L8 Viral Exanthems Flashcards
Etiology of Measles/Rubeola
Paramyxovirus
Symptoms of Measles/Rubeola
3Cs (cough, coryza-rhinitis, conjunctivitis), Koplik spots (enanthem in mouth), fever (105+), maculopapular Blanchable rash that spreads from head to toe and spares palms and soles
Koplik spots
Cluster of tiny bluish-white papules on buccal mucosa, “grains of salt on a red background”
Complications of Measles/Rubeola
Common is diarrhea or otitis media, more severe is pneumonia, encephalitis or subacute sclerosing panencephalitis
Subacute Sclerosing Panencephalitis
7-10 years after Measles, fatal degenerative disease of CNS, behavioral and intellectual deterioration, seizures
Treatment of Measles/Rubeola
Symptomatic treatment only, sometimes vitamin A or ribavirin
Etiology of erythema infectiosum(fifth disease)
Parvovirus B-19
Symptoms of erythema infectiosum
Facial rash (erythematous malar rash) called “slapped cheek” which is then followed by lacy, pink macular rash over body (trunk and extensor surfaces) 2-3 days later, starts with non-specfic flu-like sxs
Complications of erythema infectiosum
Rare but transient aplastic crisis, in pregnancy can be hydrops fetalis and/or fetal loss
Etiology of Rubella
Rubella virus
Transmission of Rubella
Inhaled large particle aerosols
Symptoms of Rubella
“3 day Measles” with a erythematous papules and purpura, head to toe progression, pinpoint/pink maculopapules, may have arthritis
Complications of Rubella
Encephalopathy, birth defects in pregnant women that lead to congenital rubella syndrome (blueberry muffin rash, hearing loss, mental retardation, CV and ocular defects)
Etiology of roseola infantum
Most commonly herpes virus 6 (HHV 6)
Symptoms of roseola infantum
High fever for 3-5 days and abruptly ends the an abrupt blanching pink/erythematous maculopapular rash (starts at neck and trunk and spreads to face then extremities)
Etiology of hand, foot and mouth disease
Coxsackie A16 virus
Transmission of hand foot mouth disease
Oral ingestion of virus (fecal oral or oral/respiratory secretions)
Symptoms of hand foot and mouth
Oral exanthem and enanthem on hand, feet and buttocks, vesicles may ulcerate
Etiology of molluscum contagiosum
Poxvirus
Symptoms of molluscum contagiosum
Flesh colored, pearly, papules with umbilication, located anywhere except palms and soles
Etiology of condylomata acuminatum or verruca vulgaris (warts)
HPV
Presentation of condylomata acuminatum
Classic cauliflower like lesions, perinatal growth, mild pruritis
Etiology of varicella
Varicella-zoster virus, a herpes virus
Symptoms of varicella
Generalized vesicular rash that is pruritic, with fever, malaise, pharyngitis or anorexia
3 main stages of varicella
Diagnose to see all 3 at same time, papules, ulcer and blister
Etiology of herpes zoster (shingles)
Varicella zoster virus
Transmission of Measles/ Rubeola
Infectious droplets spread by cough, sneeze or close breathing (stays for up to 2 hours)
Transmission of erythema infectiosum
Respiratory secretions
Transmission of molluscum contagiousum
Direct physical contact and contact with contaminated fomites, also autoinoculation
Treatment of molluscum contagiousum
Best option is no treatment, popophyllotoxin cream at home (not for pregnant women)
Treatment of condyloma acuminatium
Topical (podophyllin, immunotherapy or surgery
Tzanck smear
Use to show multinucleated giant cells associated with 3 stages of varicella
Timeline for return to school after varicella
Only contagious until all legions are crusted
Pattern of Shingles
Dormant HZV follows the dermatome of a specific sensory ganglion, unilateral
Symptoms of herpes zoster
Prodrome has acute, neuritic pain preceding eruption by 3-5 days, rash is ACTIVE and is development of grouped vesicles on an erythematous base
Complications of herpes zsoter
Post herpetic neuralgia, herpes zoster opthalmicus, acute retinal necrosis or nerve palsies
Post herpetic neuralgia
Lancinating, neuritic pain that can last months/yrs after resolution of lesions
Herpes zoster ophthalmicus
Sight-threatening linked to trigeminal ganglion activation, see hutchinson’s sign
Hutchinson’s sign
Trigeminal pattern of vesicles that go to the tip of the nose, HZV
Treatment of herpes zoster
Start within 72 hours, use antivirals (famciclovir or valacyclovir), might need to manage pain with narcotics
Infectious precautions of herpes zoster
Patient can transmit varicella to seronegative patients through contact with skin lesions
Types of HSV
HSV-1 (herpes labialis, cold sores), HSV-II (herpes genitalis, sexually), symptoms CAN flip between
Primary presentation of HSV-1
Gingivostomatitis, pharyngitis, severe mouth pain and fever
Pathogenesis of HSV
Virus can remain latent following primary infection and can be reactivated by change in immune status
Presentation of HSV
Prodrome of tingling, burning or pruritus, lesions appear as grouped vesicles on an erythematous bases (may see crusting)
Complications of HSV
Erythema multiforma, eczema herpaticum, recurrent aseptic meningitis
Treatment for chronic suppression of HSV
Antivirals with reassessment at 4-6 mos
Lipoma
Soft, mobile, non-tender subcutaneous soft-tissue tumor
Epidermal inclusion cyst
Soft, mobile, fluctuant nodule, sometimes central punctum and can be painful
