Pediatrics

Question 1

Name the rashes associated with fever

Answer 1

Enterovirus (Coxsackievirus)
Erythema Infectiosum (Parvovirus B19)
Measles
Meningococcemia
Roseola
Scarlet Fever
Varicella

Question 2

Enterovirus (Picornaviruses)

Answer 2

Non-enveloped, linear +ssRNA
Transmission: fecal-oral spread
Poliovirus (Polio)
Echovirus (aseptic meningits)
Coxsackievirus (HFMD, aseptic meningitis, myocarditis, pericarditis)
HAV (acute viral hepatitis)

Rash: erythematous and maculopapular. Rarely presents as a petechial or vesicular rash

Hand-Foot-and-Mouth Disease (HFMD): caused by the Coxsackievirus and presents as a vesicular rash on the hands, and feet. Also presents with ulcers in the mouth.

Question 3

Erythema Infectiosum (Fifth disease)

Answer 3

Parvovirus B19
Associated with a low-grade fever (100-101F) with a rash appearing seven to ten days later

Rash: starts as facial erythema (“slapped cheek” appearance). This can spread to the trunk and extremities and have an erythematous macular appearance

Polyarthropathy syndrome: pain and swelling in the joints

Patients with immune deficiencies are at risk for developing Aplastic anemia

Question 4

Measles

Answer 4

Paramyxovirus: enveloped, linear -ssRNA non-segmented virus. Contains a surface F-protein which causes respiratory epithelial cells to fuse and form multinucleated giant cells.

Presentation: fever with cough, coryza (inflammation of the mucous membranes inside the nose), and conjunctivitis.
Koplik spots: bright red spots with a blue-white center on the buccal mucosa. Precede the measles rash by 1-2 days.
Erythematous maculopapular rash: starts on the neck, behind the ears, and along the hairline. The rash spreads downward to include the trunk, limbs, and reaches the feet in two to three days.

Complications: Pneumonia (giant cell), Encephalitis (1:2000), SSPE - subacute sclerosing panencephalitis which occurs years after the infection.

Question 5

Meningoccemia (Neisseria meningitidis)

Answer 5

A serious infection with abrupt onset of fever, chills, and malaise.

Rash: initial rash may be urticarial, maculopapular, or petechial (small, purplish, hemorrhagic spots). In fulminant cases, it can become purpuric (large purple patches) .

Immunization prevents the infection.