copy exanthem lecture

Fever with exanthem

Viral Exanthem

Exanthem : Eruptions of the skin accompanied by

inflammation Enanthem : Eruptions of mucous membrane

Primary lesions of exanthema

Primary lesions of exanthem

Macule : Small flat area of altered color blanch on pressure

Erythema: Redness due to vascular dilation.

Papule : Small solid elevation of skin of <0.5cm blanch on pressure

Nodule : Solid mass in skin>0.5cm in width/depth

Primary lesions of exanthem

Vesicle : Localize elevation of skin<.5cm with clear fluid

Bullae : Large vesicles

Pustule : Visible accumulation of pus in the skin.

Petechie, Purpura: Skin bleeds

Desquamation; dry and flaky loss of surface of epidermis

Different types of exanthematous lesions

Macular, papular or maculopapular Vesicular, pustular Purpuric or petechial Nodular

Maculopapular eruptions

Maculopapular eruptions

Infections

* Measles* Rubella

* Erythema infectiosum* Enteroviruses exanthem

eg. ECHO, Coxackie* Epstein-Barr virus* Scarlet fever

{ Bacterial }Drugs

Vesicular eruptions

Vesiculopustular lesions

Infections* Herpes simplex* Varicella {chicken pox, varicella

zoster}

* Coxsackie's and ECHO viruses* Scalded skin syndrome * Toxic shock syndrome

Drug eruption

Purpuric / Petechial hemorrhages

Petechial / purpuric rashes

Infections* Thrombocytopenia due to

infection, * ECHO and Coxsackie* Bacterial endocarditis

Others: ITP, leukemia

Drugs

Measles

Measles

Etiology : Measles virus { RNA paramyxovirus }

Epidemiology : *Extremely contagious disease.

Clinical features

Measles { clinical features }

Prodrome stage: { 3 C’ s } 3-5 daysCough, Coryza, Conjunctivitis and fever

*KOPLIK spots. Grayish white dots with reddish areola in the buccal mucosa opposite lower

molar Pathognomic Appears 12-24 hours before the rash and disappears rapidly.

Measles { clinical features }

Rash stage : Temperature rises abruptly as rash

appears upto 40-40.5C Rash typically starts on the face behind

the ear --maculopapular—spreads to neck chest ,arm and legs.Finally it reaches lower limb on 2-3rd day.

It begin to fade in the same sequence disappears within 7-10days

Measles {clinical features} Convalescent phase: *Rash disappears and leaves behind

brownish post-measles staining. Diagnosis :

*Clinical diagnosis,lab diagnosis is rarely needed.

Differential diagnosis : causes of maculopapular rash.

Complications

Measles { complications } Otitis media Pneumonia Encephalitis &

SSPE= late complicationSSPE= Sub-acute Sclerosing Pan-Encephalitis

Other complications *Myocarditis *Exarcerbation of existing TB

Measles { prophylaxis } Active immunization: Treatment:

Symptomatic and treatment of complications.

Vitamin A supplementation is given in developing countries to decrease the morbidity and mortality against measles

Rubella

Rubella{German measles }{3-day measles}

Etiology: Rubella is a RNA virus Clinical features:*Prodrome– mild catarrhal symptoms*Rash : usually small maculopapular rashes

begins on the face , spreads quickly and clears by 3rd

day

*RETROAURICULAR/POST.CERVICAL POST. OCCIPITAL LYMPHADENOPATHY. Rubella infection is important for its

teratogenic effect during pregnancy.

Complication During childhood = rare Arthritis

EncephalitisMyocarditis

Infection in utero = Cong. Rubella syndrome

Rubella { congenital infection }

Mother infected in first 3 months of pregnancy: Risk is very high

Manifestations: Growth retardation, cardiac

anomaly {PDA}, cataract, glaucoma, deafness

Rubella

Diagnosis : serology and virus isolation

Prevention :

* Vaccination with MMR during childhood* Seronegative mother may be vaccinated

after delivery.

Erythema infectiosum(5th Disease)

Etiology : Human parvovirus B19 Clinical features: * Age: school –age children *Rash. Maculoppular rash on cheeks

that coalesces to give “slapped cheek” appearance. Rash spreads to other parts of body. *Mild systemic symptoms may be present.

Clinical presentation

Asymptomatic Slapped cheek syndrome with

typical rash Aplastic crises. Virus affects the

RBC precursors in bone marrow Arthritis Fetal disease= Hydrops foetalis

Exanthem subitum (6th Ds)

Caused by human herpes virus 6 High fever, no systemic toxicity Fever disappears & diffuse

maculopapular rash appears

Infectious Mononucleosis

Etiology: Epstien-Barr virus Clinical features : *Prolong fever, malaise, anorexia *Pharyngitis/ tonsillitis *Lymphadenopathy *P/A Spleenomegaly,hepatomegaly * Few patients may have maculopapular rash especially after use of ampicillin or

amoxicillin

EB virus

Infectious mononucleosis syndrome

Burkitt’s lymphoma Nasopharyngeal carcinoma Lymphoproliferative disease

Infectious Mononucleosis{Lab findings }

Blood: Leucopenia, leucomoid reaction Atypical lymphocytes Heterophil antibodies: Monospot test Anti-EBV antibody

Infectious Mononucleosis {complications }

Spleenic rupture Hematological complications

Hemolytic anemia CNS complications:

Aseptic meningitis, encephalitis Rare complications: Myocarditis .

Pneumonia

TREATMENT: Bed rest, symptomatic Tt

Enteroviruses

Coxackie viruses

ECHO viruses

Enteroviruses{ manifestations}

Acute febrile illness: Respiratory tract illnesses

*Pharyngitis, bronchitis, pneumonia *Herpangina; Acute onset of fever and post.

Pharyngeal ulcers

Enteroviruses{manifestations}

*Pleurodynia: Abrupt onset of pleural pain, fever,myalgia neck pain

*Hand,foot, mouth disease;

vesicle {mouth,hand,feet}

*Cardiac invol. Myocarditis / pericarditis

Chicken pox Etiology: Varicella zoster, Highly contagious

disease

Presentation : Mild constitutional symptomsPleomorphic Rash

Papule – vesicle – pustule on erythematous base

Centripetal distribution, Enanthems also present

Usually improves within 10 days

Papule

Vesicle

Pustule

Crusts

Complication

Bacterial superinfection CNS:

Cerebellitis ( acute cerebellar ataxia)Encephalitis, aseptic meningitis

ImmunocompromisedHemorrhagic lesionsPneumonitis

DIC

Treatment

Usually no treatment Human varicella zoster IG is

recommended for high risk Immunocompromised

Immune deficiency Patient on immunosuppressive drugs Neonate exposed to varicella