Peds ID

Question 1

Erythema infectiosum (fifth disease)

Answer 1

Parvovirus B19

Prodrome: None; fever is often absent or low grade
Rash: “Slapped-cheek,” pruritic, maculopapular, erythematous rash (see Image A)
Rash starts on the arms and spreads to the trunk and legs
Worsens with fever and sun exposure

Arthropathy in children and adults
Congenital infection is associated with fetal hydrops
and death
Aplastic crisis may be precipitated in children with
↑ RBC turnover (eg, sickle cell anemia, hereditary spherocytosis) or in those with ↓ RBC production (eg, severe iron deficiency anemia)

Question 2

Measles

Answer 2

Paramyxovirus
Prodrome: Fever (can be as high as 40°C (104°F) with Cough, Coryza, and Conjunctivitis (the “3 C’s”); Koplik spots (small irregular red spots with central gray specks) appear on the buccal mucosa after 1–2 days
Rash: An erythematous maculopapular rash spreads from head to toe
Treatment with vitamin A may improve symptoms

Common: Otitis media, pneumonia, laryngotracheitis Rare: Subacute sclerosing panencephalitis
Airborne infectious precautions needed because of
high level of contagiousness

Question 3

Rubella

Answer 3

Rubella virus
Prodrome: Asymptomatic or tender, generalized lymphadenopathy (clue: posterior auricular lymphadenopathy)
Rash: Presents with an erythematous, tender maculopapular rash that also spreads from head to toe
In contrast to measles, children with rubella often have only a low-grade fever and do not appear as ill
Polyarthritis may be seen in adolescents

Encephalitis, thrombocytopenia (a rare complication of postnatal infection)
Congenital infection is associated with congenital anomalies (PDA, deafness, cataracts, intellectual disabilities)

Question 4

Roseola infantum

Answer 4

HHV-6 and -7
Prodrome: Acute onset of high fever (> 40°C [> 104°F]); no other symptoms for 3–4 days
Rash: A maculopapular rash appears as fever breaks (begins on the trunk and quickly spreads to the face and extremities) and often lasts < 24 hours
Febrile seizures may result from rapid fever onset

Question 5

Varicella (chickenpox)

Answer 5

Varicella-zoster virus (VZV)
Prodrome: Mild fever, anorexia, and malaise precede the rash by 24 hours
Rash: Generalized, pruritic, “teardrop” vesicles on red base; lesions are often at different stages of healing (see image D). Rash usually appears on the face and spreads to the rest of the body, sparing the palms and soles
Infectious from 24 hours before eruption until lesions crust over

Progressive varicella with meningoencephalitis, pneu- monia, and hepatitis in the immunocompromised
Skin lesions may develop 2° bacterial infections
Reye syndrome (associated with ASA use)
Varicella may be prevented with vaccine or with post-
exposure prophylaxis for nonimmunized patients > 1 year of age (immunoglobulin for immunocom- promised, and vaccine for immunocompetent)

Question 6

Varicella zoster

Answer 6

VZV
Prodrome: Reactivation of varicella infection; starts as pain along an affected sensory nerve
Rash: Pruritic “teardrop” vesicular rash in a der- matomal distribution
Rash uncommon unless the patient is immunocompromised

Encephalopathy, aseptic meningitis, pneumonitis, TTP, Guillain-Barré syndrome, cellulitis, arthritis

Question 7

Hand-foot- and-mouth disease

Answer 7

Coxsackie A
Prodrome: Fever, anorexia, oral and throat pain Rash: Oral ulcers; maculopapular vesicular rash on the hands and feet and sometimes on the
buttocks

Aseptic meningitis, encephalitis, pneumonia, myopericarditis