Lecture 10: Viral Exanthems

Question 1

What are the 6 childhood exanthems?

Answer 1

Question 2

Who is rubeola/measles most common in?

Answer 2

Children <5

Question 3

What is the causative organism in rubeola?

Answer 3

Rubeola virus

Question 4

How long is someone with rubeola contagious?

Answer 4

4 days prior to rash
4 days post rash appearance

Question 5

What do koplik’s spots look like?

Answer 5

Tiny white spots with blue centers on buccal mucosa.

Question 6

How does rubeola typically present?

Answer 6

-low grade fever
-dry cough
-coryza
-conjuctivitis
-sore throat
-rash
-koplik’s spots on buccal mucosa

4C’s
Cough
Coryza
Conjunctivitis
Koplik

Question 7

What kind of rash does rubeola present with?

Answer 7

Red, blotchy skin rash
Often behind the ears and along hairline.

Usually recedes from face then extremities
Can be mistaken for scarletina.

Question 8

What is unique about the fever of rubeola?

Answer 8

It can jump to 104-105F

Question 9

What is the treatment for rubeola?

Answer 9

Supportive care.
AVOID ASA (Reye’s syndrome)
ABX if bacterial complications.

Question 10

What is the MC complication of rubeola?

Answer 10

OM

2: Bronchitis
3: Pneumonia
4: Pregnancy complications
5: Encephalitis
6: Thrombocytopenia

Rubeol = 7 letters, itself + 6 complications

Question 11

What is the vaccination schedule for rubeola?

Answer 11

12 months
4 years

Both are given in MMR form.

Question 12

What is the causative organism for Mumps?

Answer 12

Mumps virus

Question 13

How is mumps transmitted?

Answer 13

Airborne
Saliva
Surfaces

Mumps is ASS

Question 14

How long is mumps contagious?

Answer 14

5 days after their glands swell.

Must isolate someone during those 5 days.

Question 15

How does mumps present?

Answer 15

• Fever
• HA
• Muscle aches
• Tiredness
• Loss of appetite
• Parotitis

Parotitis is swollen and tender salivary glands under the ears or jaw on one or both sides of the face.

Like a chipmunk

Question 16

How is mumps treated?

Answer 16

Supportive care only.

Question 17

What are the main complications of mumps?

Answer 17

• Orchitis
• Encephalitis
• Oophoritis/Mastitis
• Deafness

Orchitis and Oophoritis are for when they reach puberty.
Mumps = 5 letters, itself + 4 complications

Question 18

How effective is the mumps vaccine?

Answer 18

2 doses = 88%
1 dose = 78%

Question 19

What is rubella also known as?

Answer 19

German Measles
3-day measles
3rd disease

Question 20

What is the main concern with rubella/3rd disease?

Answer 20

Placental transmission
Long contagious period

It is not as contagious as mumps or rubeola, but it has a longer period of communicability.
Milder symptoms.

Question 21

What are the S/S of rubella?

Answer 21

• Mild fever and HA
• Congestion and conjuctivitis
• Rash (face=>arm/leg=>disappears same way)
• SYMMETRICAL postauricular and occipital tender LAN
• Arthralgias

Rubella has 2 Ls, so bilateral LAN

Question 22

What can cause occipital LAN besides rubella?

Answer 22

MC: Tick bite removal.
Occipital lymph nodes are reactive.

Question 23

How long is someone with rubella contagious?

Answer 23

10 days prior to rash
1-2 weeks post rash DISAPPEARANCE

Question 24

What are the complications with rubella?

Answer 24

• Arthritis (mainly women)
• OM/encephalitis
• Congenital rubella syndrome

Question 24

How long is someone with rubella contagious?

Answer 24

10 days prior to rash 1-2 weeks post rash DISAPPEARANCE

Question 25

What is the classic triad of congenital rubella syndrome?

Answer 25

* Microcephaly * Cataracts * Cardiac defects ## Footnote 1/3 die before age 1. Can also cause miscarriage or stillbirth.

Question 26

What is given for congenital rubella syndrome? What does it do?

Answer 26

Hyperimmune globulin. It only fights off the infection and reduces symptoms. It DOES NOT eliminate chance of fetus developing congenital rubella syndrome.

Question 27

How do we diagnose rubella?

Answer 27

Clinically. IgM titers for confirmation if needed.

Question 28

How do we treat rubella?

Answer 28

Supportive

Question 29

Who is the main risk group for rubella?

Answer 29

Pregnant women. They should be isolated to prevent congenital rubella syndrome. They need to get the MMR vaccine PRIOR to becoming pregnant because it is a live vaccine.

Question 30

What is the only parvovirus humans can get? What does it cause?

Answer 30

Parvovirus B19 AKA Erythema Infectiosum 5th disease

Question 31

What is the transmission of erythema infectiosum?

Answer 31

Placental transmission Springtime Blood Respiratory secretions

Question 32

How long is erythema infectiosum transmissible?

Answer 32

Only prior to the rash appearing.

Question 33

What is the typical presentation of erythema infectiosum?

Answer 33

* Slapped cheeks. * Lacy macular exanthem over proximal extremities post facial rash. * Polyarthropathy syndrome in adults ## Footnote 5th disease looks like someone high-fived your face Polyarthopathy presents as swollen and erythematous palms, knees, and joints.

Question 34

Who is erythema infectiosum most common in?

Answer 34

Children 5-7 ## Footnote 5th disease = 5-7 years old

Question 35

How is erythema infectiosum diagnosed?

Answer 35

Clinical: slapped cheeks or lacy rash. IgM titers if needed.

Question 36

What is unique about the rash in erythema infectiosum?

Answer 36

NO PRURITIS.

Question 37

How is erythema infectiosum treated?

Answer 37

Tylenol IVIG for immunocompromised or RBC disorders.

Question 38

What is the main complication of erythema infectiosum?

Answer 38

People with RBC disorders. It can lead to transient aplastic anemia, hydrops fetalis, or congenital anemia. Patients at risk: Iron-def anemia, HIV, SCD, thalassemias, and spherocytosis.

Question 39

How is parvovirus B19 prevented?

Answer 39

No vaccine. Generally immune once you have been infected once.

Question 40

What causes Roseola infantum?

Answer 40

HHV6 and 7 AKA 6th disease

Question 41

What seasons is roseola most transmissible?

Answer 41

Fall and Spring Falling roses spring up Roses fall in spring

Question 42

What ages are most children infected with roseola infantum?

Answer 42

Between 6mo and 3 years. It is rare < 2y and > 4y. HHV6 = 6 months

Question 43

What is the typical presentation of roseola infantum?

Answer 43

High fever persisting 3-5 days. Post fever, blanchable, rosey pink rash appears.

Question 44

What is the concern with roseola infantum fever?

Answer 44

Duration unless patient is in acute distress. Febrile seizures most common < 3y.

Question 45

How is a child's presentation once the rash appears in roseola infantum?

Answer 45

Usually normal. Only ill during fever.

Question 46

How is roseola infantum diagnosed?

Answer 46

Clinical. Generally, Dx is made based on rash, but child is generally improving by then.

Question 46

What would worry a provider in regards to fever in roseola infantum besides duration?

Answer 46

Speed of onset. Febrile seizure is likely if the fever appears rapidly, because the body cannot compensate fast enough.

Question 46

How is roseola infantum treated?

Answer 46

Supportive.

Question 47

What are the rare complications of roseola infantum?

Answer 47

* Meningitis * Encephalitis * Leukopenia * Thrombocytopenia * Hepatitis Roses MELT Hearts

Question 48

What causes varicella/chicken pox?

Answer 48

Varicella zoster virus (VZV) ## Footnote Subtype of HHV

Question 49

How long is varicella contagious and how is it transmitted?

Answer 49

1-2 days prior to rash until all blisters scab over. Shingles and respiratory secretions can transmit it.

Question 50

What is the hallmark sign of varicella?

Answer 50

Dewdrop on a rose petal: vesicle on an erythematous base.

Question 51

What are the systemic S/S of varicella?

Answer 51

* Fever * Rash * Loss of appetite * HA * Malaise

Question 52

How is varicella diagnosed?

Answer 52

All stages of lesions. PCR swabs IgM titers

Question 53

How is varicella treated?

Answer 53

Symptomatic Antivirals for high-risk: Acyclovir (10x dosage within 24 hours for 5 days) Varicella Ig

Question 54

When is the varicella vaccine administered?

Answer 54

12 months 4 years 98% prevention ## Footnote Same as MMR.

Question 55

What causes HFM disease?

Answer 55

Coxsackievirus

Question 56

What seasons is HFM disease transmitted? What can you NOT get it from?

Answer 56

Summer and fall. You cannot get it from a pet with foot and mouth disease.

Question 57

When is HFM disease contagious?

Answer 57

First week of illness until all blisters resolved. F to M one week

Question 58

How does HFMD present?

Answer 58

* Fever + LAN * Sore throat * Malaise * Irritability * Loss of appetite * Red, non-pruritic rash with blisters on palms and feet * Red blister-like lesions on mouth and inside mouth. ## Footnote Often noted to have a halo around them.

Question 59

What is unique about the arrangement of HFMD vesicles?

Answer 59

Follows dermatoglyphs parallel with a red halo.

Question 60

How is HFMD diagnosed?

Answer 60

Clinical. Unique in its: * Age * Pattern of S/S * Rash appearance

Question 61

How is HFMD treated?

Answer 61

Magic mouthwash Motrin/tylenol

Question 62

What are the complications of HFMD?

Answer 62

* Dehydration (MC) * Encephalitis

Question 63

How is dehydration treated in infants with HFMD?

Answer 63

IVF Pedialyte + gatorade in a syringe Look for urination every 6-12 hours