Rashes Flashcards
What is the causative agent for Measles ( Rubeola)
Paramyxovirus
How is Measles transmitted?
It is transmitted by droplets of respiratory secretions or via airborne route and is extremely contagious
What is the incubation period for Measles?
8-12 days
What are the clinical manifestations of Measles?
Thee C’s
* Cough
* Coryza
* Conjunctivitis
* Koplik spots ( grey-white, sand grain- sized spots)
* Stimson line
* High fever
* Macular rash ( petechial or haemorrhagic ( Black Measles)
* Lymphadenopathy
Where does the rash begin in Measles patients?
Head ( often the hair line)
What is the spread of the Measle Rash on the skin?
Cephalad - to - Caudal
What is the laboratory studies used to diagnose Measles?
Serologic testing for IgM antibodies that appear 1-2 days of the rash.
What are the possible differentials for Measles?
- Rubella
- Roseola
- Enteroviral or Adenoviral infection
- Infectious mononucleosis
- Toxoplasmosis
- Meningiococcemia
- Scarlet fever
- Rickettsial disease
- Kawasaki disease
- Serum - sickness
- Drug rash
What is the Routine Treatment for Measles?
- Adequate hydration
- Antipyretics
- High- dose Vitamin A ( for 2 days )
What are some complications that can occur due to Measles?
- Otitis Media ( Most common)
- Interstitial (measles) Pneumonia
- Giant cell ( Hecht pneumonia) - immunocompromised patients
- Myocarditis
- Mesenteric lymphadenitis
- Encephalomyelitis
- Early encephalitis
- Subacute Sclerosing Panencephalitis ( SSPE)
When is the MMR vaccine given ?
12 months & 18 months
What is another name for Rubella?
German Measles or 3- day measles
When is the onset of Rash for Measles?
14 days after infection ( 7-21)
What is the family of viruses that the German measles belongs to?
Togavirus
What is the incubation for Postnatal rubella?
16-18 days ( range 14-21)
What are the clinical manifestations of Rubella?
- Lymphadenopathy ( Retroauricular, Post cervical , Posterior Occipital)
- Erythematous ,maculopapular , discrete rash
- Forchheimer spots ( Rose - coloured spots on the soft palate)
- Mild pharyngitis
- Conjunctivitis
- Anorexia
- Headache
- Malaise
- Low-grade fever
- Polyarthritis ( Usually on hands)
What is the laboratory diagnosis for Rubella?
Serology testing for IgM antibodies.
What are the differentials for Rubella?
- Measles
- Roseola
- Enterovirus
- Mononucleosis
- Toxoplasmosis
- Scarlet fever
- Rickettsial disease
- Kawasaki disease
- Serum sickness
- Drug rash
Which disease is known as the Sixth disease?
Roseola Infantum ( Exanthem subitem )
’ sub = six’
What is the causative agent for Roseola?
Human Herpesvirus Type 6 & 7 ( HHV 6 & 7)
” Rose has herpes”
What are the clinical manifestations of Roseola?
- High fever
- Maculopapular , rose- coloured rash ( lasts 1-3 days)
- Upper respiratory symptoms ( nasal congestion, erythematous tympanic membranes , cough ( may occur)
- Febrile seizures
How can Roseola be diagnosed?
PCR in the cerebrospinal fluid
What is the treatment for Roseola?
Adequate hydration
Antipyeretics
What are complications of Roseola?
- Encephalitis
- Virus- Hemophagocytosis syndrome
Which rash is called the Fifth disease?
Erythema Infectiosum
What is the causative agent for Erythema Infectiosum?
Human Parvovirus ( B19)
Fill in the blanks. “ Parvovirus B19 can cause __________ & __________ after infection during Pregnancy.”
Fetal anaemia & Hydrops Fetalis
What is the cell receptor for Parvovirus B19 ?
Erythrocyte P antigen
How is Erythema infectiosum transmitted?
By respiratory secretions & Blood product transfusions
What is the Incubation period for Erythema Infectiosum?
4-14 days
What are the Clinical Manifestations for t Parvovirus B19 infections?
- Fever
- Malaise
- Myalgia
- Headache
- Rash
When does the rash appear in the Parvovirus B-19 infections?
7-10 days after infection
What are the Clinical Manifestations for Erythema Infectiosum?
- Low grade or no fever
- Pharyngitis
- Mild conjunctivitis
- Myalgia ( adults)
- Rash ( may be Pruritic and DOES NOT desquamate)
- Arthralgias
- Arthritis
- Headache
- Pharyngitis
- Coryza
- GIT upset
What are the three stages in which the Fifth disease rashes appear?
- Initial stage- “ Slapped-Cheek “ rash.
- Second stage- Erythematous symmetric, maculopapular, truncal rash appearing 1-4 days later.
- Lacy, reticulated rash last (2-40 days - mean 11 days).
What are the Haematological abnormalities that can occur with Parvovirus infections?
- Reticulocytopenia lasting 7-10 days
- Mild anaemia
- Thrombocytopenia
- Lymphopenia
- Neutropenia
How can one detect Parvovirus B19 infection on Laboratory studies?
- PCR
- Electron Microscopy of Erythroid Precursors in bone marrow
What are the differentials for Fifth Disease?
Measles
Rubella
Scarlet Fever
Enteroviral or Adenoviral infection
IM
Kawasaki disease
SLE
Serum sickness
Drug reactions
What is the treatment for Erythema Infectiosum?
- Blood Transfusions
- IV Immunoglobulin for immunocompromised.
What is the causative agent for Chicken Pox ?
Varicella - Zoster virus
What is the clinical manifestation of a reactivated latent infection of Endogenous Varicella Zoster Virus ( VZV)?
Zoster ( Shingles)
What is the incubation period for Varicella?
14-16 days
What are the Clinical Manifesttaions of Varicella ?
- Fever
- Malaise
- Anorexia
- Rash ( small red papules that progress to nonumbilicated, oval, tear-drop like vesicles on an erythramatous base)
- Acute neuritis
- Lymphadenopathy
- Ramsay- Hunter syndrome ( facial paralysis and ear canal vesicles) ( only when CN VII is involved)
- Corneal and intraoral lesions ( CNV involvement)
- Ipsilateral cerebral angiitis
- stroke
NB. The fluid progresses from clear to cloudy and the vesicles ulcerate, crust and heal.
How can Chickenpox be laboratory diagnosed?
PCR of vesicular fluid
Immunofluorescence using monoclonal antibodies
What are the differentials for Chicken Pox?
- Eczema herpeticum ( Kaposi varicelliform eruption)
- localized , vesicular eruption caused by HSV
- Coxsackievirus A ( vesiculopustular appearance to the extremities and oropharynx)
What are the treatment methods for those with Chicken Pox?
- Non-aspirin Antipyretics
- Cool baths
- Careful hygiene
- Early therapy with antivirals ( immunocompromised)
- Acyclovir or Valacyclovir - those at risk for severe varicella ( unvaccinated persons older than 12 , chronic cutaneous disease, pulmonary diseases, those receiving short term corticosteroids or long term salicylate therapy.
What is the most common complication of Chicken pox?
Secondary infection of skin lesion by Streptococci or staphylococci
What are other complications of Chicken Pox?
- Pneumonia ( uncommon in healthy children )
- Myocarditis
- Pericarditis
- Orchitis
- Hepatitis
- Ulcerative gastritis
- Glomerulonephritis
- Arthritis
- Reye syndrome
- Post infectious encephalitis
- Cerebellar ataxia
- Nystagmus
- Tremor
- Guillian - Barre syndrome
- Transverse myelitis
- Cranial nerve palsies
- Optic neuritis
- Hypothalamic syndrome
When is the Varicella vaccine given?
12 months + 6 weeks later
4-6 years
What is the Causative agent for Scarlet Fever?
Group A Streptococcus ( Strep Pyogenes)
What are the diseases that can predispose Scarlet fever?
- Streptococcal pharyngitis
- Toxic shock syndrome
- Necrotizing fasciitis
What is the Incubation period for Scarlet fever?
2-5 days.
How is Scarlet fever transmitted?
Respiratory Secretions and droplet or by self- infection from nasal carriage.
What are the Clinical manifestations of Scarlet fever?
- Fever
- Vomitting
- Abdominal Pain
- Sore Throat
- Sandpaper- like diffuse rash in the neck and chest area
- Perioral pallor spreading to flexor creases ( Pastia’s lines)
- Exudative tonsillitis
- Uvular oedema
- Strawberry Tongue
- Palatal petechiae
- Cervical lymphadenopathy
What are the laboratory investigations for Scarlet fever?
Throat swab
Culture and Growth of the organism individual
Serum : Antistreptolysin O (ASO) and anti-DNase B titres
What is the treatment for Scarlet Fever?
Penicillin V for 10-14 days
Isolation for 24 hours
What are the complications of Scarlet Fever?
Peritonsillar abscess
Retropharyngeal abscess
Post- Streptococcal glomerulonephritis
Rheumatic fever
