Viral Exanthems

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1.

Generally, what is a viral exanthem

Viral Infections
are associated
with rash
(a skin eruption
occurring as a sx
of an acute
illness)

2.

"Fifth Disease"

Erythema
Infectiousum Parvo B19

3.

4.

"Sixth Disease"

Exanthema
Subitum - HHV6
/ Roseloa

Best prevention for these viral

exanthem?

IMMUNIZATION

Case 1
4 month old infant. No recent illness
or symptoms except one day of fever
yesterday
Up to date on childhood
immunizations. Non-itchy red
bumps trunk, no fever. ("Afebrile
with non-pruritic erythematous
maculopapular lesions")

Roseola
- high fever, rash
after fever, not
"ill"

In Roseola which features helps

distinguish the cause?

The rash occurs

after fever is gone

Pathophysiology of Roseola?

- dsDNA virus
herpes family
- Incubation 5-15
days
- 85-90% adults
shed virus and
give it to kid

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Case 2
3-year-old healthy girl. Initially rash
on cheeks, now also on trunk and
arms. Did have a cold / flu prior
week, now resolved. Flushed
appearance on cheeks "slapped
cheek" & flat lacy red rash on trunk
and arms.

Parvovirus B19 "Fifth's Disease"

- "flu like"
prodrome
- "lace" rash after
2-5 days

The child in this case, with

Parvovirus B19, can return to school
(is no longer contagious) when?

The rash appears

Pathophysiology of Parvovirus B19?

- Erythema
Infectiousum
- Incubation
period: 4-14 days
- Infectious
during viremia
(fever, before
rash)

19.

Major disease & congenital

complications with Parvovirus
B19/Erythema Infectiosum?

- Pre-natal:
Hydrops fetalis
(fetus stops
making RBCs)
- Polyarthropathy
syndrome,
transient aplastic
crisis, persistent
anemia

Case 3
3 year-old with rash. 5 days cough,
red eyes, nasal congestion. Diffuse
morbilliform rash with antecubital
petechiae. Mild cough with bibasilar
lung crackles, & buccal white spots.

Rubeola

Rubeola aka _________.

Measles

With Rubeola evaluation for possible

transmitted infection would be
needed in people exposed to this
patient during the time ...

Before the cough

through the
initial few days of
the rash

Classic clinical & diagnostic features

of Rubeola?

- Prodromal fever
- Cough, Coryza
(runny nose),
Conjunctivitis
- Koplik spots (in
mouth)

Case 4
Previously healthy 15 year-old male.
New onset diffuse red rash. Fever
started 2-3 days ago. Sore bumps
behind his earsstarted 7-10 days ago.

Rubella

Rubella aka __________.

German Measles

Evaluation for possible transmitted

infection of Rubella would be needed
in people exposed to this patient
during...

The week before

and up to two
weeks after the
rash appeared.

Clinical and diagnostic features of

Measles.

- Incubation 5-7
days after
exposure
- Preceded by
non-specific flu
- Accompanied by
lymphadenopathy

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Congenital rubella syndrome.

- 85% effected
in 1st trimester
- Rare defects
after 20th week
of gestation
- Defects:
Deafness,
Catarracts,
glaucoma,
Valve abnl
Ment. Retard.
& microceph,
Later diabetes
- Still born
baby,
BLUEBERRY
MUFFIN

Case 5
Girl with blister-like rash. Preceded by
several days of flu with fever & body
aches. Rash started on face then spread
to body. Rash started as red spots that
became bumps and then filled with
fluid.

Variola

Variola aka ________.

Small Pox

For Variola, the period of contagion

would last until...

Until the last

crust falls off scabs are still
CONTAGIOUS!

Clinical and Diagnostic features of

Virola.

- 1 to 2 weeks
incubation
- Rash
preceded by few
days of "flu"
- Vesicles
appear in
SAME stages of
progression (vs
chicken pox)

Worse type of Variola?

Flat &
hemorrhagic
types = 100%
fatality rates
Generally 1/10
mortality rate.

Special isolation requirements for

small pox?

Requires
STRICT
QUARANTINE
from onset
fever &
Vaccinate all
contacts

Case 6
Young immigrant male. Patient
uncertain about personal history of
childhood illnesses or vaccinations.
New onset of blister-like rash,
associated with fever. Non-specific
"flu" ~ 1-2 weeks prior.

Varicella

For Varicella - the period of contagion

would last until...

The rash is
crusted

29.

Key Diagnostic Points of Varicella (2)

- Rash
preceded by
non-specific
"flu"
- Vesicles
appear in
DIFFERENT
STAGES of
progression (
vs small pox same stage)

30.

"Chick pea" appearing vesicles.

Varicella

Timing of Maternal infection of

Varicella:
Before 20 weeks --> ___________
28 wks - > than 5d before delivery -->
______
5d before - 2d afterd elivery -->
__________

- Before 20
weeks ->2-8%
congenital
malformations
- 28 wks - more
than 5d before
delivery -->
Infant
unaffected
- 5d before - 2d
after delivery ->
can be fatal

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