on pals/soles, serology

92
Q

dengue fever management

A

symptomatic meds

use of screened windows, insect repellant

93
Q

Big differential dx of other conditions w/ rash

A

scarlet fever, pityriasis rosea, impetigo, meningococcemia

Skin MS: Week 4 (10 decks)

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