Viral Exanthems Flashcards
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
MEASLES (RUBEOLA)
rashes appear at the height of the fever
CEPHALOCAUDAL – forehead, behind the ear and upper neck –> torso and extremities
BRANNY DESQUAMATION
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
KOPLIK SPOT
Lab findings in Measles
decrease WBC
IgM antibody
4 fold rise in IgG antibodies
Pathognomonic sign of Measles
Warthin Finkeldey giant cells (fusion of infected cells)
MC complication of measles
Otits media
MCC of mortality in measles
PNEUMONIA
Bronchiolitis obliterans - final common pathway to fatal outcome
Fatal degenerative disease from persistent infection 7-10 yrs after natural measles infections
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
Management for Measles
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
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
GERMAN MEASLES (RUBELLA)
enanthem of German measles
tiny, rose colored lesions ot petechial hemorrhage on the soft palate
appear at the SAME time as the rash
FORCHEIMER SPOTS
Lab findings in German Measles
4fold increase in IgM and IgG
The MOST SERIOUS COMPLICATION of postnatal rubella
Encephalitis
Congenital Rubella Syndrome
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
Human Herpesvirus 6 and 7
IP - 9-10 days
fever for 3-5 days w/ fussiness
seizures
rashes APPEAR when fever ABATES
Roseola Infantum (Exanthem subitum or 6th disease)
rash appears w/n 12-24 hrs of fever resolution
faint pink or rose colored
TRUNK
CENTRIPETAL
enanthem of 6th disease
NAGAYAMA SPOT
ulcers at the uvulopalatoglossal junction
MC complication of Roseola
CONVULSIONS
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
VARICELLA
rash appear on the scalp, face or trunk
CENTRIPETAL
Passive immunization with Varicella Zoster IG (VZIG)
immunocompromised
pregnant
newborns whose mother had chickenpox 5 days before up to 2 days after delivery
Post Exposure Prophylaxis (Varicella)
Active vaccine – given within 5 days of exposure
Anti-VZV Ig for immunocompromised, pregnant and newborns within 96 hrs
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
HAND, FOOT AND MOUTH DISEASE
ulcers on tongue, buccal mucosa
tender ulcers on hands and feet
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
ERYTHEMA INFECTIOSUM (5TH DISEASE)
Complication of Erythema Infectiosum (5th disease)
APLASTIC CRISIS
ARREST OF ERYTHROPOIESIS
Postexposure prophylaxis for Measles
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
Most frequent complication of zoster infection
Post herpetic neuralgia
Cicatricial skin scarring
Limb hypoplasia
Neurologic, Renal and ANS abnormalities
Congenital Varicella
