Viral Exanthems Flashcards
any eruptive skin rash that may be associated with fever or other systemic symptoms
exanthem
what are the 6 classical infectious childhood exanthems
- rubeola (measles)
- scarlet fever, associated with strep
- rubella (german measles)
- “Dukes’ disease” - thought to be wrong
- erythema infectiosum (parvovirus B19)
- roseola infantum (HHV-6 and HHV-7)
incubation of rubeola
7-14 d
transmission of rubeola
- airborne
- can spread for about 8 days
- starts 4 days before the rash appears
- ends when the rash has been present for 4 days.
kids with rubeola are not allows to return to school for ____ after rash appears
4 days
s/s of rubeola (measles)
- Low Grade Fever
- can be high as 104-105 - Dry Cough
- Coryza (Runny nose)
- Conjunctivitis
- Sore throat
- Koplik’s spots on buccal mucosa
- Red, blotchy skin rash
- Face (behind the ears and along the hairline) → arms and trunk → thighs, lower legs, and feet
- recedes - fading first from the face and last from the thighs and feet
Initial symptoms cause a relatively mild illness and may last for 2-3 days
tx for rubeola
- Supportive care:
- Increased fluid intake
- Acetaminophen for fever (No ASA)
- Antibiotics for complications of bacterial infection - Post-exposure vaccination
- within 72 hours of exposure to provide protection against the disease.
- If measles still develops, the illness usually has milder symptoms and lasts for a shorter time
no cure
what is the vax scheduling for rubeola
- 1st dose - 12-15 months
- 2nd dose - 4-6 yrs
- may be given during any visit
- at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 mos - no second dose - complete the schedule by the visit at age 11-12 yrs.
what is the incubation of mumps
12-25 days after infection
transmission of mumps
- Airborne
- Contact w/ saliva
- Contaminated surfaces
isolation of pts with mumps is ___ after their glands begin to swell
5 days
if a pt presents with:
Fever
Headache
Muscle aches
Tiredness
Loss of appetite
Parotitis
what is the probable diagnosis
mumps
complications with mumps
- orchitis
- encephalitis
- oophoritis/mastitis
- deafness
prevention for mumps
- Vaccine – MMR
- 2 doses of mumps vaccine are 88% effective at preventing the disease
(one dose is 78% effective) - be clean
- Washing hands
- Not sharing eating or drinking utensils
- Cleaning surfaces that are frequently touched regularly with soap and water or with cleaning wipes
- Minimize close contact with other people if you are sick
- Cough and sneeze etiquette
incubation of rubella
2-3 wks
transmission of rubella
- airborne
- direct contact
- bloodstream from pregnant women
communicable period of rubella (German measles)
10 d prior to rash ➤ 1-2 wks after rash disappears
- Mild fever
- HA
- Stuffy or runny nose
- Inflamed, red eyes
- Symmetrical postauricular and occipital tender LAN
- fine, pink rash
- face and quickly → trunk → arms and legs
- disappears in the same sequence - Arthralgias
- especially in young women.
rubella
complications with rubella
- arthritis
- Women mainly
- Fingers, wrists, knees
- Lasts up to 1 month - OM/encephalitis
- congenital rubella syndrome
highest risk for congenital rubella syndrome to the fetus is when during the pregnancy?
first trimester
but exposure later in pregnancy is also dangerous
If a patient contracts rubella while pregnant and wishes to continue with the pregnancy, she may be given ___ to fight off the infection and reduce symptoms
hyperimmune globulin
does not necessarily eliminate the possibility of the baby developing congenital rubella syndrome
what is the classic triad of congenital rubella syndrome
Microcephaly
Cataracts
Cardiac defects
diagnosis and tx for rubella?
how do you confirm it is rubella?
- clinically
- IgM antibody titers - for confirmation - isolation
- especially pregnant women - tx
- supportive
prevention of rubella
- Vaccine – MMR
- Women before getting pregnant (Live, attenuated vaccine) - Once sick = permanently immune
incubation of Erythema Infectiosum
1-2 wks
transmission of Erythema Infectiosum
- Respiratory secretions
- Blood / blood products
- Springtime
- Transmitted through pregnancy
communicable period of erythema infectiosum
before rash appears
s/s of Erythema Infectiosum
1.1st symptoms - mild
- fever, rhinitis, HA
2. 1–2 wks
- fiery-red facial erythema “slapped cheeks”
- 1–4 days after the slapped cheek eruption - lacy (reticular) macular exanthem over the proximal extremities
- The exanthem can recur bc of certain stimuli
- local irritation, high temps and emotional stress
- Polyarthropathy syndrome, esp in adults, lasting 1-3 wks or longer
diagnosis of Erythema Infectiosum
what would show in their lab results?
- clinical - “slapped cheeks”/lacy rash
- blood test - IgM-specific antibodies to parvovirus B19
tx for Erythema Infectiosum
- mild - self-limiting
- Symptomatic relief
- IV immune globulin for immunocompromised patients and those with RBC disorders
complications with Erythema Infectiosum
- suppress RBC production
- transient aplastic crisis
- chronic red cell aplasia
- hydrops fetalis
- congenital anemia
more likely in pts with RBC problems
prevention for Erythema Infectiosum
- be clean
- develop immunity after infection
no vaccines
incubation of Roseola Infantum
5-15 days
transmission of Roseola Infantum
airborne
spring&fall
HH-6 and -7 are prevalent in what demographic
healthy population
almost all children between 6 months - 3 yrs
rarely in >4yrs and <2yrs
s/s of Roseola Infantum
- High fevers lasting 3-5 days
- blanchable, rosey pink, nonpruritic macular rash
- predominantly on the neck and trunk
- happens after fever
during fever = feels sick
rash appears = feels normal again
diagnosis of Roseola Infantum? additional work up?
- clinical
- febrile seizure = seizure workup
tx for Roseola Infantum
supportive - fluids, acetaminophen
complications with Roseola Infantum
rare
meningitis, encephalitis, leukopenia, thrombocytopenia, hepatitis
incubation of Varicella
10-21 days after exposure to chickenpox or shingles
transmission of Varicella
- Very contagious
- Does not require skin-skin contact
- Can be spread by someone who has shingles
communicable period of Varicella
1-2 days before the rash appears until time all blisters have scabbed over
pt with vesicles on an erythematous base = “dewdrop on a rosepetal” has what infection
varicella
diagnosis of varicella
- PCR swab of lesion
- IgM titers
tx for varicella
- Symptomatic
- Calamine lotion / oatmeal baths
- Trim nails
- Acetaminophen - Antivirals (high risk)
- Acyclovir / valacyclovir
- Started w/in 24 hours and treat 5 days - Varicella immunoglobulin
- High risk individuals
CDC vax recommendations for varicella
2 doses
- age of 12–15 months
- at 4–6 years
incubation of HFMD
3-7 d
transmission of HFMD
- Highly contagious
- Nasal secretions, saliva, stool, blisters, resp droplets
- Summer and fall
communicable period of HFMD
Most contagious first week of illness
can transmit until all blisters resolved
- A red non-pruritic rash, often with blistering (vesicles), on the palmar and plantar skin
- Painful, red, blister-like lesions on the tongue, gums, hard palate, and buccal mucosa
what is the diagnosis?
HFMD
diagnosis and tx for HFMD
- clinically - Distinction from other viral infections by:
- The age of the affected person
- The pattern of signs and symptoms
- The appearance of the rash or sores - supportive
- resolves 7-10 d
- topical oral anesthetic
- OTC pain medications
complications with HFMD
- dehydration (MC)
- encephalitis
prevention for HFMD
good hygiene
