Infectious Exanthems Flashcards
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)
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
3
Q
exanthem
A
expressed on cutaneous surfaces
4
Q
enanthem
A
expressed on mucosal surfaces
5
Q
HPV –>
A
common warts, plantar warts, flat warts, genital warts, condylomata
6
Q
HPV transmission
A
person to person by contact or through fomites
non-seasonal
7
Q
HPV incubation
A
3 months to many years
8
Q
HPV management
A
liquid N2, various acids, laser, surgical, laser
prevention
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
10
Q
Asymptomatic discrete papular waxy lesions gradually develop on surface of skin. Umbilicated appearance. 2-20 in generalized location
A
Molluscum contagiosum (poxvirus)
11
Q
Molluscum contagiosum spread
A
humans - direct contact/fomites
non-seasonal
infectivity low
12
Q
MC incubation
A
2-7weeks to 6 months
13
Q
MC management
A
mechanical removal
liquid N2, acids
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
15
Q
Variola transmission
A
direct contact w/ skin lesions, mucous membranes
human transmission
animals in winter/spring
16
Q
incubation smallpox
A
12 days
17
Q
communicability of smallpox
A
onset of rash - clearing of crusts
18
Q
dx of smallpox
A
culture of lesions, serology
19
Q
smallpox management
A
strict isolation, symptomatic tx, active immunization
20
Q
eczema vaccinatum
A
skin reaction - underlying skin disease + smallpox vaccine
21
Q
Sheep herder (spring) notices small pimple on finger. No other sxs.
A
Ecthyma contagiosum, orf (poxvirus)
22
Q
orf virus transmission
A
working with sheep - zoonosis usually seen in spring
directly from infected animal
23
Q
incubation orf virus
A
4-7days
24
Q
dx of orf
A
solitary lesion on hand, beginning as erythematous papule and developing into a vesicle
25
management of orf
duration is usually 30-40 days
spontaneously resolves w/ only symptomatic care
wear gloves
26
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)
varicella (chickenpox)
| Herpes virus - VZV
27
VZV transmission
exposure to nasopharyngeal droplet, skin lesion contact, easily air spread
Peaks in late winter/spring
28
VZV incubations
14-16 days
29
VZV communicability
1-2 days before rash to when rash begins to crust (5 days)
30
VZV dx
clinical inspection of rash, spreading from macule to vesicles in 24 hours, hx of contact, immunofluorescence stain of lesion, serology
31
vzv management
strict isolation, avoid use of aspirin, avoid hospitalization, vitamin a, immunization
oral acyclovir w/in 24 hrs
32
smallpox vs chickenpox
```
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
33
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
Herpes simplex 1 and 2
34
HSV1/2 transmission
direct contact - sexual and birthing contacts
| non-seasonal but associated w/ stress
35
HSV1/2 incubation
varies from 2d-2w, becomes latent and recurs
36
HSV1/2 communicability
not well defined, 1 to several weeks
37
dx of HSV1/2
clinical picture, recovery from lesion for cell culture, fluorescent antibody
38
HSV1/2 management
drying agents, acyclovir oint, oral/IV acyclovir/famciclovir/valacyclovir/penciclovir
protect newborns from exposure - pregnancy precautions
39
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
```
HHV 6/7 roseola
exanthem subitum (sixth disease)
```
40
HHV6/7 transmission
probably nasopharyngeal droplet
| yearround
41
incubation HHV6/7
9 days
42
HHV6/7 communicability
early, during febrile stage
43
HHV6/7 dx
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
management sixth disease
antipyretics, ?ganciclovir, no isolation
observe for febrile convulsion
*frequently mislabel as penicillin allergy
45
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.
Infectious mono "Kissing Disease"
| Epstein-Barr Virus (herpesvirus 4)
46
EBV transmission
close contact
pharyngeal secretions
non-seasonal
47
EBV incubation
30-50 days
48
EBV communicability
indeterminate, but virus recovery for months after recovery
49
EBV dx
increased posterior cervical lymph nodes, tender and enlarged spleen, atypical lymphocytes, rapid mono test, heterophile Ab
50
EBV management
symptomatic tx, avoid contact sports, possible steroids, observe for jaundice, avoid tx w/ ampicillin
51
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
Hand, Food and Mouth Disease
herpangina
coxsackievirus (enterovirus)
52
Coxsackievirus transmission
nasopharyngeal droplet, saliva, fecal
| peaks in summer, early fall
53
incubation coxsackievirus
2-6 days
54
communicability coxsackievirus
possible for several weeks
55
coxsackievirus dx
clinical appearance, virus isolation from mucous membranes, feces, serology
56
management coxsackievirus
symptomatic medications, protect newborns, good handwashing, personal hygiene
57
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.
```
Non-specific viral exanthem
Echo virus (enterovirus)
```
58
Echovirus transmission
fecal to oral route
| peaks in summer and early fall
59
incubation echovirus
3-6 days
60
Echovirus communicability
several weeks during fecal viral shedding
61
echovirus dx
clinical course, viral isolation from feces, serology
62
echovirus mngmnt
symptomatic meds, personal hygiene, care w/ diaper changing
63
Non-specific respiratory virus w/ possible exanthem - causative agent
Enterovirus D-68
64
Enterovirus D-68 transmission
respiratory secretions, most serious in asthma, may be found in fecal excretions
peaked last year in mid-August
65
Incubation enterovirus D68
1-5days
66
communicability D68
1 day prior to 5 days after onset
67
Dx D68
clinical course, PCR serology
| episodes of paralysis of arms and legs?
68
D68 management
symptomatic meds, personal hygiene, admission if asthma or serious respiratory sxs
69
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
Erythema infectiosum, fifth disease
| Human parvovirus B19
70
Parvovirus B19 transmission
nasopharyngeal droplet, possible via blood
| peaks in spring
71
B19 incubation
4-14 d
72
B19 communicability
from before onset of rash to shortly after rash appears
| once rash - no need to keep out of school
73
B19 dx
clinical appearance, serology
74
B19 management
symptomatic meds, personal hyg. protect pregnant women from exposure.
75
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.
Rubeola (measles)
| Paramyxovirus
76
Measles transmission
nasopharyngeal droplets, direct contact
| peaks in winter, spring in 2-5 year cycles
77
measles incubation
8-12 days
78
measles communicability
1-2 days before onset of sxs (3-5 days before rash) to 4 days after onset of rash
79
dx measles
clinical appearance, serology for acute/convalescent sera, possible SSPe
80
management measles
isolation, symptomatic medications, vit A
| active immunization, immunoglobulin if exposed IC
81
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.
Rubella = German measles
| Togavirus
82
Rubella transmission
nasopharyngeal droplet, direct contact, maybe stool/urine
| peaks winter/spring, occurs in 6-9 year cycle
83
rubella incubation
16-18 d
84
rubella communicability
7d before to 5 days after onset of rash
85
rubella dx
clinical course and appearance of rash, suboccipital and posterior auricular nodes, serology on acute and convalescent sera
86
rubella management
isolation, symptomatic meds
active immunization
consider globulin in susceptible/pregnant women
87
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.
```
Dengue fever
Dengue virus (arbovirus) and no chikungunya virus
```
88
Dengue fever transmission
mosquitoborne
not present about or below 25degrees N/S
Not seen in winter months
89
Dengue fever incubation
3-8 days
90
Dengue fever communicability
Over lifetime of infected mosquito- up to70 days
91
Dengue fever dx
biphasic fever, pharyngitis, arthralgias, generalized maculopapular rash, not on pals/soles, serology
92
dengue fever management
symptomatic meds
| use of screened windows, insect repellant
93
Big differential dx of other conditions w/ rash
scarlet fever, pityriasis rosea, impetigo, meningococcemia
