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Viral Exanthems

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Angad , JaL. Viral Exanthems. RUBEOLA. (MEASLES). Measles. Etiology RNA virus of the genus Morbillivirus in the family Paramyxoviridae Epidemiology Prior to use of vaccine, peak incidence was among 5-10 y/o Transmission 90% of susceptible contacts acquire the disease

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  • Etiology
    • RNA virus of the genus Morbillivirus in the family Paramyxoviridae
  • Epidemiology
    • Prior to use of vaccine, peak incidence was among 5-10 y/o
  • Transmission
    • 90% of susceptible contacts acquire the disease
    • Maximal dissemination occurs by droplet spray during the prodromal period
clinical manifestations
Clinical Manifestations
  • Incubation Period: Last 10-12 days
  • Prodromal stage: Last 3-5 days characterized by low-mod grade fever, dry cough , coryza, photophobia & conjunctivitis. Kopliks spots appear by 2nd -3rd day
  • Rash - as exanthem progresses systemic symptoms subside
course and prognosis
Course and Prognosis
  • Self-limited infection in most patients
  • Complications common in malnourished children, the unimmunized & those w/ congenital immunodeficiency,and leukemia
  • Acute complications: otitis media, pneumonia (Hecht giant cell pneumonia), diarrhea, measles encephalitis, thrombocytopenia.
  • Chronic complication: subacute sclerosing panencephalitis.
  • Based on Clinical picture
  • Laboratory confirmation is rarely needed
  • Measles IgM – detectable for 1 month after the illness but sensitivity is limited
  • Prevention – MMR
  • Acute Infection – treatment is entirely supportive (antipyretics, bed rest, adequate fluid intake)
  • Secondary Bacterial Infection – administration of appropriate antibiotics


  • Common benign childhood infection manifested by a characteristic exanthem and lymphadenopathy
  • Etiology: RNA virus , genus Rubivirus, family Togaviridae
  • Epidemiology
    • Humans are the only natural host of Rubella virus
    • Spread by oral droplet or transplacentally to the fetus
    • Peak incidence is 5-14 y/o
  • Pathogenesis: Not well understood
clinical manifestations1
Clinical Manifestations
  • Incubation Period: 14 to 21 days.
  • Prodromal phase
    • Mild catarrhal symptoms
    • In adolescents and young adults: anorexia, malaise, conjunctivitis, headache, low-grade fever, mild URT symptoms.
    • Retroauricular, post cervical & postoccipital lymphadenopathy
  • An enanthem appears just before the onset of the rash (FORCHHEIMER SPOTS)
physical examination1
Physical Examination
  • Skin Lesions
  • Petechiae on soft palate
  • Enlarged lymph nodes
  • Maybe apparent from clinical symptoms and PE
  • Usually confirmed by serology or viral culture
  • Latex agglutination, enzyme immunoassay & fluorescent immunoassay
course and prognosis1
Course and Prognosis
  • In most persons, rubella is mild
  • Pregnant women infected during the 1st trimester can pass the infection transplacentally
  • Congenital rubella syndrome
    • Congenital heart defects
    • Cataracts
    • Microphthalmia
    • Deafness
    • Microcephaly
    • Hydrocephaly
  • Prevention – MMR
    • Pregnant women should not be given live rubella virus vaccine and should avoid becoming pregnant for 3 mo after they have been vaccinated
  • Acute Infection – symptomatic
erythema infectiosum


fifth disease
Fifth Disease
  • EI is a childhood exanthem occurring with primary parvovirus B19 infection
  • Characterized by edematous erythematous plaques on the cheeks (“slapped cheeks”) and an erythematous lacy eruption on the trunk and extremities
  • Transmission:Spreads via droplet aerosol
clinical manifestations2
Clinical Manifestations
  • Incubation Period: 7 to 28 days
  • Children:Fever, malaise, headache, coryza. Headache, sore throat, fever, myalgias, nausea, diarrhea, conjunctivitis, cough may coincide with rash.
  • Adults:Constitutional symptoms more severe, with fever, adenopathy, arthritis/arthralgias involving small joints of hand, knees, wrists, ankles, feet. Numbness and tingling of fingers.
erythema infectiosum1

Diffuse erythema and edema of the cheeks with “slapped cheek” facies in a child

  • Usually based on clinical presentation of the typical rash
  • Serologic test for B19
  • PCR, nucleic acid hybridization
course and prognosis2
Course and Prognosis
  • “Slapped cheeks” lesions fade over 1 to 4 days. Eruption lasts for 5-9 days but can recur
  • Arthralgia is self-limited
  • In patients w/ chronic hemolytic anemias transient aplastic may occur
  • Fetal B19 infection may be complicated by nonimmune fetal hydrops secondary to infection of erythroid precursors
  • No specific antiviral therapy
  • IVIG have been used to treat episodes of anemia and bone marrow failure
roseola infantum


exanthem subitum
  • Exanthema subitum (sudden rash) is associated with primary HHV-6 and HHV-7 infection, characterized by the sudden appearance of rash as high-fever lysis in a healthy-appearing infant
  • Primary infection is acquired via oropharyngeal secretions
  • Pathogenesis of ES rash is not known
clinical manifestation
Clinical Manifestation
  • Incubation period: 7 -17 days
  • High fever with morning remission until the 4th day when it falls to normal coincident with the appearance of rash
  • Infant remarkably well despite high fever
  • In Asian countries, ulcers at the uvulo-palatoglossal junction (NAGAYAMA SPOTS) are common.
physical examination2
Physical Examination
  • Multiple, blanchable macules and papules on the back of a febrile child, which appeared as the temperature fell
  • Based on age, history and PE findings
  • Serology, virus culture, Antigen detection and PCR
course and prognosis3
Course and Prognosis
  • Self-limited with rare sequelae
  • High fever maybe associated w/ seizures
  • HHV-6 & HHV-7 persist throughout the life of the patient
  • Treatment is supportive (antipyretics, bed rest, adequate fluid intake)