Viral Exanthem, Vaccine-Preventable Diseases Flashcards
Gianotti-Crosti syndrome (flat-top red papules)
a/w HBV, EBV, CMV, enterovirus infections
- prodrome
- self-limiting slapped cheek syndrome (over malar areas)
- followed by fine lact maculopapular rash trunk/limbs + symmetrical small joint arthralgia/arthritis
Erythema infectiosum (5th disease) d/t parvo B19
no longer infectious once facial rash resolves (when Ab production occurs)
Dx: serology - IgM w/in 7-10 days of exposure; IgG - w/in 15 days
puritic erythema/edema of distal extremities → petechial/purpuric in glove and socks distribution (sharp demarcation)
mucosal involvement (may have oral ulcerations/lesions or pharyngeal erythema)
+/- F/LAD
Papular-Purpuric “Glove and Socks” syndrome d/t parvo B19
self-limiting
Non-rash manifestations of Parvo B19
- aplastic crisis in pts w/ SCD/thalassemia (d/t transient disruption to erythropoiesis)
- chronic infection in IC pts → severe chronic anemia and chronic bone marrow suppression
- may remain infectious mos-yrs
- intrauterine infection (IUD, hydrops fetalis) - worse in earlier pregnancy
Enterovirus Classes and spectrum of clinical disease
Classes A-D. Polio, “new” enteroviruses (serotype E), coxsackievirus, echoviruses
- aseptic meningitis +/- rash
- hemorrhagic conjunctivitis
- Bornholm disease: epidemic pleurodynia (Coxsackievirus)
- HFM (CV, enterovirus 71)
- herpangina (CV)
- myopericarditis (CV, echo, parecho)
- paralysis (polio, also with some CV, echo, and entero 71)
- rash
- respiratory
summer/early autumn
worldwide
painful ulcerative lesions in oral cavity + vesicles on soles of feet and palms of hands (after oral lesions appear)
may occur on buttocks/genitals
resolve w/in 5-10 days
HFM
- Coxsackie A
- also CV B and EV71
Clinical syndromes a/w EV71 (largely in Asia-Pacific regions)
- HFM outbreaks
- aseptic meningitis
- meningoencephalitis
- acute flaccid paralysis
- effects on cardiopulmonary system
vaccine in development
2-4 day prodrome: malaise, high fever, cough, conjunctivitis
rash that begins behind ears, spreads over face → trunk → limbs (erythematous, maculopapular → confluent)
Measles
Koplik spots = pathognomonic (white papules on erythematous base during prodromal phase)
infectious from prodrome till 4 days after onset of rash
Complications of Measles
- can have secondary bacterial infections: PNA, OM, croup
- ADEM = acute disseminated encephalomyelitis (after natural infection>vaccine)
- MIBE = measles inclusion body encephalitis - progressive/fatal in children w/ impaired cellular immunity
- SSPE = subacute sclerosing panencephalitis - rare, fatal degenerative neuro condition
- 5-10yrs after infection (typically in those who were infection <2yo)
prodrome: mild, generalized malaise, +/- mild conjunctivitis, posterior auricular LAD
rash that begins on forehead, then face → rapidly to trunk/limbs (pinpoint lesions)
occurs at same time as prodrome (or 1-5 days after)
rubella
Complications of Rubella
- thrombocytopenia - self-limiting, but can result in epistaxis/GIB/hematuria
- hand/wrist arthritis, lasting for wks
- encephalitis - usually good prognosis
- progressive rubella panencephalitis (PRP) - rare, progressive, fatal
- 2-5yrs post infection
Ramsey-Hunt syndrome (HSV) - vesicles in ear or mouth
- perhipheral facial (VII) palsy
- may also have auditory (VIII) n sx: tinnitus, vertigo, nystagmus, nausea
EBV rashes
- infectious mono syndrome 80% d/t EBV (20% CMV)- maculopapular (may be urticarial, petechial)
- Eythema multiforme
- Cianottie-Crosti syndrome
- amp/amox a/w rash (usually 5 days into tx)
Clinical features of mumps
- parotitis - 95% of sx cases
- orchitis, epididymoorchitis, oophoritis - 30% of sx cases
- CNS: meningitis (1-10%), encephalitis (0.1%)
- sensorineural hearing loss - common complication, self-limited
- Other: pancreatitis, myocarditis, thyroiditis, interstitial nephritis, mastitis, hepatitis, migratory polyarthritis
