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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
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