Viral Exanthems ppt
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Transcript Viral Exanthems ppt
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)
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
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.
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.
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.
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.
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.
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.
Rubeola
TREATMENT:
– Isolation until 1 wk after rash starts
– Symptomatic
– Treat secondary bacterial infections
HEALTH MAINTENANCE:
– Immunize (2 doses MMR)
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.
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.
Coxsackievirus
LABS:
– Serology, culture.
DIAGNOSIS:
– Usually clinical
PROGNOSIS:
– Self limiting.
– Rarely can cause meningitis, myocarditis
Coxsackievirus
TREATMENT:
– Symptomatic.
– Self-limiting.
– Topical lidocaine gel for oral discomfort.
HEALTH MAINTENANCE:
– OK for daycare.
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.
Erythema Infectiosum
PE:
– Edematous, confluent plaques on malar
face, “slapped cheek”.
– Fade 1-4dconfluent macules, “lacy”, on
extensor surfaces, extremities, trunk.
– Adults: more constitutional symptoms
(fever, arthralgias, adenopathy).
Erythema Infectiosum
LABS:
– Serology
DIAGNOSIS:
– Clinical
PROGNOSIS:
– Slapped cheeks fade then reticulated rash lasts 59 d.
– Sunlight worsens, can last weeks to months
– Arthralgias, aplastic crisis (immunocomp, anemic)
Erythema Infectiosum
TREATMENT:
– Symptomatic
HEALTH MAINTENANCE:
– Prognosis excellent in immunocompetent
– Immunocompromised: persistent anemia
– Pregnant women: can cause hydrops
fetalis and fetal anemia.
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.
Varicella
HISTORY:
– About 14 d incubation.
– Prodrome absent or mild. Worse in adults
(fever, HA, malaise).
PE:
– Papulesvesicles. ‘Dewdrop on rose
petal’. umbilication pustules crusts in
8-12hr. PRURITIC
– Crops: face scalp trunk & extremities
Varicella
LABS:
– Leukopenia
– VZV antigen or culture (scrapings), serology
DIAGNOSIS:
– Usually clinical
PROGNOSIS:
– Healthy: usually self limiting.
– Bacterial superinfection, pneumonia, encephalitis,
maternal varicella syndrome.
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.