Presentation is loading. Please wait.

Presentation is loading. Please wait.

Pediatric Exanthems.

Similar presentations

Presentation on theme: "Pediatric Exanthems."— Presentation transcript:

1 Pediatric Exanthems

2 Objectives Be familiar with the terminology to describe rashes accurately to other providers Be able to identify the rashes of Measles, Rubella, Scarlet Fever, Erythema Infectiousum, and Roseola Infantum Know the general clinical features of each of the above rashes

3 Review of Terminology of Skin Lesions

4 The Basics of Rashes Distribution Configuration Description Evolution
Localized vs. Systemic Sun exposed areas? Configuration Round Serpiginous Coalesce Description Macular, Papular, Petechial Evolution Where it began and where it ended Associated Findings

5 Description of Rashes Macule – circumscribed color change in the skin that is flat Papule – solid, elevated area < 1 cm in diameter Plaque – solid, circumscribed area >1 cm in diameter Vesicle – circumscribed, elevated < 1 cm with serous fluid Bulla – circumscribed, elevated > 1 cm with serous fluid Pustule – vesicle with purulent material Nodule – mass with indistinct borders, elevates over epidermis Wheal – circumscribed, flat topped, firm elevation of skin resulting from tense edema of papillary dermis


7 Definitions Exanthem – a skin eruption occurring as a symptom of a general disease Enanthem – eruptive lesions on the mucous membranes

8 Classic Childhood Exanthems
Measles (Rubeola) Scarlet Fever Rubella (German Measles) Filatow-Dukes Disease Erythem Infectiousum Roseola Infantum

9 “1st Disease” - Measles Paramyxovirus At risk:
Preschool age children unvaccinated School age children in whom vaccine failed Season: late winter/spring Incubation: days Infectious: 1-2 days before prodrome to 4 days after onset of rash

10 Measles – clinical features
Prodrome Day 7-11 after exposure Fever, cough, coryza, conjunctivitis Enanthem Koplik’s spots appear 2 days before rash and lasts 2 days into rash

11 Koplik’s Spots

12 Koplik’s Spots                                                                                                          

13 Exanthem of Measles

14 Exanthem of Measles                                                                              

15 Complications of Measles
Otitis Media Bronchopneumonia Encephalitis Pericarditis Subacute sclerosing panencephalitis – late sequellae due to persistent infection of the CNS

16 “2nd Disease” - Scarlet Fever
Due to erythrogenic exotoxin-producing group A beta-hemolytic streptococci At risk: <10 years old Peak 4-8 years old Season: late fall, winter, spring Likely due to close contact indoors in school Incubation period: 2-4 days Infectious period: during acute infection, gradually diminishes over weeks

17 Scarlet Fever – Clinical Features
Abrupt onset fever, headache, vomiting, malaise, sore throat Enanthem Bright red oral mucosa Palatal petechiae Tongue changes

18 Strawberry Tongues

19 Scarlet Fever - Exanthem

20 Scarlet Fever - Exanthem

21 Scarlet Fever - Complications
Purulent Otitis media Sinusitis Peritonsillar/retropharyngeal abscesses Cervical adenitis Nonsuppurative sequalae Rheumatic Fever Acute glomerulonephritis

22 “3rd Disease” - Rubella Togavirus At risk: Unvaccinated adolescents
Season: late winter/early spring Incubation: days Infectious period: 5-7 days before rash to 3 to 5 days after rash

23 Rubella – Clinical Features
Asymptomatic infection in up to 50% Prodrome Children: absent to mild Adolescent & adult: fever, malaise, sore throat, nausea, anorexia, painful occipital LAD Enanthem Forschheimer’s spots  petechiae on the hard palate

24 Rubella - Exanthem

25 Rubella - Exanthem

26 Rubella - Complications
Arthralgias/arthritis in older patients Peripheral neuritis, encephalitis, thrombocytopenic purpura (rare) Congenital rubella syndrome Infection during first trimester IUGR, eye findings, deafness, cardiac defects, anemia, thrombcytopenia, skin nodules

27 “4th Disease” – Filatow Dukes Disease
Obsolete Probably now better defined as another clinical entity

28 “5th Disease” – Erythema Infectiosum
Human Parvovirus B19 At risk: school age children Season: sporadic Incubation period: days Infectious period: up until onset of the rash

29 Erythema Infectiosum Clinical Features
Over 50% of infections are asymptomatic Prodrome: Mild fever (15-30%) Sore throat Malaise Adults: flu like symptoms, arthralgias/arthritis, rash in up to 40% Hematological changes: proerythrocyte tropic virus – drop in RBC count

30 EI: Slapped Cheek

31                                                                                                           EI: Exanthem

32 EI: Exanthem

33 EI: Complications Immunocompromised:
Chronic infection with severe, persistent, relapsing and remitting anemia, prolonged viral shedding Patients with decreased RBC survival time Hemoglobinopathies, hemolytic disease Aplastic crises Prolonged viral shedding Fetal infection – hydrops fetalis (1-9% risk of death)

34 “6th Disease” – Roseola Infantum
Human Herpes Virus 6 (and 7) At risk: 6-36 months (peak 6-7 months) Season: sporadic Incubation: 9 days Infectious period: Virus is intermittently shed into saliva throughout life; asymptomatic persistent infection

35 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

36 Roseola - Exanthem

37 Roseola - Exanthem

Download ppt "Pediatric Exanthems."

Similar presentations

Ads by Google