Lecture 10: Viral Exanthems Flashcards
What are the 6 childhood exanthems?
Who is rubeola/measles most common in?
Children <5
What is the causative organism in rubeola?
Rubeola virus
How long is someone with rubeola contagious?
4 days prior to rash
4 days post rash appearance
What do koplik’s spots look like?
Tiny white spots with blue centers on buccal mucosa.
How does rubeola typically present?
-low grade fever
-dry cough
-coryza
-conjuctivitis
-sore throat
-rash
-koplik’s spots on buccal mucosa
4C’s
Cough
Coryza
Conjunctivitis
Koplik
What kind of rash does rubeola present with?
Red, blotchy skin rash
Often behind the ears and along hairline.
Usually recedes from face then extremities
Can be mistaken for scarletina.
What is unique about the fever of rubeola?
It can jump to 104-105F
What is the treatment for rubeola?
Supportive care.
AVOID ASA (Reye’s syndrome)
ABX if bacterial complications.
What is the MC complication of rubeola?
OM
2: Bronchitis
3: Pneumonia
4: Pregnancy complications
5: Encephalitis
6: Thrombocytopenia
Rubeol = 7 letters, itself + 6 complications
What is the vaccination schedule for rubeola?
12 months
4 years
Both are given in MMR form.
What is the causative organism for Mumps?
Mumps virus
How is mumps transmitted?
Airborne
Saliva
Surfaces
Mumps is ASS
How long is mumps contagious?
5 days after their glands swell.
Must isolate someone during those 5 days.
How does mumps present?
- 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
How is mumps treated?
Supportive care only.
What are the main complications of mumps?
- Orchitis
- Encephalitis
- Oophoritis/Mastitis
- Deafness
Orchitis and Oophoritis are for when they reach puberty.
Mumps = 5 letters, itself + 4 complications
How effective is the mumps vaccine?
2 doses = 88%
1 dose = 78%
What is rubella also known as?
German Measles
3-day measles
3rd disease
What is the main concern with rubella/3rd disease?
Placental transmission
Long contagious period
It is not as contagious as mumps or rubeola, but it has a longer period of communicability.
Milder symptoms.
What are the S/S of rubella?
- 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
What can cause occipital LAN besides rubella?
MC: Tick bite removal.
Occipital lymph nodes are reactive.
How long is someone with rubella contagious?
10 days prior to rash
1-2 weeks post rash DISAPPEARANCE
How long is someone with rubella contagious?
10 days prior to rash
1-2 weeks post rash DISAPPEARANCE
What is the classic triad of congenital rubella syndrome?
- Microcephaly
- Cataracts
- Cardiac defects
1/3 die before age 1.
Can also cause miscarriage or stillbirth.
What is given for congenital rubella syndrome? What does it do?
Hyperimmune globulin.
It only fights off the infection and reduces symptoms.
It DOES NOT eliminate chance of fetus developing congenital rubella syndrome.
How do we diagnose rubella?
Clinically.
IgM titers for confirmation if needed.
How do we treat rubella?
Supportive
Who is the main risk group for rubella?
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.
What is the only parvovirus humans can get? What does it cause?
Parvovirus B19
AKA
Erythema Infectiosum
5th disease
What is the transmission of erythema infectiosum?
Placental transmission
Springtime
Blood
Respiratory secretions
How long is erythema infectiosum transmissible?
Only prior to the rash appearing.
What is the typical presentation of erythema infectiosum?
- Slapped cheeks.
- Lacy macular exanthem over proximal extremities post facial rash.
- Polyarthropathy syndrome in adults
5th disease looks like someone high-fived your face
Polyarthopathy presents as swollen and erythematous palms, knees, and joints.
Who is erythema infectiosum most common in?
Children 5-7
5th disease = 5-7 years old
How is erythema infectiosum diagnosed?
Clinical: slapped cheeks or lacy rash.
IgM titers if needed.
What is unique about the rash in erythema infectiosum?
NO PRURITIS.
How is erythema infectiosum treated?
Tylenol
IVIG for immunocompromised or RBC disorders.
What is the main complication of erythema infectiosum?
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.
How is parvovirus B19 prevented?
No vaccine. Generally immune once you have been infected once.
What causes Roseola infantum?
HHV6 and 7
AKA 6th disease
What seasons is roseola most transmissible?
Fall and Spring
Falling roses spring up
Roses fall in spring
What ages are most children infected with roseola infantum?
Between 6mo and 3 years.
It is rare < 2y and > 4y.
HHV6 = 6 months
What is the typical presentation of roseola infantum?
High fever persisting 3-5 days.
Post fever, blanchable, rosey pink rash appears.
What is the concern with roseola infantum fever?
Duration unless patient is in acute distress.
Febrile seizures most common < 3y.
How is a child’s presentation once the rash appears in roseola infantum?
Usually normal. Only ill during fever.
How is roseola infantum treated?
Supportive.
What are the rare complications of roseola infantum?
- Meningitis
- Encephalitis
- Leukopenia
- Thrombocytopenia
- Hepatitis
Roses MELT Hearts
What causes varicella/chicken pox?
Varicella zoster virus (VZV)
Subtype of HHV
How long is varicella contagious and how is it transmitted?
1-2 days prior to rash until all blisters scab over.
Shingles and respiratory secretions can transmit it.
What is the hallmark sign of varicella?
Dewdrop on a rose petal: vesicle on an erythematous base.
What are the systemic S/S of varicella?
- Fever
- Rash
- Loss of appetite
- HA
- Malaise
How is varicella diagnosed?
All stages of lesions.
PCR swabs
IgM titers
How is varicella treated?
Symptomatic
Antivirals for high-risk:
Acyclovir (10x dosage within 24 hours for 5 days)
Varicella Ig
When is the varicella vaccine administered?
12 months
4 years
98% prevention
Same as MMR.
What causes HFM disease?
Coxsackievirus
What seasons is HFM disease transmitted? What can you NOT get it from?
Summer and fall.
You cannot get it from a pet with foot and mouth disease.
When is HFM disease contagious?
First week of illness until all blisters resolved.
F to M one week
How does HFMD present?
- 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.
Often noted to have a halo around them.
What is unique about the arrangement of HFMD vesicles?
Follows dermatoglyphs parallel with a red halo.
How is HFMD diagnosed?
Clinical.
Unique in its:
* Age
* Pattern of S/S
* Rash appearance
How is HFMD treated?
Magic mouthwash
Motrin/tylenol
What are the complications of HFMD?
- Dehydration (MC)
- Encephalitis
How is dehydration treated in infants with HFMD?
IVF
Pedialyte + gatorade in a syringe
Look for urination every 6-12 hours
What would worry a provider in regards to fever in roseola infantum besides duration?
Speed of onset.
Febrile seizure is likely if the fever appears rapidly, because the body cannot compensate fast enough.
How is roseola infantum diagnosed?
Clinical.
Generally, Dx is made based on rash, but child is generally improving by then.
What are the complications with rubella?
- Arthritis (mainly women)
- OM/encephalitis
- Congenital rubella syndrome