classic childhood exanthems
DESCRIPTION
I. Measles (Rubeola)II.Scarlet FeverIII.Rubella (German measles)IV.Filatow-Dukes DiseaseV.Erythema InfectiosumVI.Roseola InfantumBy: Sarah Stein, MDUniversity of ChicagoTRANSCRIPT
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Pediatric Exanthems
Sarah Stein, MDSections of Dermatology and Pediatrics
University of Chicago
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Definitions
Exanthem: A skin eruption occurring as a symptom of a general disease.
Enanthem: Eruptive lesions on the mucous membranes.
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Classic Childhood Exanthems
I. Measles (Rubeola)II. Scarlet FeverIII. Rubella (German measles)IV. Filatow-Dukes DiseaseV. Erythema InfectiosumVI. Roseola Infantum
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1st Disease=Measles
Paramyxovirus At risk: preschool-age children who escaped
vaccination; school-age children/adolescents in whom vaccination failed
Season: late winter/spring Incubation period: 8-12days Infectious period: 1-2d before prodrome to 4d
after onset of rash
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Measles: clinical features Prodrome: day 7-11 after exposure
Fever, cough, coryza, conjunctivitis Enanthem: Kopliks spots appear 2 days
before the rash, last 2 days into the rash
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Measles: morbilliformexanthemPresents day 14 after exposure
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Measles: complications
Otitis media Bronchopneumonia Encephalitis Myocarditis Pericarditis Subacute sclerosing panencephalitislate
sequellae due to persistent infx of the CNS
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2nd Disease=Scarlet Fever
Due to erythrogenic exotoxin-producing group A beta-hemolytic streptococci
At risk:
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Scarlet Fever: clinical features
Abrupt onset fever, headache, vomiting, malaise, sore throat
Enanthem Bright red oral mucosa Palatal petechiae Tongue changes
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Strawberry tongues
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Scarlet Fever: exanthem(12-48hrs after fever onset)
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Scarlet Fever: complications
Purulent complications Otitis media Sinusitis Peritonsillar/retro-
pharyngeal abscesses Cervical adenitis
Nonsuppurativesequalae Rheumatic fever Acute
glomerulonephritis
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Scarlet Fever and a negative strep culture?
Scarlet fever-like syndrome in a young adult
Arcanobacterium haemolyticum (akacorynibacterium haemolyticum) Gram positive rod Grows on 5% human blood agar More sensitive to erythromycin
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3rd Disease=Rubella
Togavirus At risk: unvaccinated adolescents Season: late winter/early spring Incubation period: 14-21 days Infectious period: 5-7d before rash to 3-5d
after rash
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Rubella: clinical features
Asymptomatic infection in up to 50% Prodrome
Children: absent to mild Adol and Adult: Fever, malaise, sore throat,
nausea, anorexia, painful occipital LAD Enanthem
Forschheimers spots = petechiae on the hard palate
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Rubella: exanthem
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Rubella: complications
Arthralgias/arthritis in older patients Peripheral neuritis, encephalitis,
thrombocytopenic purpurarare Congenital rubella syndrome
Infection during first trimester IUGR, eye findings, deafness, cardiac defects,
anemia, thrombocytopenia, skin nodules
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4th Disease=Filatow-Dukes Disease
Obsolete Probably now better defined as another
clinical entity
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5th Disease=ErythemaInfectiosum
Human Parvovirus B19 At risk: school-age children Season: sporadic Incubation period: 4-14 days Infectious period: up until onset of the rash
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EI: clinical features
Over 50% of infections are asymptomatic Prodrome
Mild fever (15-30%), sore throat, malaise
Adultsflu-like symptoms, arthralgias/arthritis (potentially chronic), rash in up to 40%
Hematological changesproerythrocyte tropic virus Drop in RBC count
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ErythemaInfectiosum:slapped cheekappearance
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EI: complications
Immunocompromisedchronic infection with severe, persistent, relapsing and remitting anemia, prolonged viral shedding
Patients with decreased RBC survival time (hemoglobinopathies, hemolytic dis)aplastic crises, prolonged viral shedding
Fetal infectionhydrops fetalis (overall risk of fetal death 1-9%)
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Papular purpuric glove and sock syndrome
2nd syndrome ascribed to Parvovirus B19, other viruses may be possible causes
Spring/summer; young adults Rash, LAD, fever, anorexia, arthralgias Self-limited over 7-14 days Viremia clears after rash
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Papular purpuric glove and sock syndrome
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6th Disease=Roseola infantum(aka Exanthem subitum)
Human Herpes Virus 6 (and 7) At risk: 6-36 mo (peak age 6-7mo) Season: sporadic Incubation period: 9 days Infectious period: virus is intermittantly
shed into saliva throughout life; asymppersistent infection
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Roseola: clinical features
High fever for 3-4 days Abrupt defervescence with appearance of
rash Associated seizures likely due to infection
of the meninges by the virus
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Roseola: exanthem
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The rest of the herpes family
Herpes simplex virus 1 and 2 Varicella-zoster virus Cytomegalovirus Epstein-Barr virus Human Herpes virus 6 and 7 Human Herpes virus 8
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Chicken Pox=Varicella
Varicella zoster virus, family herpesviridae At risk: young children, nonimmune inds
Second attack rate within households is 80-95% Season: sporadic Incubation period: 10-21 days Infectious period: via resp drop and vesicle
fluid, 2d before to 5d after onset of rash
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Chicken Pox: clinical features
Prodrome Ranges from asymp to fever, malaise, cough,
coryza, sore throat Pruritus
Variable from mild to severe
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Chicken Pox: exanthem
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Chicken Pox: complications
Secondary bacterial infection5-10% Otitis media5% Higher risk for adults, neonates, immunocomp.
Pneumonitis Encephalitis Cerebellar ataxia Hepatitis
Other rare compsReye syn, Guillain-Barre, nephritis, carditis, arthritis, orchitis, uveitis
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Smallpox(variola):exanthem
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Herpes Zoster: clinical features
Reactivation of latent VZV in sensory ganglia
At risk: elderly, immunocomp., children who had chicken pox in utero or in 1st year
Prodrome Unusual in children In adults, dull ache for up to a week before rash
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Varicella Zoster: exanthem
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Cephalic herpes zoster: Ramsey-Hunt Syndrome
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Varicella Zoster: complications
Post-herpetic neuralgiauncommon in kids Disseminated disimmunocompromised
Widespread cutaneous lesions Visceral disease
Ulcerations Secondary infection
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Infectious Mononucleosis
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Infectious Mononucleosis: and ampicillin/amoxicillin
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Enterovirus rashes
Hand-foot-mouth disease Herpangina Nonspecific eruptions
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Hand-foot-mouth disease
Typically due to Coxsackie A16 At risk: preschool-school aged children
Highly contagious Incubation period: 4-6 days Prodrome: 1-2 days before rash
Low-grade fever, anorexia, malaise, sore mouth
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HFMD: enanthem
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HFMD: exanthem
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Nail matrix arrest and HFMD
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Herpangina
Coxsackie A viruses At risk: young children Prodrome
Fever, sore throat
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Herpangina: enanthem
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Nonspecific enteroviralexanthems
Multitude of presentations Morbilliform or rubelliform Vesicular Petechial (typical of echovirus 9) Urticarial
Involvement of other systems-rare, but not to be ignored CNS, pulmonary, GI, muscular, cardiac
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Enterovirus:nonspecificexanthem
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Named exanthems
Gianotti-Crosti Syndrome, aka papularacrodermatitis of childhood
Unilateral Laterothoracic Exanthem, akaasymmetric periflexural exanthem of childhood (APEC)
Pityriais Rosea
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Gianotti-Crosti syndrome: clinical features
Most often due to EBV, also Hep B and all other viruses
At risk: 6mo-14yrs, mean 2yrs Season: spring and early summer Constitutional symptoms: mild
Low grade fever, malaise, LAD, rare pruritus, mild hepatitis (except in Hep B-associated case)
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Gianotti-Crosti Syndrome
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Gianotti-Crosti Syndrome
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Gianotti-Crosti Syndrome
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Unilateral LaterothoracicExanthem
aka Asymmetric Periflexural Exanthem ?viral: suggested by age, clustering, resp
symptoms At risk: 1-5yos, mean 2yo Prodrome: 60-75%
Rhinitis, pharyngitis, bronchitis, conjunctivitis, gastroenteritis
Fever in 40-65%
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UnilateralLaterothoracicExanthem
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Pityriasis Rosea
?viral: suggested by seasonality, mild prodromal symptoms, assoc URI, clustering of cases
Season: spring, autumn, winter At risk: 10-35yos, can be seen in younger Prodrome: very mild, if any
Malaise, nausea, anorexia, headache, low fever
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Pityriasis Rosea
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Pityriasis Rosea
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Pityriasis Rosea
Pediatric ExanthemsDefinitionsClassic Childhood Exanthems1st Disease=MeaslesMeasles: clinical featuresMeasles: complications2nd Disease=Scarlet FeverScarlet Fever: clinical featuresStrawberry tonguesScarlet Fever: exanthem(12-48hrs after fever onset)Scarlet Fever: complicationsScarlet Fever and a negative strep culture?3rd Disease=RubellaRubella: clinical featuresRubella: exanthemRubella: complications4th Disease=Filatow-Dukes Disease5th Disease=Erythema InfectiosumEI: clinical featuresEI: complicationsPapular purpuric glove and sock syndrome6th Disease=Roseola infantum(aka Exanthem subitum)Roseola: clinical featuresRoseola: exanthemThe rest of the herpes familyChicken Pox=VaricellaChicken Pox: clinical featuresChicken Pox: exanthemChicken Pox: complicationsHerpes Zoster: clinical featuresCephalic herpes zoster: Ramsey-Hunt SyndromeVaricella Zoster: complicationsInfectious MononucleosisInfectious Mononucleosis: and ampicillin/amoxicillinEnterovirus rashesHand-foot-mouth diseaseHFMD: enanthemHFMD: exanthemNail matrix arrest and HFMDHerpanginaHerpangina: enanthemNonspecific enteroviral exanthemsNamed exanthemsGianotti-Crosti syndrome: clinical featuresGianotti-Crosti SyndromeGianotti-Crosti SyndromeGianotti-Crosti SyndromeUnilateral Laterothoracic Exanthem Pityriasis RoseaPityriasis RoseaPityriasis RoseaPityriasis Rosea