5 Exanthems (Historical) 1 Measles2 Scarlet fever3 Rubella4 "Dukes' disease”- ? measles, rubella, scarlet fever, Staph infection, or one of several unspecified enteroviral infections;5 Erythema Infectiosum6 Roseola.
6 Measles (Rubeola) Diff Dx S/S’s: Fever, conjunctivitis, cough Characteristic Koplik spots hours before rashRash:Days 4-5, red & blotchybegins on face & behind earsusually with onset high feverspreads to bodyUsually spares palms/solesRash coalesces on trunk/face
7 Rubella (German measles) "little red”; 3rd DiseaseSchoolchildren highest infectivity in unvaccinated populationsCongenital Rubella Syndromedeafness, eye lesions, heart malformations & mr24 cases , mostly immigrant25-50,000 cases Mexico 1998Higher suspicion cases in patients immigrating from countries with higher ratesVaccination contraindicated pregnancy(MMWR, 2001)
12 Fifth Disease (Erythema infectiosum) Parvovirus B19S/S’s: low fever, cold, mildly illSkin:"slapped-cheek" rash on facelacy red rash trunk & limbsinfected adults may develop joint pains hands, wrists, kneeskids may return to school- no longer infectiouspregnant women exposed- refer to guidelines(Crane J, J Obstet Gynaecol Can, 2002)
13 Roseola/Exanthem Subitum Human Herpes Virus 6>7spread via saliva72-95% sero + in US early ageS/S’s: irritable, diarrhea, cough, fever F, for 3-7 days; 10% seizureSkin:As fever resolves, faint macules develop on trunk and extremities that blanch upon pressureRash resolves 1-2 days
14 Roseola/Exanthem Subitum Skin:As fever resolves, faint macules develop on trunk and extremities that blanch upon pressureRash resolves 1-2 days
18 Pityriasis rosea Unknown cause Lasts 6-12 weeks Herpes viruses 6 & 7 associatedHerald patch 1-20 days before rashSometimes confused with T. Corporis or psoriasis
19 Pityriasis rosea Oval patches follow line of ribs like fir tree Erythromycin may be effective tx(Sharma, JAAD, 2000)
20 Asymmetric periflexural exanthem of childhood (APEC) Laterothoracic exanthemUncommon, G > BViral symptoms can occurOften mistaken for eczema, fungalSkin:Usually starts in armpit or groin and extends outwards, on one side of bodyMay spread to face, genitalia, hands or feetPatches are net-like or in ringsPruriticResolves within 3 months
21 Kawasaki disease 80% in children < 4 years Self-limiting & resolves spontaneously without treatment 4-8 weeks15-20% have damage to coronary arteries and 2% of patients die from heart attack(Brogan PA, Arch Dis Child, 2002)
26 Smallpox Classic generalized exanthem Latin word for “spotted” referring to the raised bumps on the face and bodyRash, high fever & mortality rate 30%Last natural case Somalia in 1977
27 Smallpox Exanthem from vaccination 1/100,000 Vaccinia rash or outbreak of soresGeneralized vacciniaErythema multiforme
28 Smallpox From Vaccination 1/50,000 Eczema vaccinatum Progressive vacciniaPostvaccinal encephalitis
29 Scarlet fever Group A streptococcus toxin children aged 4-8 contagious by coughing/sneezing or touching the infected skinsudden fever with sore throat, swollen LN’s, h/a, n, v, loss of appetite, swollen and red strawberry tongue, abdominal pain, body aches, and malaise
30 Scarlet fever Skin: rash 12-48 hours after fever ears, neck, chest, armpits, groin, then rest of body over 24 hoursscarlet spots or blotches, often the first signstarts to look like sunburn with goose pimplesskin may have a rough sandpaper-like feelas rash fades, it peels similar to that of sunburned skin
49 ReferencesTrizna Z. Viral diseases of the skin: diagnosis and antiviral treatment. Pediatr Drugs 2002;4:9-19.Crane J. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can 2002; 24:Glatman-Freedman A. Rubella vaccine. Pediatr Rev 2002; 23(3):Smallpox Vaccine. Pediatrics American Academy of Pediatrics, Committee on Infectious Diseases; 110: 4.Bromberg K. Group A beta-hemolytic streptococcal pharyngitis. Am Fam Physician 2001; 63(8):Bisno AL. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis 2002; 35(2):
50 References Gable EK. Pediatric exanthems. Prim Care 2000; 27: 353-69. Brogan PA. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002; 86:Hairston BR. Viral diseases of the oral mucosa. Dermatol Clin 2003; 21(1):De Araujo T. Human herpesviruses 6 and 7. Dermatol Clin 2002; 20(2):Sharma PK. Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial. J Am Acad Dermatol 2000; 42:MMWR. Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. July 13, 2001; 50: 1-23.
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