Viral Exanthems

Question 1

Single stranded lipid enveloped RNA virus (Paramyxoviridae)

IP - 8-12 days

communicability - 4 days before and 4 days after onset of rash

3 Cs - coryza, cough, conjunctivitis

Answer 1

MEASLES (RUBEOLA)

rashes appear at the height of the fever
CEPHALOCAUDAL – forehead, behind the ear and upper neck –> torso and extremities

BRANNY DESQUAMATION

Question 2

enanthem of Measles

discrete red lesion with bluish white spots in the center on the inner aspects of the cheeks at the level of the PREMOLARS

before the onset of rash

Answer 2

KOPLIK SPOT

Question 3

Lab findings in Measles

Answer 3

decrease WBC
IgM antibody
4 fold rise in IgG antibodies

Question 4

Pathognomonic sign of Measles

Answer 4

Warthin Finkeldey giant cells (fusion of infected cells)

Question 5

MC complication of measles

Answer 5

Otits media

Question 6

MCC of mortality in measles

Answer 6

PNEUMONIA

Bronchiolitis obliterans - final common pathway to fatal outcome

Question 7

Fatal degenerative disease from persistent infection 7-10 yrs after natural measles infections

Answer 7

Subacute Sclerosing Panencephalitis (SSPE)

I - mild symptoms

II - massive myoclonus

III - choreathetosis, dystonia, immobility, pipe rigidity, dementia, stupor then coma

IV - loss or cortical centers

Question 8

Management for Measles

Answer 8

SUPPORTIVE

VITAMIN A PO for 2 days
12 mos or older - 200 000 IU
6 mos - 11 mos - 100 000 IU
<6 mo - 50 000 IU

ZINC for 14 days

Question 9

Single stranded lipid enveloped RNA virus (Togaviridae)

IP - 14-21 days

communicability - 7 days before 7 days after onset of rash

SUBOCCIPITAL POSTAURICULAR AND ANTERIOR LYMPH NODES

low grade fever
(-) photophobia

Answer 9

GERMAN MEASLES (RUBELLA)

Question 10

enanthem of German measles

tiny, rose colored lesions ot petechial hemorrhage on the soft palate

appear at the SAME time as the rash

Answer 10

FORCHEIMER SPOTS

Question 11

Lab findings in German Measles

Answer 11

4fold increase in IgM and IgG

Question 12

The MOST SERIOUS COMPLICATION of postnatal rubella

Answer 12

Encephalitis

Question 13

Congenital Rubella Syndrome

Answer 13

Nerve Deafness – single MC finding among infants

Salt pepper retinopathy - MC ocular abnormality

Unilateral or Bilateral Cataracts - most serious eye findings

PDA - most frequently reported cardiac defects

Question 14

Human Herpesvirus 6 and 7

IP - 9-10 days

fever for 3-5 days w/ fussiness
seizures

rashes APPEAR when fever ABATES

Answer 14

Roseola Infantum (Exanthem subitum or 6th disease)

rash appears w/n 12-24 hrs of fever resolution
faint pink or rose colored
TRUNK
CENTRIPETAL

Question 15

enanthem of 6th disease

Answer 15

NAGAYAMA SPOT

ulcers at the uvulopalatoglossal junction

Question 16

MC complication of Roseola

Answer 16

CONVULSIONS

Question 17

DS DNA; Varicella Zoster Virus

IP - 10-21 days

communicability - 1-2 days before rash, 7 days after rash and ALL LESIONS HAVE CRUSTED

fever
malaise 1-2 das before rash

maculopapular, vesicular, pustular lesions present simultaneously

Answer 17

VARICELLA

rash appear on the scalp, face or trunk
CENTRIPETAL

Question 18

Passive immunization with Varicella Zoster IG (VZIG)

Answer 18

immunocompromised
pregnant
newborns whose mother had chickenpox 5 days before up to 2 days after delivery

Question 19

Post Exposure Prophylaxis (Varicella)

Answer 19

Active vaccine – given within 5 days of exposure

Anti-VZV Ig for immunocompromised, pregnant and newborns within 96 hrs

Question 20

Coxsackie A16
Enterovirus 17

IP - 3-6 days

communicability - respiratory tract shedding limited to a week or less

fever, sorethroat, respi and GI symptoms

1-2 days fever – enanthem – exanthem

Answer 20

HAND, FOOT AND MOUTH DISEASE

ulcers on tongue, buccal mucosa
tender ulcers on hands and feet

Question 21

Parvovirus B19
Bocavirus

IP - 4-14 days

communicability - before onset of the rash until after the onset of rash

mild fever and systemic infections

SLAPPED CHEEK - rash w/ erythematous facial flushing – trunk and proximal extremities

Answer 21

ERYTHEMA INFECTIOSUM (5TH DISEASE)

Question 22

Complication of Erythema Infectiosum (5th disease)

Answer 22

APLASTIC CRISIS

ARREST OF ERYTHROPOIESIS

Question 23

Postexposure prophylaxis for Measles

Answer 23

Measles Ig for prevention and attenuation w/n 6 days of exposure

Measles active vaccine can be given for susceptible children > 1 year old within 72 hrs

Infants < 6 mos old, pregnant and immunocompromised person should receive Ig but not the active vaccine

Question 24

Most frequent complication of zoster infection

Answer 24

Post herpetic neuralgia

Question 25

Cicatricial skin scarring
Limb hypoplasia
Neurologic, Renal and ANS abnormalities

Answer 25

Congenital Varicella