Viral Exanthems Etc Flashcards
What are the 3 C’s of measles
Cough
Coryza
Conjunctivitis
Where do vesicles appear in Hand Foot and Mouth disease?
Hands, feet, mouth, and BUTTOCKS***
How do you diagnose varicella
Visualize lesions in all 3 stages at the same time
What are the two kinds of HPV?
Mucosal
Cutaneous
When do Koplik spots appear
48 hours before rash
What is in your ddx for the prodrome of herpes zoster
Migraine, cardiac/pleural disease, acute abdomen, vertebral disease
~many misdiagnoses during prodrome of shingles~
What are the clinical stages of measles
- Incubation
- Prodrome
- 3 C’s
- Enanthem
- Exanthem
What is a differential diagnosis for condyloma acuminata
Anal SCC
How is measles spread
Cough
Sneeze
Close breathing
What disease has fatal complications after 7-10 years
Measles
What is the key to diagnosing measles?
Clinical presentation
What % of US population has HSV-II
15-20%
How is HFM disease transmitted
Oral ingestion of virus
What is the etiology of hand foot and mouth disease
Coxsackie A16 Virus
What is the treatment for molluscum contagiosum?
Home treatment with podophyllotoxin cream (NOT OK for pregnancy)
(Otherwise it clears up on its own in 6-12 months)
When can a kid with varicella go back to school?
After all the lesions are crusted
How do we prevent rubella
MMR vaccine (not while pregnant though)
Draw rubella titers at first prenatal visit
What is the etiology of Roseola Infantum?
Herpes virus 6 (HHV-6)
What is herpes zoster ophthalmicus (HZO)
A vision-threatening activation of trigeminal nerve ganglion due to shingles
How do you prevent herpes zoster
Shingrix vaccination
Approved for 50yo+
What do molluscum contagiosum lesions look like?
UMBILICATED, flesh colored, pearly papules
Anywhere but palms and soles
What is congenital rubella syndrome
Baby looks like a BLUEBERRY MUFFIN
Hearing loss
Mental retardation
Heart & eye problems
Death
How is HSV spread
Direct contact with active lesions, even though pt may be asymptomatic
What is the pattern of spreading for roseola infantum?
Starts at neck/trunk
Moves to face/extremities
What is known as the 3 day measles
Rubella
How is varicella transmitted
Aerosolzied droplets or direct contact with skin lesions
highly contagious
How do you diagnose verruca vulgaris (common warts)
Scrape off hyperkeratotic portion until you can see the thrombosed capillaries (“seeds”)
What body area is usually affected by condyloma acuminatum
Anorectal area
C.a. Is mucosal HPV
What is the etiology of varicella
Varicella zoster virus (VZV), a herpes virus
What do Koplik spots look like?
bluish white grains of salt on a red background (inside mouth)
How do you manage the pain of herpes zoster
Acute: narcotics, NSAIDS, topical anesthetic
Chronic: gabapentin (neurontin), pregabalin(lyrica), tricyclic antidepressants
What disease has generalized lymphadenopathy and polyarthralgias
Rubella (German measles)
What is Verruca Vulgaris
Common warts
What is the common name for herpes zoster
Shingles
When is the worst presentation of HSV-I
Primary presentation most severe
What is unique about the prodrome of measles
VERY high fever 104-105*F
What is the cycle of roseola infantum
- Very high fever
- Resolves abruptly
- Rash appears
How do you tell apart measles (rubeola) from German measles (rubella)?
German measles has:
1. No Koplick’s spots
- Lower fever
- Less intense face rash
What is the etiology of condyloma acuminatum?
Human papillomavirus (HPV)
C.a is mucosal HPV
What is the etiology of rubella
Rubella virus
What disease is known to cause outbreaks at Disneyland
Measles
What is the other name for measles
Rubeola
What is the etiology of Erythema Infectiosum?
Parvovirus B-19
What disease is consistent with a LACY rash
Erythema infectiosum (Fifth disease)
Can you get chicken pox more than once
Yes
What is the etiology of herpes zoster
Varicella zoster virus (VZV) a herpes virus
same one as varicella
What is part of the enanthem of measles
Koplik spots
What are the complications of rubella?
- Encephalitis
- Congenital rubella syndrome if pregnant mom gets it
- Mortality
What is the common name for varicella
Chicken pox
When should you treat herpes zoster/shingles
EARLY like within 72 hours
Accelerates healing, decreases pain, and may reduce the incidence of PHN
What is in your ddx for the active phase of shingles
Allergic contact dermatitis, poison ivy, erysipelas, bullous impetigo
~single area so it looks like it could be something they came in contact with~
What are the serious complications of erythema infectiosum?
- Transient aplastic crisis (anemia)
2. Hydrops fetalis + fetal loss if pregnant mom gets it
What is the etiology of molluscum contagious?
Poxvirus
When should you treat HSV
EARLY within 72 hours
Where does the lacy rash of erythema infectiosum affect?
Trunk and extremities (extensor surfaces)
What is Hutchinson’s sign
Shingles vesicles on nose indicating Herpes Zoster opthalmicus
What is the clinical presentation of condyloma acuminatum?
Cauliflower lesions around anus
What is the treatment for HSV
Valacyclovir (Valtrex)
Famciclovir (Famvir)
Acyclovir (Zovirax)
Doses differ depending on if its an initial outbreak vs a recurrence
What is the clinical presentation of verruca vulgaris
Raised rough lesions with tiny pigmented, thrombosis capillaries (“seeds”)
Common on hands and feet
What is the active phase of herpes zoster
When the vesicles show up
What is the prodrome like for erythema Infectiosum?
Low grade fever+ various flu like symptoms
How long is the prodrome of HFM disease
12-24 hours (short)
What do HSV lesions look like?
grouped vesicles on an erythematous base
How long does the area remain infectious after measles person leaves
2 hours
How long does shingles last
Resolves within 2-6 wks
When are you contagious if you have rubella?
7 days before and after rash
Where are the vesicles distributed for each of these:
- HFM
- Varicella
- herpes zoster
- HFM: hand foot mouth butt
- varicella: everywhere
- herpes zoster: along dermatome
What are the complications of chronic shingles/herpes zoster
Post-herpetic neuralgia (PHN)
Herpes Zoster Ophthalmicus (HZO)
Retinal necrosis
Nerve palsies
A 7 year old presents with an eryhtematous rash on cheeks and lower extremities. It’s not itching and he doesn’t feel ill. What does kid have and what is his pregnant mom at risk for?
Kid has Fifth disease (Erythema infectiosum)
Mom at risk for hydrops fetalis
What is the spreading pattern of measles
Starts intensely on face, and then spreads down to toes.
Palms and soles spared.
What is the treatment for varicella
Symptomatic treatment
Avoiding pregnant females
Avoiding susceptible people until all lesions are crusted
What is the treatment for Roseola infantum?
Supportive treatment
Antipyretics
What is the progression of the rash of Rubella
Head to toe (just like measles)
What is the etiology of measles
Paramyxovirus
What is the other name for Erythema Infectiosum?
Fifth Disease
What is the other name for Rubella
German measles
What is in the ddx during the chronic phase of shingles
Neuropathy
Drug seeking
What disease has anemia as a complication
Fifth disease/erythema infectiosum
What are the complications of HFM disease
Decreased oral intake/dehydration due to very painful mouth
+encephalitis, aseptic meningitis, nail loss, fetal loss
Where won’t you find molluscum contagiosum lesions?
Palms and soles
If you did, you should think HFM instead
40% of newly acquired genital herpes is due to?
HSV-I tee hee
Is there a vaccine for HFM disease
No, prevent with hand washing only
What is unique about the prodrome for Roseola infantum?
3-5 days of EXTREMELY high fever with an abrupt end.
Risk of febrile seizures
Patient usually feels ok otherwise
How do we treat measles?
Symptomatic treatment only
Who is most likely to get rubella?
People who traveled or immigrants
It was eliminated in 2015
What antiviral do you treat herpes zoster with
Famciclovir (Famvir) TID x 7d
Valacyclovir (Valtrex) TID x 7d
(Acyclovir ok but its QID)
What is post herpetic neuralgia (PHN)
Stabbing pain that can last months-years after resolution of shingles lesions
How is molluscum contagiosum transmitted
Direct contact with person or fomites
Ex: drying 2 kids off with same towel
Frequent autoinoculation
What are the clinical stages of varicella
- Incubation 10-21 days
- Prodrome 2-5 days
- Rash
Where does HSV-II usually affect
Genitals
“Herpes genitalis”
What % of adults have HSV-I
90%
How do you get herpes zoster (shingles)
Reactivation of latent VZV from dorsal root ganglion due to stress/aging
What is the treatment for HFM disease
Symptomatic, including lidocaine gets for oral discomfort
What is the etiology of verruca vulgaris
Human papillomavirus (HPV)
How do you treat erythema infectiosum?
- Reassurance and symptomatic treatment
- Blood transfusions if severely anemic
- Avoid contact with pregnant people
How do you treat verruca vulgaris?
USe #15 blade to shave down the callus proper to cryotherapy
Other txs can be salicylic acid, duct tape, or electrodessication
What is involved in the prodrome of HSV
Burning, tingling, or pruritus
What is classic about the prodrome for herpes zoster (shingles)
Acute nerve pain on skin but there’s nothing there for 3-5 more days
What is the management for Rubella
Avoiding contact with pregnant women
Symptomatic treatment
What type of HPV forms benign warts but plays a role in oncogenesis of skin and mucosal malignancies?
Cutaneous HPV
Can you get shingles if you never had chicken pox
Yes varicella vaccine can cause shingles later in life
Where do herpes zoster lesions form
Along a dermatome
11 yr old presents with itchy rash after a fever foe r 3 days. Started on trunk and then went to extremities and face. It began as flat papules and is progressing to blisters. What is the diagnosis?
Varicella zoster
Who is most likely to get condyloma acuminatum
Gay men
Where does HSV-I usually affect
Oral: cold sores
“Herpes labialis”
What are the the infectious precautions you must take when having a shingles outbreak
- can transmit varicella to seronegative people via contact with lesions
- avoid pregnant women, infants, and immunocompromised ppl
- use caution until primary crusts have healed
What does the rash of erythema Infectiosum look like?
Slapped cheek
Lacy body rash 2-3 days later
What is the other name for mucosal HPV?
Condylomata Acuminata
What are the severe complications of measles?
Pneumonia
Encephalitis
Subacute Sclerosing Penencephalitis (SSPE) 7-10 yrs later
What is unique to the varicella rash
The vesicles occur at different stages over 4 days and are crusted over after 6 days
