Verma: Viral Exanthems

Question 1

A skin eruption occurring as a symptom of a general disease.

Answer 1

exanthem

Question 2

Eruptive lesions on the mucous membranes.

Answer 2

enanthem

Question 3

This is the most common viral exanthem; 1st disease; it was eliminated in the US in 2000

Answer 3

measles

Question 4

How is measles acquired?

Answer 4

direct or airborne droplets

Question 5

How long is the measles incubation period? How long is the infectious period?

Answer 5

7-18 days

1-2 days prior to prodrome, 4 days after rash onset

Question 6

Is measles contagious?

Answer 6

YES, highly contagious!

Question 7

What occurs during the prodrome phase in measles? When does the prodrome phase occur?

Answer 7

fever, coryza, conjunctivitis, cough (3 Cs); occurs 2-4 days before Koplik spots and 3-5 days before exanthem (rash)

Question 8

How does the measles exanthem begin? Then what happens to the lesion?

Answer 8

around the ears as irregular macules; lesions spread to trunk in 24-48 hours, become more papular (purplish/red) and last 3-5 days

Question 9

How can you diagnose measles?

Answer 9

Koplik spots, exanthem (rash)
IgM in acute serum *most rapid detection
PCR of throat swab looking for paramyxovirus
Viral cultures
Serial IgG

Question 10

List some measles complications

Answer 10

otitis media
pneumonia
encephalitis
blindness due to Vit A deficiency

Question 11

This is one of the first diseases to reappear when vaccine rates fall

Answer 11

measles

Question 12

What should international travelers be given to avoid measles?

Answer 12

2 doses MMR

Question 13

How to treat measles?

Answer 13

supportive treatment
Vit A in malnourished children
Live attenuated vaccine *prevention
Post-exposure prophylaxis with vaccine w/i 3 days or Ig within 6 days with vaccine 5-6 months later

Question 14

Togavirus; “German measles;” 3rd disease

Answer 14

Rubella

Question 15

How is rubella spread?

Answer 15

direct contact and droplets

Question 16

How long is the incubation period in rubella? How long is the infectious period?

Answer 16

14-21 days; 5-7 days before rash onset, 3-5 days after rash

Question 17

What does rubella present like clinically?

Answer 17

asymptomatic infection in up to 50% or low grade fever

children: rhinorrhea, cough, sore throat

adolescents/adults: malaise, sore throat, nausea, anorexia

enanthem

Forschheimer’s spots: petechiae on hard palate

Question 18

What are Forschheimer’s spots?

Answer 18

petechiae on the hard palate

Question 19

How does the rash in rubella start? What is one notable feature of the rash? How is it different from the measles rash?

Answer 19

starts on the face and then fades from face w/i 24 hours;
notable feature: appearance rapidly changes in 24 hours;
pink-red lesions in rubella, instead of purplish-red lesions in measles

Question 20

What is the diagnostic testing for rubella?

Answer 20

IgM or IgG in serum

Question 21

What are some complications of rubella?

Answer 21

arthralgias/arthritis in older pts
peripheral neuritis, encephalitis
congenital rubella syndrome: cataracts, microencephaly, deafness, cadiac defects, anemia, low platelets

Question 22

When is a fetus at risk of becoming infected with rubella?

Answer 22

30-50% risk if mother is infected during the first 6 weeks of the pregnancy **early in first trimester

Question 23

What causes fifth disease, or erythema infectiosum?

Answer 23

human parvovirus B19

Question 24

How long is the incubation period for fifth disease? How long is this disease contagious?

Answer 24

4-14 days; only contagious in the first stage

Question 25

Over 50% of fifth disease infections are (blank)

Answer 25

asymptomatic

Question 26

How do you diagnose fifth disease?

Answer 26

detection of serum parvovirus B19-specific IgM antibody

Question 27

What happens on day #1 in patients with fifth disease? What is unique about this stage of the disease?

Answer 27

slapped cheek appearance; it is contagious during this first stage

Question 28

What happens on day #2 in patients with fifth disease (2nd stage)? What happens on day #6 (3rd stage)?

Answer 28

erythematous maculopapular eruption; reticular pattern of rash which lasts 9-11 days

Question 29

What cells does the parvovirus B19 infect? So what are some complications?

Answer 29

erythrocytic precursors; can cause hemolysis and anemia, may need RBC transfusion, may cause hydrops fetalis (severe anemia leading to cardiac failure)

Question 30

``` 2nd syndrome ascribed to Parvovirus B19 Spring/Summer Young Adults Exanthem, LAD, fever, anorexia, arthralgias Self-limited over 7-14 days Viremia clears after rash ```

Answer 30

Papular purpuric glove and sock syndrome

Question 31

What is Roseola infantum also called? What viruses cause this disease?

Answer 31

6th disease; Human herpes virus 6 and 7

Question 32

What is unique about the infectious period of roseola infantum?

Answer 32

the virus is intermittently shed into the saliva throughout life, causing an asymptomatic persistent infection

Question 33

How does roseola present clinically?

Answer 33

high fever for 3-4 days followed by abrupt appearance of rash, which begins on the trunk and spreads to extremities * *otherwise well-appearing child * *febrile seizures may occur

Question 34

How is herpes simplex transmitted?

Answer 34

through abraded skin or intact mucous membranes

Question 35

What are the symptoms of herpes simplex infection?

Answer 35

painful, recurring vesicular eruptions that are worse primarily than they are when they recur; fever, LAD, and malaise w primary infection; prodromal tingling, burning or pain

Question 36

Two ways in which varicella zoster (chicken pox) is spread?

Answer 36

respiratory droplets | vesicle fluid

Question 37

Symptoms of the prodrome phase of chicken pox?

Answer 37

asymptomatic to fever, malaise, cough, coryza, sore throat **coryza: inflammation of mucous membranes of the nose

Question 38

One complication associated with chicken pox?

Answer 38

secondary bacterial infection **occurs 5-10% of the time

Question 39

What would you give an immunocompotent patient if they were exposed to varicella zoster?

Answer 39

varicella vaccine prophylaxis w/i 72hrs

Question 40

Treatment for herpes viruses, including chicken pox?

Answer 40

acyclovir

Question 41

What age are the majority of shingles patients? What is one complication with immunocompromised patients?

Answer 41

>50yo; reactivation of the virus may occur multiple times

Question 42

Describe the progression of small box

Answer 42

prodrome phase: chills, fever, backache, malaise exanthem starts on face/forearms and spreads to trunk and legs last (centrifugal - from distal to core) macular vesicles --> papular vesicles --> thick walled pustules

Question 43

What drug WAS used for small pox? **it has been eradicated globally

Answer 43

anti-viral cidofovir

Question 44

Enteroviruses, like coxsackie A16 cause this disease...

Answer 44

hand-foot-and-mouth disease

Question 45

What symptoms does hand-foot-and-mouth disease cause? Is it contagious?

Answer 45

highly contagious; low-grade fever, anorexia, malaise, sore mouth, rash

Question 46

So what would be the difference b/w enantham and exanthem?

Answer 46

enantham is in the mucous membranes, while exanthem is in the skin

Question 47

What virus causes herpangina? What is it?

Answer 47

Coxsackie A virus; painful mouth ulcers preceded by fever and sore throat

Question 48

What does enterovirus D68 cause?

Answer 48

severe respiratory illness | pin pointed generalized rash

Question 49

How does enterovirus D68 spread?

Answer 49

from person to person through coughs, sneezes, or contaminated surfaces

Question 50

Pink macules and papules surrounded by white halos. Begins on trunk, spreads to neck and proximal extremities.

Answer 50

roseola infantum (exanthem subitum)