Viral Exanthems Flashcards
What are the viral exanthems?
First disease - measles Second - scarlet fever Third - rubella Fourth - Dukes Fifth - Parvovirus B19 Sixth - Roseola Infantum
What are the symptoms of measles?
10-12 days after exposure
Fever, coryzal, conjunctivitis
Koplik grey white spots on mucosa, 2 days after fever
What is the measles rash?
Starts on face
Behind ears
3-5 days after fever
Erythematous macular rash with flat lesions
What is the treatment for measles?
Self resolving 7-10 days
Isolate until 4 days after symptoms
Notifiable disease
What are some of the complications of measles?
Pneumonia Diarrhoea Encephalitis Meningitis Hearing, vision loss
What is scarlet fever associated with?
Group A strep infection
Usually tonsilitis
Not caused by a virus
Due to exotoxin from strep pyogenes bacteria
What is the rash in scarlet fever?
Red-pink blotchy macular rash
Rough sandpaper skin
Starts on trunk, spreads outwards
What are other symptoms of scarlet fever?
Red flushed cheeks Fever Lethargy Sore throat Strawberry tongue Cervical lymphadenopathy
What is the treatment for scarlet fever?
Abx for underlying strep infection
Phenoxymethylpenicillin for 10 days
Keep off school for 24 hours following starting abx
Report to public health
What are some other conditions associated with group A strep infection which can occur with scarlet fever?
Post strep glomerulonephritis
Acute rheumatic fever
What is the rash seen in rubella?
Milder erythematous macular rash, compared to measles
Starts on face, spreads to rest of the body
Rash lasts for 3 days
Associated with mild fever, joint pain, sore throat, lymphadenopathy
What is the management of rubella?
Supportive
Condition is self limiting
Notifiable disease
Avoid pregnant women
Stay off school for at least 5 days after rash appears
What are the features of congenital rubella syndrome?
Deafness, blindness
Congenital heart disease
What are the features of parvovirus b19?
Mild fever
Coryza
Non specific viral symptoms like muscle aches, lethargy
What is the rash in parvovirus b19?
Appears 2-5 days after symptoms
Diffuse bright rash on both cheeks
A few days later - reticular mildly erythematous rash
What is the management of parvovirus b19?
Self limiting
Symptoms fade over 1-2 weeks
Stay off school until rash forms, then no longer infectious
Patients at risk - immunocompromised, pregnant, sickle cell etc - need serology testing, FBC, reticulocyte count for aplastic anaemia
What are complications of parvovirus b19?
Aplastic anaemia
Encephalitis, meningitis
Pregnancy complications
What are the causes of roseola infantum?
Human herpesvirus 6 HHV-6
HHV-7 less frequently
What is the presentation of roseola and the rash?
High fever comes on suddenly, 1-2 weeks after infection
Lasts for 3-5 days then suddenly disappears
Coryzal symptoms
Rash appears for 1-2 days when fever has settled
Mild erythematous macular rash
Not itchy
What are the complications of roseola?
Febrile convulsion due to the high temperature
Immunocompromised at risk of myocarditis, thrombocytopenia, GBS
What is the chickenpox rash and symptoms?
Varicella zoster virus
High contagious
Widespread, erythematous, raised, vesicular (fluid filled) blistering rash
Starts on trunk or face and spreads outwards
Lesions scab over then stop being infectious
Fever, itch, general fatigue
What is the infectivity of chickenpox?
Direct contact with lesions or infected droplets from cough/sneeze
Symptomatic 10 days-3 weeks after exposure
What are the complications of chickenpox?
Bacterial superinfection Dehydration Conjunctival lesions Pneumonia Encephalitis
What is the management of chickenpox?
Mild self limiting
Aciclovir if immunocompromised
Admission for complications e.g. encephalitis
Itching - calamine or chlorphenamine
Kept off school
Avoid pregnant women and immunocompromised
Until lesions dry and crusted - around 5 days after rash
What is the presentation of hand foot and mouth disease?
Coxsackie A virus
Incubation 3-5 days
Viral URTI symptoms
Tiredness, sore dry throat, temperature
Small mouth ulcers appear after 1-2 days, painful mouth ulcers on tongue
Blistering red spots - hands, feet, around mouth
Rash itchy
What is the management of hand foot and mouth?
Supportive
Adequate fluids
Simple analgesia
Avoid sharing towels, bedding
What are the differentials for a non blanching rash?
Meningococcal septicaemia Other sepsis Henoch Schonlein Purpura Idiopathic thrombocytopenic purpura Acute leukaemia Haemolytic uraemic syndrome Mechanical e.g. vomiting or breath holding Traumatic - NAI tight pressure on skin Viral illness - influenza, enterovirus
What is impetigo and the treatment?
Superficial bacterial infection - staph aureus
Golden crust
Bullous or non bullous
Topical fusidic acid
Flucloxacillin if widespread
Off school until all lesions healed, or treated with abx for at least 48 hours
