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VIRAL EXANTHEMS

VIRAL EXANTHEMS. Brenda Beckett, PA-C NO PICTURES. Overview. Many of the “childhood” exanthems are rare due to immunizations (rubella, rubeola, etc) Some benign infections do not have immunizations so there are still outbreaks (coxsackievirus, etc) Some have been eradicated (smallpox).

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VIRAL EXANTHEMS

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  1. VIRAL EXANTHEMS Brenda Beckett, PA-C NO PICTURES

  2. Overview • Many of the “childhood” exanthems are rare due to immunizations (rubella, rubeola, etc) • Some benign infections do not have immunizations so there are still outbreaks (coxsackievirus, etc) • Some have been eradicated (smallpox)

  3. General Considerations • Systemic viral infection leads to cutaneous eruption (exanthem) • Prodrome: fever, malaise, n/v, headache, sore throat and other sx. • PE: rash varies with virus, may have other symptoms. Diagnosed on HX&PE • Course: Incubations different, usually resolves in <10 days

  4. Rubella(German Measles) • EPIDEMIOLOGY/ETIOLOGY: • Rubella virus. • Immunization has  incidence by 99%. Now seen in young adults, developing countries. • Trans. respiratory droplet. Mod. Communicable. • HISTORY: • 14-21 d incubation. • Usually no or mild prodrome, may have HA, malaise, low grade fever, arthralgias.

  5. Rubella • PE: • Pink macules, papules. • Start on forehead, move inferiorly to face, trunk, extremities. Progress rapidly, gone by day 3. • LABS: • Leukopenia • Acute & convalescent antibody titers, cultures. • DIAGNOSIS: • Clinical, can confirm with labs.

  6. Rubella • PROGNOSIS: • Usually mild disease. Rare: encephalitis • In first trimester of pregnancy, can lead to multiple congenital defects. • TREATMENT: Symptomatic. • HEALTH MAINTENANCE: • Immunize (2 doses MMR) • Check titers in young women, immunize.

  7. Rubeola(Measles) • EPIDEMIOLOGY/ETIOLOGY : • Measles virus. • No longer endemic in US. Major worldwide cause of pediatric morbidity and mortality. • Trans. respiratory droplet. Highly contagious. • HISTORY: • 10-15 d incubation. • Prodrome – fever, malaise, URI, cough, photophobia, conjunctivitis.

  8. Rubeola • PE: • Day 4 of fever: red macules & papules on forehead, hairline. • Spread to face, trunk, palms and soles last. Can be confluent. • Resolves 4-6 days. • Koplik’s spots – pathognomonic. • Lymphadenopathy, D/V, splenomegaly.

  9. Rubeola • LABS: • Leukopenia • Serology, cultures (nasopharangeal washings) • DIAGNOSIS: • Clinical, confirm with labs if questionable. • PROGNOSIS: • Usually self limiting. Mortality can be up to 10%. Can cause: otitis media, pneumonia, encephalitis, diarrhea.

  10. Rubeola • TREATMENT: • Isolation until 1 wk after rash starts • Symptomatic • Treat secondary bacterial infections • HEALTH MAINTENANCE: • Immunize (2 doses MMR)

  11. Coxsackievirus(Hand-foot-mouth disease) • EPIDEMIOLOGY/ETIOLOGY : • Coxsackievirus A16 (and other types) • Usually <10 years old. • Epidemic outbreaks • Highly contagious (oral-oral, fecal-oral). • HISTORY: • 3-6 d incubation • Prodrome: low fever, malaise, abd pain.

  12. Coxsackievirus • PE: • Painful oral lesions, refusal to eat. • Cutaneous lesions +/- pain. • Macules or papules  vesicles. +/- Erosions, crusts. • Palms, soles, buttocks, hard palate, tongue, buccal mucosa.

  13. Coxsackievirus • LABS: • Serology, culture. • DIAGNOSIS: • Usually clinical • PROGNOSIS: • Self limiting. • Rarely can cause meningitis, myocarditis

  14. Coxsackievirus • TREATMENT: • Symptomatic. • Self-limiting. • Topical lidocaine gel for oral discomfort. • HEALTH MAINTENANCE: • OK for daycare.

  15. Erythema Infectiosum(Fifth Disease) • EPIDEMIOLOGY/ETIOLOGY : • Human parvovirus B19. • Common in young, can be any age. • Transmission: respiratory droplet. • HISTORY: • 4-14 d incubation. • Prodrome: fever, malaise, HA, URI 2d prior. ST, N/V coincides with rash. • Adults: more severe with arthralgias.

  16. Erythema Infectiosum • PE: • Edematous, confluent plaques on malar face, “slapped cheek”. • Fade 1-4dconfluent macules, “lacy”, on extensor surfaces, extremities, trunk. • Adults: more constitutional symptoms (fever, arthralgias, adenopathy).

  17. Erythema Infectiosum • LABS: • Serology • DIAGNOSIS: • Clinical • PROGNOSIS: • Slapped cheeks fade then reticulated rash lasts 5-9 d. • Sunlight worsens, can last weeks to months • Arthralgias, aplastic crisis (immunocomp, anemic)

  18. Erythema Infectiosum • TREATMENT: • Symptomatic • HEALTH MAINTENANCE: • Prognosis excellent in immunocompetent • Immunocompromised: persistent anemia • Pregnant women: can cause hydrops fetalis and fetal anemia.

  19. Varicella(Chicken Pox) • EPIDEMIOLOGY/ETIOLOGY : • Varicella zoster virus (herpesvirus) primary infection. • 90% in <10 year olds. • Airborne droplet, direct contact. Highly contagious. • Contagious before vesicles until last vesicles crust. • Herpes zoster (secondary infection): shingles.

  20. Varicella • HISTORY: • About 14 d incubation. • Prodrome absent or mild. Worse in adults (fever, HA, malaise). • PE: • Papulesvesicles. ‘Dewdrop on rose petal’. umbilication pustules crusts in 8-12hr. PRURITIC • Crops: face scalp trunk & extremities

  21. Varicella • LABS: • Leukopenia • VZV antigen or culture (scrapings), serology • DIAGNOSIS: • Usually clinical • PROGNOSIS: • Healthy: usually self limiting. • Bacterial superinfection, pneumonia, encephalitis, maternal varicella syndrome.

  22. Varicella • TREATMENT: • Isolation until crusts gone • Lotions and antihistamines for pruritis. • Antivirals will  severity • Bacterial infection: topical/oral antibiotics. • HEALTH MAINTENANCE: • Immunization: 2 doses varivax • Check titers in young women, immunize.

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