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Continuity Clinic Pediatric Exanthems. Continuity Clinic Objectives Be familiar with the terminology to describe rashes accurately to other providers.

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Presentation on theme: "Continuity Clinic Pediatric Exanthems. Continuity Clinic Objectives Be familiar with the terminology to describe rashes accurately to other providers."— Presentation transcript:

1 Continuity Clinic Pediatric Exanthems

2 Continuity Clinic 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 Continuity Clinic Review of Terminology of Skin Lesions

4 Continuity Clinic The Basics of Rashes Distribution –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 Continuity Clinic 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

6 Continuity Clinic Description of Rashes MACULE PUSTULE VESICLE NODULE

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

8 Continuity Clinic Classic Childhood Exanthems 1.Measles (Rubeola) 2.Scarlet Fever 3.Rubella (German Measles) 4.Filatow-Dukes Disease 5.Erythem Infectiousum 6.Roseola Infantum

9 Continuity Clinic “1 st Disease” - Measles Paramyxovirus At risk: –Preschool age children unvaccinated –School age children in whom vaccine failed Season: late winter/spring Incubation: 8-12 days Infectious: 1-2 days before prodrome to 4 days after onset of rash

10 Continuity Clinic 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 Continuity Clinic Koplik’s Spots

12 Continuity Clinic Koplik’s Spots

13 Continuity Clinic Exanthem of Measles

14 Continuity Clinic Exanthem of Measles

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

16 Continuity Clinic “2 nd 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 Continuity Clinic Scarlet Fever – Clinical Features Abrupt onset fever, headache, vomiting, malaise, sore throat Enanthem –Bright red oral mucosa –Palatal petechiae –Tongue changes

18 Continuity Clinic Strawberry Tongues

19 Continuity Clinic Scarlet Fever - Exanthem

20 Continuity Clinic Scarlet Fever - Exanthem

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

22 Continuity Clinic “3 rd 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 Continuity Clinic 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 Continuity Clinic Rubella - Exanthem

25 Continuity Clinic Rubella - Exanthem

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

28 Continuity Clinic “5 th Disease” – Erythema Infectiosum Human Parvovirus B19 At risk: school age children Season: sporadic Incubation period: 4-14 days Infectious period: up until onset of the rash

29 Continuity Clinic 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 Continuity Clinic EI: Slapped Cheek

31 Continuity Clinic EI: Exanthem

32 Continuity Clinic EI: Exanthem

33 Continuity Clinic 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 Continuity Clinic “6 th 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 Continuity Clinic 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 Continuity Clinic Roseola - Exanthem

37 Continuity Clinic Roseola - Exanthem


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