Classic Pediatric Viral Exanthems

Kami D MS III SGU Pediatrics Clerkship Woodhull Medical & Mental Health Center 4/20/12

Erythema Infectiosum Fifth Disease

Causative Virus: Parvovirus B19 Prodrome: None; Fever is absent or low grade Rash: Slapped Cheek Puritic Maculopapular rash Starts on arms and spreads to the trunk and legs Worsens with fever or sun exposure

Complications:

-Arthropathy in children and adults. -Congenital infections associated with hydrops and death
-Aplastic crisis may be percipitated in children with high RBC turnover (eg. Sickle Cell Anemia, hereditary spherocytosis) or in those with decreased RBC production (eg. Severe Iron Deficiency Anemia)

The child shown in the image presents with a 3 day history of malaise, fever to 41.1 (106 F), cough, coryza and conjuctivitis. He then develops the erythematous, maculopapular rash pictured. He is noted to have white pinpoint lesions on a bright red buccal mucosa in the area opposite his lower molars. Which of the following is the most likely diagnosis?

A) Parvovirus B) Rubella C) Herpes D) Rubeola E) Varicella

Measles Rubeola
Causative Virus: Paramyxovirus

Prodrome: Low grade fever Cough Coryza Conjunctivitis

1-2 days later.. Koplicks spots (small irregular red spots with central gray specks on buccal mucosa)

Measles Rubeola
Rash: Erythematous Maculopapular Spreads from head to toe Common Complications: Otitis media Pneumonia Laryngotracheitis Rarely, subacute sclerosing panencephalitis

A 14 year old girl awakens with a mild sore throat, low grade fever, and diffuse maculopapular rash. During the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the following is the most likely diagnosis?

A) B) C) D) E)

Rubella Rubeola Roseola Erythema Infectiosum Erythema Multiforme

Rubella 3 Day Measles German Measles

Causative Virus: Rubella Virus Prodrome: Asymptomatic or tender lymphadenopathy Posterior Auricular lymphadenopathy

Rash:
Erythematous Tender Maculopapular Head to toe

Rubella 3 Day Measles German Measles

Complications: Encephalitis, thrombocytopenia ( a rare complication of a postnasal infection) Congenital Rubella: Associated with congenital anomalies (PDA, deafness, cataracts, mental retardation)

A 11 month old boy has had a fever of 103-104 F for 4 days and was seen in the ED because of febrile seizures. He had no vomiting, did not look sick and his neurologic examination was normal. The only finding at the time was a small suboccipital lymph nodes. No workup was done. Three days later, the childs fever has resolved, but now he has a maculopapular rash.

A)Rubella B)Rubeola C)Measles D)Exanthema Subitum

Roseola Infantum Exanthema subitum 6th Disease Rose Rash

Causative Virus: HHV 6 + 7 Prodrome: Acute onset high fever (>40C, >104) with no other symptoms for 3-4 days Rash: Maculopapular APPEARS WHEN FEVER BREAKS Begins on the trunk and quickly spreads to the face and extremities Generally lasts <24 hours Complication: febrile seizure

Varicella Chicken Pox

Causative Virus: Varicella Zoster Prodrome: Mild fever, anorexia and malaise precede the rash by 24 hours Rash: Puritic tear drop vesicular periphery Lesions at different stages of healing Usually appears on the face and then spreads to the rest of the body, SPARING palms and soles Infectious 24 hours before eruption until lesions crust over

Varicella Zoster Shingles

Causative Virus: VZV Prodrome: Reactivation of varicella infection, starting with pain along an affected sensory nerve Rash: Puritic teardrop vesicular rash in a dermatomal distribution. UNCOMMON unless IMMUNOCOMPRIMISED Complications: Encephalopathy, aseptic meningitis, pneumonitis, TTP, Guillian-Barre syndrome, cellulitis, arthritis

Hand-Foot-and-Mouth Disease
Causative Virus: Coxsackie A Prodrome: Fever, anorexia, oral pain. Rash: Oral Ulcers Maculopapular vesicular rash on hangs and feet and sometimes on the buttocks