Viral Exanthema

Question 1

Measles virus.

Answer 1

Droplet infection through the
 respiratory tract or
 conjunctivae.

Question 2

Measles

Answer 2

4 phases:
 Incubation period (8-12 days)
 Prodromal illness: 3C
 Exanthematous phase
 Recovery
Prodromal phase: ( 3C )
 fever,
conjunctivitis with photophobia,
coryza,  a prominent cough

 Koplick’s spots: the pathognomonic sign of measles
 Red lesions with bluish white spots in the center
 on the inner aspects of the cheeks at the level of the
premolars
 spread to involve the lips,
hard palate & gingiva

Answer 3

Temperature rises abruptly as rash appears & may
reach upto 40OC
 Measles rash: generalized, maculopapular,
erythematous, confluent
 Begins  on the face around
the hairline & behind the ears
 Spreads  downward
to the neck, trunk, arms, legs
& feet over next 24-48 hours

 Fades over about 7 days

Question 4

القاعدة في اي فايروس

Answer 4

CBC
Serology/ IgG IgM
Isolation = pCr or culture

Question 5

Mesels

Answer 5

CBC: Decreased total white blood cell count, with

relative lymphocytosis

Question 6

.Complications of measls

Answer 6

 Sinusitis
 Acute otitis media
 Retropharyngeal abscess
 Croup, tracheitis or bronchiolitis
 Pneumonia- giant cell pneumonia (direct viral infection) or superimposed bacterial infection (Streptococcus pneumoniae, Haemophilus influenzae & Staphylococcus aureus).
Diarrhea & vomiting
 Appendicitis- obstruction of the appendiceal lumen
by lymphoid hyperplasia
 Myocarditis
 Encephalitis- 1-3/1,000 cases of measles;

Question 7

Treatment mesels

Answer 7

Treatment
 SUPPORTIVE
 Antipyretics-comfort and fever control
 Maintenance of hydration, oxygenation & comfort
 Immunoglobulin –
-for susceptible household contacts:
 immunocompromised persons pregnant women & younger than 6 months of age, - Immune globulin may be given up to 6 days after exposure to prevent or modify infection.
 Vitamin A supplementation-reduced morbidity and
mortality from measles

Answer 8

Rubella (German measles) ( 3-day measles)

Question 9

Rubella

Answer 9

Incubation period: 14-21 days (2-3 weeks)
 ( Mild measles + lymphadenopathy )
 Prodrome: low-grade fever, sore throat, red eyes with or without eye pain, headache, malaise, anorexia &

The duration of the rash is generally 3 days & it
resolves.

Question 10

Congenital Rubella Syndrome

Answer 10

Classical CRS triad:

1- cataract, 2- sensorineural hearing loss & 3- congenital heart disease

Question 11

Treatment Rubella

Answer 11

Supportive treatment- antipyretics and analgesics
 Intravenous immunoglobulin
 or corticosteroids-for severe, nonremitting
thrombocytopenia

Question 12

Roseola infantum

Answer 12

Roseola infantum
(6th disease) :
Roseola infantum (6th disease) :
Human herpesvirus 6 (HHV-6) or 7 (HHV-7), through the saliva between 6 months and 3 years sudden high fever (39–40 °C)
rash appear as the fever disappears. rash is pink and lasts for less than three days.

Question 13

erythema infectiosum
………..Differential Diagnosis
(Slapped cheek syndrome) (5th diseas

Answer 13

parvovirus B19 (B19) virus, through the saliva  low-grade fever, rash, and cold-like symptoms,  Self limited artheritis:
Joint pain usually most noticeable in the:

Question 14

Hand-foot-and-mouth disease

………..

Answer 14

Hand-foot-and-mouth disease, or (HFMD)
 Coxsackie virus a16 and entero virus 71,
through the saliva or by fecal-oral transmission
 symptoms of the HFMD include fever, nausea, vomiting  Skin rashes at Hand, foot, and mouth  It often occurs in small outbreaks
 A vaccine known as the EV71 vaccine
is available to prevent HFMD in China as of December 2015

Question 15

Differential Diagnosis

Od mes

Answer 15

Differential Diagnosis
 Rubella: rashes & fever are less striking + lymphadenopathy
 Roseola infantum: 6th disease rash appear as the fever disappears
 Erythema infectiosum: 5th disease (Slapped cheek syndrome)
 Hand , foot and mouth disease.,CoxsacKie, enterovirus,
 Kawasaki disease:
 no cough,  Leucocytosis (elevations of neutrophils) and acute-phase reactants;  the characteristic thrombocytosis.

Answer 16

Incubation period (10-21 days)
 Prodromal symptoms: fever (moderate), malaise,
anorexia, headache & occasionally mild abdominal pain,
24-48 hours before the rash appears
These symptoms resolve within 2-4 days after the onset of the rash
.

Vesicular rashes, Varicella rash Start as papule then vesicular (clear, fluid-filled
vesicles).
 appear first on the scalp, face, or trunk
 new crops form on the trunk & then the extremities

Question 17

Chickenpox (Varicella)

Answer 17

CLINICAL
 CBC: Leukopenia & absolute lymphocytosis
 Specific diagnosis of VZV infection (IgM & IgG ):
needed in immunocompromised children.
 Elevated hepatic enzymes

Question 18

Complictions

Chickenpox (Varicella)

Answer 18

Mild thrombocytopenia, petechiae (common); purpura, hemorrhagic vesicles, hematuria & gastrointestinal
bleeding (rare)  Cerebellar ataxia, encephalitis, Guillian-Barre syndrome, transverse myelitis  Pneumonia  Nephritis, nephrotic syndrome, hemolytic-uremic syndrome  Arthritis  Myocarditis, pericarditis  Pancreatitis  Orchitis

Question 19

Chickenpox (Varicella)
Vaccine at 18 mthes

Treatment

Answer 19

Supportive treatment for fever & itching
Indications for acyclovir in children:
 Severe vaicella
 Immuno defficincy or supression e.g.
 Chmotherapy or high dose steroid treatment
 HIV infection
 Malignancies
 BMT
 Chronic skin disease  Long term salicylate therapy
 Treatment should be initiated within 24 hr of the
onset of rash

Question 20

Differential Diagnosis

Vesicular rashes

Answer 20

Vesicular rashes caused by?
 Herpes simplex virus
 Insect bites
 Drug reactions
 Contact dermatitis
 coxsackievirus and enterovirus
 Enterovirus, Rickettsial pox
 S. aureus (pastules)