Week 6: Rashes in Infectious Disease Flashcards
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Learning Objectives
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What is a macule?
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What is a papule?
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Macule vs Papule
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What is a nodule?
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What is a Plaque?
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Nodule vs plaque
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What is a pustule?
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What is a vesicle/Bulla?
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Pustule vs vesicle/Bulla
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What are hives?
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What is angioedema?
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Hives vs angioedema
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What are scales?
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What is crust?
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Scales vs crust
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What is an erosion?
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What is an ulcer?
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What is a fissure?
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Erosion vs ulcer vs fissure
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What is a cyst?
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What is a burrow
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Cyst vs burrow
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What is petechiae?
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What is purpura?
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Petechiae vs purpura
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Question
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Measles clinical presentation
* Fever
* The 3 C's:
* Cough
* Coryza
* Conjunctivitis
* Koplik spots 1-2 days prior to rash
* The rash starts on the face and spreads down
* Rash is NOT pruritic
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Complications of Measels
Rare complications are
* Secon dary bacterial infection
* Encephalitis
* Subacute sclerosing panencephalitis
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Measels overview
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Rubella AKA
German Measles
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Rubella clinical manifestations
* Nonspecific
* Low grade fever
* 50% asymptomatic
* The rash starts on the face and moves down to the trunk
* It IS pink, NOT red like Measels
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Rubella complications
* Congenital Rubella (highest risk first 4 months of pregnancy)
* hearing-loss
* mental retardation
* Cardiovascular defects
* ocular defects
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Rubella overview
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Reseola AKA
HHV-6 or HHV-7
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Roseola Clinical Manifestations
* Upper respiratory symptoms
* High fever for 5-7 days
* 90% case in children \<2 y/o
* The rash starts when fever breaks
* spreads from neck/trunk to face and extremities
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Roseola complications
* Occasionally high fever will trigger febrile seizures
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Roseola overview
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Hand-foot-mouth Disease AKA
Coxsackievirus
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Hand-foot-mouth Disease clinical manifestations
* Fever
* Sore-throat
* Malaise
* Painful sores develop in the mouth (Herpangina)
* similar lesions on the hands and feet
* Some appear lie blisters that break and ulcerate
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Complications of Hand-foot-mouth Disease
* Fingernail/Toenail loss (Temporary)
* Aseptic meningitis
* Encephalitis
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Hand-foot-mouth Disease overview
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Fifth Disease AKA
Parvovirus B19
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Fifth Disease Clinical manifestations
* Flu-like symptoms for 3 days
* Rash
* "slapped-cheek" with erythematous macular or papular lesions
* "Lacy" rash on trunk and extremities
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Fifth Disease complications
* Arthralgias
* Aplastic crisis
* Fetal hydrops
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Fifth Disease overview
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Scarlet Fever Clinical manifestations
* Very sore-red-throat
* High fever
* Headache
* NV
* Strawberry tongue
* Rash
* Begins neck, underarms and groin and then spreads
* Red rash with sandpaper feel
* Skin may desquamate
* Pastia's lines
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Complications of Scarlet Fever
* Rheumatic fever
* Poststreptococcal glomerulonephritis
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Scarlet Fever AKA
Group A Strep
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Scarlet Fever overview
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Penicillin Skin Rash
* Occurs hours or sometimes days after exposure to penicillin
* Skin rash can be macular, papular or hives
* Associated itching, swelling, possible wheezing or anaphylaxis
* Can be diagnosed via skin testing
* Desensitization available
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Question
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Chicken Pox AKA
Varicella or VZV
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Chicken pox clinical manifestations
* Mild fever
* malaise 1-2 days prior to the rash
* Rash
* Starts on the head/chest/back and then generalizes
* macules to papules to vesicles to crust
* varying stages of lesions
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Complications of Chicken pox
* Secondary bacterial infections of skin
* Pneumonia in adults
* Rarely encephalitis or cerebellar ataxia
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Chicken pox overview
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Shingles AKA
Herpes Zoster
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Shingles Clinical manifestations
* Pain
* Itching
* Tingling of skin dermatome
* Rarely systemic symptoms like
* fever
* malaise
* headache
* Rash
* Unilateral dermatome
* Blisters (vesciles) to crusts in varying stages
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Shingles complications
* Postherpetic neuralgia
* Ocular movement (fifth cranial nerve)
* Bacterial superinfection
* Disseminated zoster
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Shingles overview
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Herpes Zoster AKA
Shingles
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Herpes AKA
* HSV-1
or
* HSV-2
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Herpes clinical manifestations
* 1st infection has associated fever, achiness, headache, lymphadenopathy
* Recurrent outbreaks with tingling or pain in skin
* Rash
* Vesicles that open to painful ulcers that heal 2-4 weeks
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Herpes complications
* Aseptic meningitis
* Encephalitis
* Blindness
* Disseminated infection if immunocompromised
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Molluscum contagiosum clinical manifestations
* Rash
* 2-5 mm painless
* flesh colored, pearly papules with a central umbilication
* Resolves in 6-12 months to 4 years
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Molluscum contagiosum complications
* Scarring if manipulated
* Bacterial superinfection
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Molluscum contagiosum overview
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Question
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What is Erysipelas?
Bacterial skin infection of the upper dermis
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Erysipelas clinical manifestations
* Very erythematous, indurated plaque with a sharply demarcated border
* Typically associated with Group A Streptococcus (Though other bacteria are also implicated)
* Previously associated with the face but now more commonly on legs
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What is cellulitis?
* A non-necrotizing inflammation of skin and subcutaneous tissues from acute infection
* Typically from a break in the skin
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Cellulitis clinical manifestations
Symptoms of
* erythema
* swelling
* pain
* warmth
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Cellulitis pathogens
Staph aureus (including MRSA) and streptococcus are most common
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Cellulitis complications
If left untreated, may progress to deeper infection or bloodstream infection
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Cellulitis overview
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What is Necrotizing fasciitis?
Infection that spreas along fascial planes, causing tissue necrosis
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Necrotizing fasciitis pathogen
Typically Group A Streptococcus but also Staph aureus, Clostridium species or polymicrobial species
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Necrotizing fasciitis clinical manifestations
* Patients have intense pain compared to the appearance of the skin
* They are also quite ill with fever, tachycardia
* Skin eventually develops blisters, clear fluid drainage and crepitus
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Necrotizing fasciitis Treatment
* Surgical for extensive debridement
* Antibiotics are usually broad spectrum initially plus clindamycin to disrupt toxin production
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Necrotizing fasciitis overview
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Furuncle, Carbuncle, Abscess overview
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What is a Furuncle?
Deep folliculitis typically caused by S. aureus
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What is a carbuncle?
Cluster of furuncles connected to each other under the skin
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What is an abcess?
Collection of pus causing swelling and inflammation (Often deeper than a furuncle or carbuncle
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Furuncle, Carbuncle, Abscess Treatment
Drainage +/- antibiotics
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