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Gen Med: Peds > Pediatric Exanthem > Flashcards

Pediatric Exanthem Flashcards

1
Q

Rubeola: Description

A
  • Morbilliform rash- pathognomonic for measles*
  • Cephalocaudal extension*
  • Blanchable
  • Facial exanthem is often confluent
  • Appears sick or systemically ill (toxic)
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2
Q

Rubeola: Etiology

A

SS RNA virus of Paramyxoviridae family
More common developing countries*
Unvaccinated pop.

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3
Q

Rubeola: Transmission

A

Direct contact
Airborne via aerosolized droplet nuclei

Reportable disease

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4
Q

What is an enanthem?

A

Breaking out of mucus membranes

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5
Q

What is morbilliform?

A

resembling a measles rash

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6
Q

Rubeola is another name for?

A

Measles

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7
Q

Rubeola: General Information

A
  1. Incubation period: range 7-21 days
    a. Ave. 10-12 days
  2. Prodrome of 3-4 days
    a. High fever (up to 105oF) that lasts 3-5 days
    b. Classic triad (3 C s)
    - Cough (nonproductive) can be “barking” cough
    - Coryza
    - Conjunctivitis
  3. Rash develops after prodrome
    a. Typically - 14 days after exposure
    b. Desquamation may occur afterwards
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8
Q

Rubeola: Signs & Symptoms

A 
Fever (103-105F)
Malaise
Photophobia
3 C’s 
-Cough
-Coryza (inflamm of nasal mucosa)
-Conjunctivitis
Koplik’s spots
-Grainy appearing area typically located near 2nd molars
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9
Q

Rubeola: Differential Dx

A 
Drug eruption
Other viral exanthems
-Rubella, parvovirus
Scarlet fever
Kawasaki Syndrome
Infectious Mono (EBV)
RMSF
HHV-6
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10
Q

What are Koplik’s Spots?

A

Associated with Rubeola
Ulcerated mucosal lesions characterized by neutrophilic exudate and neovascularization.

They are described as appearing like “grains of salt on a wet background”

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11
Q

Rubeola: Labs

A

Measles-specific IgM
Viral swab of throat, nasopharyngeal
CBC w/diff
+/- LP

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12
Q

Rubeola: Treatment

A

Isolation
Vitamin A support
Rest, Antipyretics, Antitussives
Hydration

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13
Q

Rubeola: Complications

A
  1. Pneumonia
    a. Strep pneumoniae or Staph aureus
    b. Group A Strep
    c. immunocompromised patients
  2. Otitis media
  3. Encephalitis
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14
Q

Rubeola: Prevention

A

MMR Vaccine

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15
Q

Rubella (German Measles) AKA 3 Day Measles: Description

A
  1. Pinpoint pink maculopapules
    a. 1st on face, spreads caudally to trunk/extr & generalized w/in 24 hrs
    b. w/in 1 day rash fades from face –> centrifugal spread: trunk to extrem.
    c. Pink macules coalesce on trunk but remain discrete on extrem

Usually benign Illness

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16
Q

Rubella: Etiology

A

Rubella virus, togavirus RNA virus

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17
Q

Rubella: Transmission

A

Contaminated nasal airborne respiratory droplets

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18
Q

Rubella: Incubation Period

A
  • 14-21 days
  • Onset of rash is usually day 15
  • UTD: infected pts may shed virus and are potentially contagious for 1-2 wks before infection is clinically apparent
  • Many cases of rubella are asymptomatic
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19
Q

Rubella: Pathophysiology & Prevention

A
  1. Pathophysiology
    a. Virus invades respiratory epithelium
    b. Spreads to bloodstream
    c. Disseminates to skin
  2. Prevention
    a. MMR vaccine
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20
Q

Rubella: Sxs

A

Maculapapuars are more pinpoint!

  1. Sxs
    a. Children – little to no prodrome
    - Mild conjunctivitis, HA, adenopathy, low-grade fever (100.9 F)
    b. Adolescents
    • HA
      - Malaise
      - Anorexia
      - Arthralgias
  2. Signs
    a. Forschheimer’s spots (20%)
    - Red petechiae on soft palate
    - During prodrome phase
    b. Lymphadenopathy
    • Postauricular
      - Suboccipital
      - Post. Cervical
      c. Possible splenomegaly
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21
Q

Rubella: Differential Dx

A 
Drug eruptions
Other viral exanthems
Scarlet Fever
Acute Rheumatic Fever
Measles
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22
Q

Rubella: Labs

A
  1. Viral cultures
    a. Throat
  2. Rubella-specific IgM antibody
  3. Acute phase: leukopenia with lymphocytosis
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23
Q

Rubella: Complications

A
  1. Congenital rubella syndrome (CRS)
    a. Hearing loss, deafness
    b. Mental retardation
    c. CV defects
    d. Ocular defects
    - Cataracts
    e. Hydrocephalus
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24
Q

Contraindications to MMRV vaccine:

A

Pregnancy and immunocompromised patients

Pregnant women are screened for rubella and syphilis at 1st prenatal visit

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25
Q

Treatment of Rubella

A

Supportive
Isolation
Antipyretics
Hydration

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26
Q

Scarlet Fever (Scarlatina): Description

A
  1. Fine erythematous papular rash 1st on trunk
    - Sandpaper texture
    - Blanches
  2. Involves neck, trunk, axilla, extremities
  3. No facial rash typically
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27
Q

Scarlet Fever: Etiology

A

Group A Beta hemolytic Strep pyogenes (GAS)

Exotoxin producing Staph aureus (rare)

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28
Q

Scarlet Fever: Transmission

A
  • Direct contact with infected patient
  • Direct contact with carrier
  • Site of GAS infection: pharynx, tonsils
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29
Q

Complications of GAS tonsillopharyngitis (Can get this rash as well)

A

Nonsuppurative (Acute Glomerulonephritis, acute rheumatic fever, Strep toxic shock syndrome)
Suppurative (forming pus or purulent exudate - otitis media, tonsilar absess, etc.)

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30
Q

Scarlet Incubation Period

A

2-5 days

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31
Q

Scarlet Fever: Pathophysiology

A
  • Rash due to exotoxin from bacteria

- Possible hypersensitivity reaction

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32
Q

Scarlet Fever: S&S

A 
1. Signs
Fever 
Strawberry tongue
Punctate petechiae palate
Pastia’s lines 
Sandpaper rash
Desquamation
-On body and extr when exanthem fades

2. Symptoms
Sore throat
Headache
Myalgias
Nausea / Vomiting
Cough
Diarrhea
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33
Q

What are Pastia’s Lines?

A

Exacerbation in skin folds:

antecub., popliteal fossa, axilla, groin

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34
Q

Scarlet Fever: Differential Dx

A

Staph or Strep TSS
Kawasaki’s Syndrome
Viral exanthems
Drug eruption

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35
Q

Scarlet Fever: Labs

A

Rapid Strep Ag test
Throat cx (TC)
Increased ASO titer

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36
Q

Scarlet Fever: Treatment

A
  1. Penicillin V 250-500 mg po BID-TID x 10 days- DOC
  2. Amoxicillin 50 mg/kg/day po divided doses x 10 days
  3. Erythromycin/Azithromycin/Clarithromycin/Cephalexin
    - If allergy to penicillin
  4. Supportive Care
37
Q

What is Exanthema Subitum also known as?

A

Roseola Infantum

formerly Sixth Disease

38
Q

Exanthem Subitum: Description

A
  1. Generalized fine MP rash
    a. Small blanchable
  2. Starts behind ears
  3. Spreads to trunk
39
Q

Exanthem Subitum: Etiology

A

Human herpes virus type 6 (HHV-6)
-Most common
Human herpes virus type 7 (HHV-7)
-10-30%

Usually course of infection is benign self-limited w/ rare sequelae

40
Q

Exanthem Subitum: Transmission

A

Oropharyngeal secretions

41
Q

Exanthem Subitum: Incubation

A

5-15 days

Common Age Group: 6-36 mo

42
Q

Exanthem Subitum: Signs & Sxs

A
  1. High fever x 3-5 days*
    a. 38.9 – 40.6C
    b. 103 – 105F
  2. Rash appears when fever breaks (4th day)
  3. Toxic appearance
  4. LAD, TM’s red
43
Q

Exanthem Subitum: Differential Dx

A

Other viral exanthems

Differential Dx: Consider drug allergy when child with fever tx w/ abx, then develops rash (a lot of times pruritic)

44
Q

Exanthem Subitum: Labs

A

Seldomly necessary

HHV6 & HHV7 Ab titers

45
Q

Exanthem Subitum: Treatment

A

Supportive care:
-Hydration
-Antipyretics
(Acetaminophen)

46
Q

Exanthem Subitum: Complications

A
  • Febrile seizures possibly

- Not considered contagious

47
Q

What is Erythema Infectiosum also known as?

A

Fifth Disease

48
Q

Erythema Infectiosum: Description

A

Edematous erythematous plaques on cheeks
“Slapped cheeks”
Lacy reticulated rash trunk & extremities (stocking/glove)

49
Q

Erythema Infectiosum: Etiology

A

Parvovirus B19

School-aged children, although adults too

50
Q

Erythema Infectiosum: Transmission

A
  • Respiratory via droplet aerosol
  • Perinatally
  • Exposure to classmates or siblings
51
Q

Erythema Infectiosum: Incubation

52
Q

Erythema Infectiosum: Sxs

A 
Nonspecific prodrome:
		Fever
		Malaise
		HA
		Coryza
		Mild Conjunctivitis
	      Diarrhea
2 days prior to rash

“Slapped cheeks” appearance
Lacy erythematous rash on trunk & ext*
Often pruritic
May recur with intermittent rash over 2-3 weeks

53
Q

Erythema Infectiosum: DDX

A 
Roseola
Rubella
Measles
Enteroviral inf
GAS inf
Drug Eruption
54
Q

Erythema Infectiosum: Complications

A

-Arthritis*
-Hemolytic Anemia
Sickle Cell
Thalassemia
-Fetal death or hydrops fetalis
20 wks: rare

55
Q

Erythema Infectiosum: Labs

A

HPV B19 IgM Ab

B19 DNA using NAAT

56
Q

Erythema Infectiosum: Treatment

A

Symptomatic

57
Q

Varicella-Zoster Virus (VZV) : Description

A
  • Systemic illness
  • Successive crops of pruritic vesicles that evolve to pustules, crusts and at times scarring
  • 90% cases children
58
Q

VZV: Etiology

A

VZV DNA Virus

59
Q

VZV: Transmission

A

Direct contact

Airborne droplets

60
Q

VZV: Incubation Period

A

14 days (10-23 days) from contact

61
Q

VZV: Pathophysiology

A
  • Virus enters mucosa respiratory tract
  • Viral replication
  • Viremia
  • Dissemination to skin
  • Skin to sensory nerves to sensory ganglia to latent infection
62
Q

VZV: Sxs

A
  1. Prodrome of:
    a. HA, myalgias
    b. Malaise, low-grade fever
    c. Pharyngitis
    d. Loss of appetite
  2. Generalized vesicular rash usually w/in 24 hrs
    a. Papules to vesicles to pustules to crusts
  3. “Dewdrops on a rose petal”
  4. Cephalocaudal spread
63
Q

VZV: DDX

A

Disseminated HSV
Enterovirus infection

Diagnosis usually made on clinical findings alone*

64
Q

VZV: Labs Tests

A
  • Tzanck prep.- cytology of fluid or scraping of vesicles show giant and multinucleated epidermal cells
  • VZV titers
65
Q

VZV: Treatment

A
  1. Symptomatic
    - No aspirin
  2. Acyclovir
66
Q

VZV: Complications in children

A
  1. S aureus or Group A Strep Superinfection
  2. Varicella encephalitis
  3. Reye’s Syndrome**
    In adults:
    -VZV encephalitis
    -Pneumonia
    -VZV hepatitis in immunocompromised pts
67
Q

VZV: Prevention

A
  1. VZV vaccination (Varivax)
    a. 1995
    b. MMRV
68
Q

Impetigo: Description

A
  1. Superficial infection of epidermis
  2. Crusted erosions
    a. Golden-yellow, stuck-on), honey-crusted
  3. Two types
    a. Non-bullous
    b. Bullous
69
Q

Impetigo: Caused by?

A
  1. S. aureus
    a. Most common with bullous
  2. GAS (Strep pyogenes)
    a. Most common with non-bullous
70
Q

Impetigo: Transmission

A

Bacteria enters through breaks in skin (non-bullous)

71
Q

Impetigo: Pathophysiology

A
  1. Non-bullous - Bacteria in epidermis causes vesicles or pustules leading to erosions and crusting
  2. Bullous - Eruption occurs in non-traumatized skin via exfoliating toxin
72
Q

Impetigo: Sxs

A 
Variable pruritis
Erythema
Crusted lesions
Bullous lesions
Regional lymphadenopathy possible
73
Q

Impetigo: DDX

A 
Excoriation
Perioral dermatitis
Seborrhea dermatitis
Allergic contact dermatitis
HSV
74
Q

Impetigo: Labs

A

Gram stain or Culture lesions but usually clinical dx

75
Q

Impetigo: Treatment

A
  • Mupirocin ointment 2% (Bactroban) Apply topically TID x 7-10 days
  • Cephalexin (Keflex) - 1st choice for oral therapy
76
Q

Impetigo: Complications

A

Cellulitis
Bacteremia
Septicemia

77
Q

Other name for Coxsackie Virus?

A

Hand, Foot & Mouth Disease (HFMD)

78
Q

Hand, Foot and Mouth Disease : Description

A
  • Systemic infection
  • Ulcerative oral lesions
  • Vesicular exanthem on distal extremities
  • Usually children
79
Q

Hand, Foot and Mouth Disease: Cause

A
  1. Most Common
    a. Coxsackie Virus
    A16
    b. Enterovirus A71
    -More severe
80
Q

Hand, Foot and Mouth Disease: Transmission

A
  1. Direct Contact
    - Highly contagious
    - Oral-Oral route
    - Oral-Fecal route
81
Q

Hand, Foot and Mouth Disease: Incubation Period

A

3-5 days

  • Illness usually resolves in 2-3 days w/o complication
  • Most contagious during first week
82
Q

Hand, Foot and Mouth Disease: Pathophysiology

A
  • Enteroviral implantation in GI tract
  • Extends to regional lymph nodes
  • Viremia
  • Oral lesions, skin lesions
83
Q

Hand, Foot and Mouth Disease: Sxs

A
  1. Anorexia
  2. Low grade fever
  3. Sore mouth
  4. Possible URI sxs
  5. Prodrome 12-24 hrs of low-grade fever, malaise, abd pain or resp sxs
  6. Painful ulcerative oral lesions
    - Refusal to eat
  7. Skin lesions on palms and soles come together or shortly after oral lesions
    - Macules, papules –> vesicles
84
Q

Hand, Foot and Mouth Disease: DDX

A 
If only oral lesions:
HSV infection
Herpangina
Adverse drug rxn
Sudden outbreak of oral and distal ext. lesions is pathognomonic for HFMD**
85
Q

Hand, Foot and Mouth Disease: Labs

A

Viral cultures from vesicles or throat

Stool/rectal swabs

86
Q

Hand, Foot and Mouth Disease: Treatment

A

Supportive

Lidocaine/xylocaine gel

87
Q

Hand, Foot and Mouth Disease: Complications

A 
Myocarditis
Aseptic meningitis (enterovirus )
Encephalitis
Pulmonary edema
Above uncommon
88
Q

With hand foot and mouth disease which lesions tend to come visit?

A

Mouth Lesions

Gen Med: Peds (6 decks)

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