VIRAL EXANTHEMS Brenda Beckett PAC NO PICTURES Overview

VIRAL EXANTHEMS Brenda Beckett, PA-C NO PICTURES

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

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

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

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

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

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

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

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

Coxsackievirus (Hand-foot-mouth disease) n EPIDEMIOLOGY/ETIOLOGY : – Coxsackievirus A 16 (and other types) – Usually <10 years old. – Epidemic outbreaks – Highly contagious (oral-oral, fecal-oral). n HISTORY: – 3 -6 d incubation – Prodrome: low fever, malaise, abd pain.

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

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

Erythema Infectiosum (Fifth Disease) n EPIDEMIOLOGY/ETIOLOGY : – Human parvovirus B 19. – Common in young, can be any age. – Transmission: respiratory droplet. n HISTORY: – 4 -14 d incubation. – Prodrome: fever, malaise, HA, URI 2 d prior. ST, N/V coincides with rash. – Adults: more severe with arthralgias.

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

Erythema Infectiosum n LABS: – Serology n DIAGNOSIS: – Clinical n PROGNOSIS: – Slapped cheeks fade then reticulated rash lasts 59 d. – Sunlight worsens, can last weeks to months – Arthralgias, aplastic crisis (immunocomp, anemic)

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

Varicella (Chicken Pox) n 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 n HISTORY: – About 14 d incubation. – Prodrome absent or mild. Worse in adults (fever, HA, malaise). n PE: – Papules vesicles. ‘Dewdrop on rose petal’. umbilication pustules crusts in 812 hr. PRURITIC – Crops: face scalp trunk & extremities

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

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