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120 Cards in this Set
- Front
- Back
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With regard to exanthems -- what is the "1st Disease"? Caused by what type of virus/bacteria?
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Measles/Rubeola
- Paramyxovirus |
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With regard to exanthems -- what is the "2nd Disease"? Caused by what type of virus/bacteria?
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Scarlet Fever
GABHS |
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With regard to exanthems -- what is the "3rd Disease"? Caused by what type of virus/bacteria?
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German measles, Rubella
Togavirus |
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With regard to exanthems -- what is the "4th Disease"? Caused by what type of virus/bacteria?
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Dukes Disease
Not a distinct entity |
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With regard to exanthems -- what is the "5th Disease"?
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Erythema infectiosum
Parvovirus B19 |
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With regard to exanthems -- what is the "6th Disease"?
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Exanthem subitum, roseola infantum
HHV6, HHV7 |
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Name the DNA viruses? Which one is the ssDNA virus?
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DNA:
Herpes Hepadnavirus Adenovirus Papovavirus Parvovirus -- ssDNA Poxvirus |
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Name the Herpesvirus group?
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HSV
VZV CMV EBV |
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Name the Hepadnavirus group
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Hepatitis B
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Examples of the Poxvirus?
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Molluscum contagiosum
Smallpox ORF Milker's nodules |
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Name the RNA viruses
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Paramyxovirus (measles, mumps)
Togavirus (Rubella) Rhabdovirus (Rabies) Retrovirus (HIV, HTLV) Picornovirus (Enteroviruses, Coxsackie virus, Hand-Foot-and-Mouth Dz) |
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Of the Herpesvirus family, which ones are Alpha, Beta, and Gamma?
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How is VZV transmitted? and, infectious period is?
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Via respiratory droplets
INFECTIOUS PERIOD: Until at least 5 d after onset of rash Or until all lesions are dry, crusted |
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Name the cause of this type of exanthem?
24-48 hours after prodrome “dewdrop on a rose petal” Centrifugal spread, starting on scalp, trunk, or face, and spreading to extremities Pathognomonic finding: lesions in various stages at the same time Most lesions have crusted over by day 6 Heal with hypopigmentation & scarring |
Varicella
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What is Reye syndrome?
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Associated with Varicella infection.
Reye syndrome is acute encephalopathy & fatty degeneration of viscera; almost always occurs w/ viral illness, unclear etiology Symptoms: decreased LOC, vomiting, abnormal LFT’s |
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What is the most common complication of Varicella in kids?
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#1 - Secondary bacterial superinfection
M/C S. aureus or GABHS more common in kids <5 #2: Neurologic involvement; Reye syndrome |
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What is Varicella gangrenosa?
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Varicella gangrenosa: rapidly progressing erythema, induration, and pain
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What is the M/C serious complication in adults with Varicella?
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Varicella pneumonia
- Can also get thrombocytopenia, arthritis, uveitis, nephritis, myocarditis, pancreatitis, hepatitis - Purpura fulminans, DIC |
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Varicella vaccine is live or dead? When is it given?
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- Live attenuated vaccine
- Routine vaccination at 12-18 months of age - Post-exposure prophylaxis - Immunocompromised children - Adults susceptible to varicella Effective in decreasing overall incidence: -- Milder disease w/ fewer lesions in vacinees w/ breakthrough -- High vaccine efficacy over 10 yrs for both groups receiving either 1 or 2 doses |
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What type of virus is VZV?
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Alphaherpesvirus (HHV-3)
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What type of virus causes Rubeola?
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Rubeola aka Measles
Caused by Paramyxovirus (ssRNA) |
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What viral family is Mumps?
What viral family is rubella? |
Mumps - Paramyxovirus
Rubella - Togavirus |
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Name the three C's of Rubeola?
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Cough, Coryza, Conjunctivitis
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What are Koplik spots?
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Enanthem of Rubeola:
Koplik’s spots Punctate gray-white to erythematous papules on buccal mucosa Occur during prodromal period Grains of sand on a red background |
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Describe the exanthem of Rubeola
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- 2-4 dd after prodrome
- Begins on face (esp forehead), hairline, behind ears, spreads downward onto trunk & extremities - Erythematous to purple-red macules, papules; may become confluent - Fades in same order of appearance |
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What is the delayed neurodegenerative disease associated with measles?
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Subacute sclerosing panencephalitis:
- Characterized by seizures, personality changes, coma, death - Occurs in 1 in 100K pts w/ measles |
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How is Rubeola transmitted?
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Nasopharyngeal epithelium, to conjunctiva, to LN, to RES, to viremic state, to skin/liver/GI
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How long should a person with rubeola stay in respiratory isolation?
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from 4 days from the rash onset
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What are some of the complications of Rubeola?
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Pneumonia - Gastroenteritis
Bronchitis - Myocarditis Otitis - Encephalitis |
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How do you treat Rubeola?
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ribavirin (synthetic nucleoside analog) and Vitamin A supplementation
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What type of virus is rubella?
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Togavirus
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How long is incubation of rubella?
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14-23 days
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How long is the prodrome for rubella
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2-5 days prior the Exanthem
50% of pts are asymptomatic mild, self-limited disease is common |
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Describe the exanthem of rubella?
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Erythematous to “rose-pink” macules & papules, tend to become
confluent Most commonly involves the face and trunk Spreads in a cephalocaudad manner Involutes after 1-3 days in the same order it appeared Generalized lymphadenopathy often occurs -- Suboccipital, postauricular, and cervical regions -- Highly characteristic of Rubella but not pathognomonic. Arthralgias, arthritis, esp in females (52%) --- Fingers, wrists, knees |
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What is the enanthem associated with Rubella?
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Forscheimer's spots
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What are the complications of rubella?
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Encephalitis
Mycocarditis Hepatitis Pancytopenia, Hemolytic-uremic syndrome |
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How long should a child be in isolation from rubella?
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Contact isolation for 7 days following rash onset
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What is the etiology of Scarlett Fever?
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Bacterial exanthem caused by GABHS
Streptococcal pyogenic exotoxin shift from SPE-A to SPE-B, SPE-C --- ↓ morbidity, mortality |
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Describe the tongue finding in scarlet fever?
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Tonsillopharyngeal erythema, exudate, petechial macules of palate
White strawberry tongue in 1st few dd: white coating w/ red, edematous papillae projecting through Red strawberry tongue by 4th-5th day: red, glistening tongue w/ prominent papillae |
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Do you have rhinorrhea with scarlet fever?
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Usually absent rhinorrhea and cough; tender anterior cervical LAD
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Describe the exanthem of scarlet fever
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Fine, erythematous, macular and papular eruption: “sandpaper” or “gooseflesh”
Trunk, extremities Accentuation in flexural areas w/ petechial component: Pastia’s lines Circumoral pallor Generally resolves over 4-5 days May heal with desquamation (hands, feet, toes, fingers) |
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Which disease has Pastia's lines?
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Scarlet Fever
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Which disease has Forscheimer spots?
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Rubella
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Name some complications of scarlet fever
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Pneumonia, pericaridits, meningitis, hepatitis, glomeulonephritis, rheumatic fever
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How do you prevent acute rheumatic fever?
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Primary mode of prevention is to start abx (TOC Pen V or macrolides) within 9 days of symptoms
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What is the etiology of Erythema Infectiosum?
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Parvovirus B19
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How long is the prodrome of Erythema Infectiosum?
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Lasts 5-7 days, characterized by f/c, h/a; rash and arthralgias usually appear in the 3rd week of illness -- usu occuring time with IgG Ab appear.
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Name five other diseases/clinical associations w/ parvovirus B19
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Papular-purpuric gloves and socks syndrome
Petechial exanthems Transient aplastic crisis Fetal hydrops Arthritis |
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Describe Stage 1 of Erythema Infectiosum
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Stage I:
2-3 dd following prodrome Fiery-red facial erythema: “Slapped Cheeks”, spares nasal bridge & perioral areas |
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Describe Stage II of Erythema Infectiosum
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Lacy, reticulated eruption on extremities, trunk
1-4d after facial rash, fades over 2-3 wks May be pruritic, evanescent Spares palms/soles |
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Describe Stage III of Erythema Infectiousum
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Intermittent waxing/waning of lacy, reticular eruption in response to environmental stimuli: physical activity, warm temperatures, sunlight
Variable length, usually 1-3 weeks |
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What percent of patients with ill joint symptoms following Erythema Infectiousum?
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8-10% of kids, 60% of adults (esp females)
MCP, PIP, knees, wrists, ankles |
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What is the risk of getting B19 infection if you have an underlying RBC production disorder?
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Transient aplastic crises in pts w/ d/o of ↓ RBC production or ↑ RBC destruction
B19 has high affinity for erythroid precursors, binding to? P antigen (globoside) receptor |
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What receptor does B19 target on erythroid precursors?
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Transient aplastic crises in pts w/ d/o of ↓ RBC production or ↑ RBC destruction
B19 has high affinity for erythroid precursors, binding to? P antigen (globoside) receptor |
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Can B19 cross the placenta
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Yes
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What can B19 do to a fetus?
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- Anemia
- High output CHF - Hydrops fetalis Generalized edema w/ ascites, pleural effusions, polyhydramnios - Intrauterine fetal demise |
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What is the greatest risk to the fetus from a B19 infection?
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1st 20 wks of pregnancy
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B19 can cause an erythematous, petechial patch and plaques on the palms and soles, normal mucosal exam, no LAD -- aka?
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Papular purpuric gloves and socks syndrome
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Identify:
Acute onset of rapidly progressive, symmetric swelling & erythema of the hands, feet Often w/ petechial or purpuric component Sharp dermarcation at the wrists, ankles Usually very pruritic |
Papular purpuric gloves and socks syndrome
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When pts have the exanthem in gloves and socks syndrome, are they infectious?
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Yes (C2 EI)
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What is the enanthem in gloves and socks syndrome?
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Hyperemia, petechiae, erosions on the soft and hard palate, pharynx, tongue, inner lips
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What is 6th disease also known as?
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Roseola infantum, aka Exanthem subitum
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What causes roseola infantum?
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HHV 6 and HHV7:
-- Preferentially infect activated T cells -- Majority of childhood infections: HHV-6A -- More frequent in immunocompromised hosts: HHV-6B |
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How is roseola infantum transmitted?
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Via Saliva
Horizontal transmission |
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What is classic presentation of Roseola Infantum?
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High fever (101-106) for 3-5 dd
Exanthem when temp normalizes Mild illness in children < 3 yo |
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What is the Berliner's sign?
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Periorbital edema that causes child to look sleepy, seen in roseola infantum.
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Describe the exanthem in roseola infantum.
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Nondescript, erythematous blanchable macules & papules
Peripheral halo of vasoconstriction Appears initially on the trunk, spreads to extremities, neck, face Resolves over 1-3 dd Periorbital edema is common clue to dx in febrile but o/w well appearing child prior to the exanthem Sleepy look caused by palpebral & periorbital edema? Berliner’s sign |
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What is the enanthem in roseola infantum?
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Nagayama's spots;
Erythematous papules involving mucosa of the soft palate and uvula (2/3) |
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In solid organ and BMT recipients, reactivation of roseola infantum may mimic what disease?
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may mimic acute GvHD
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Name some common causes of exanthems in children
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Nonpolio enteroviruses (summer months)
Respiratory viruses (winter months) Adenovirus Rhinovirus Parainfluenza virus Respiratory synccytial virus Influenza virus EBV HHV-6,7 Parvovirus B19 |
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What is another name for Papular Acrodermatitis of Childhood
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Gianotti-Crosti syndrome
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What causes Gianottic-Crosti?
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- distinct viral exanthem that may occur after infection with any of several viral agents
EBV (MCC in US) HBV (Italy, Japan) |
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Describe the exanthem in Gianottic-Crosti
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Edematous, erythematous, monomorphous papules & occasionally papulovesicles
Distributed symmetrically over the face and extensor surfaces of UE/LE Usually spares the trunk -- Buttocks may be involved Hemorhagic changes or localized purpura may be present Usually asymptomatic, may be pruritic May take 8-12 wks to resolve |
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Unilateral Laterothoracic Exanthem is aka?
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Asymmetric periflexural exanthem of childhood
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Describe the exanthem of Unilateral Laterothoracic exanthem
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EXANTHEM:
- Onset is unilateral on the trunk - Extends toward axilla & less often around inguinal region or an extremity - Centrifugal spread - Often becomes bilateral --- Maintains predominance on initial side of presentation Various morphologies: Macules, papules, eczematous, mobilliform, scarlatiniform, annular, reticulate Pruritus in 50% |
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What is a unique finding on unilateral laterothoracic exanthem biopsy?
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lymphocytic infiltrate around dermal eccrine ducts
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Enterovirus are part of what virus family?
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Picornavirus (ssRNA);
Includes: Echovirus Poliovirus Enterovirus Coxsackie virus A&B |
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What are some associated disease with enteroviruses?
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HFMD - Gianotti-Crosti
Herpangina - Non-Specific Aseptic meningitis - HSP Still’s like disease - AGEP |
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What is the leading cause of viral meningitis?
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Nonpolio enteroviruses are leading cause of viral meningitis
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Name the disease:
EXANTHEM: Gray-white vesicular lesions on palms, soles, less often involving dorsal or lateral srfaces of hands/feet Associated w/ fever, malaise, occ cervical & submandibular LAD |
Hand Foot Mouth Disease
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Name the disease:
ENANTHEM: Painful vesicles, erosions of buccal surfaces, palate, tongue, uvula, gingivae, anterior tonsillar pillars Can lead to anorexia, dehydration |
Hand Foot Mouth Disease
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Which serotype has been implicated in more severe disease and even death in HFMD epidemics in Taiwan?
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Enterovirus 71
More severe disease in children < 5 Majority of deaths from pulmonary edema or pulmonary hemorrhage |
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Herpangina is caused by what virus?
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Coxsackie A & B
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Name the disease:
- Children ages 3-10 - F, sore throat, malaise - Gray-white vesicles, erythematous erosions involving palate, uvula, tonsillar pillars |
Herpangina
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Which Echovirus can mimic zoster?
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Echovirus 6 can mimic zoster with a vesicular eruption that is dermatomal
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Which Echovirus can mimic meningococcemia?
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Echovirus 9: aseptic meningitic, petechial rash similar to meningitis
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Which echovirus mimics roseola?
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Echovirus 16
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What is eruptive pseudoangiomatosis?
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Acute onset of hemangioma-like lesions
-- Angiomatous papules surrounded by rim of blanching Spontaneous resolution 2-6 dd F, malaise, HA, diarrhea, respiratory complaints |
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What causes Mono?
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Epstein Barr Virus
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What type of virus is EBV?
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Epstein Barr Virus is a DNA herpesvirus family; Tropism for lymphocytes (B-cells) and epithelial cells
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What % of patients with infectious mononucleosis will develop a rash following the administration of ampicillin or amoxicillin?
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90-95% of pts develop an erythematous macular & papular eruption
May be related to ampicillin-antibody immune complexes resulting from B cell activation Occurs 5-9 dd after starting antibiotic Does not represent a true allergy |
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How do you dx Mono in the lab?
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Heterophil Ab: most useful confirmatory test (high specificity)
Virus-specific serologies for: kids <4 (often heterophile antibody negative), atypical presentations, severe or prolonged disease |
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What are the four genus groups of Rickettsial Disease?
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Bartonella
Coxiella Ehrlichia Rickettsia |
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What organism causes bacillary angiomatosis?
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Bartonella henselae
Bartonella quintana |
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What organism causes trench fever? transmitted by?
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B. quintana
transmitted by Human body louse |
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What organism causes Qfever? transmitted by?
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Coxiella Burnetii -- by ticks
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What organism causes Human monocytic ehrlichiosis? human granulocytic ehrlichiosis? vector?
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Ehrlichia chaffeensis -- HME -- lone start tick
Anaplasma phagocytophilum -- human granulocytic ehrlichiosis -- deer tick, dog tick |
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What organism causes rickettsialpox?
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Rickettsia akari; transmitted by house mouse mite
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What does rickettsia conorii cause? transmitted by?
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Mediterranean spotted fever -- Dog ticks
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What organism causes epidemic typhus? Endemic typhus?
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Epidemic = Rickettsia prowazekii
-- transmitted by the human body louse Endemic = Rickettsia typhi -- transmitted by the rat flea |
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What organism causes Rocky Mountain spotted fever?
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Rickettsia rickettsii -- wood tick and dog tick
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What is another name for murine typhus?
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Endemic Typhus
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Who transmits endemic typhus?
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Rat Flea, Xenopsylla cheopsis -- organism is Rickettsia typhi
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What is the treatment(s) of choice for endemic typhus?
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Tetracycline or Chloramphenicol
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Who transmits rickettsia akari? and, what disease does it cause?
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House mouse mite, Liponyssoides sanguineus
- Caused by Rickettsialpox |
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What is the triad of Rickettsialpox?
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Classic triad:
Fever Eschar Rash (numerous monomorphous red papules with small central vesicular component) -- usu black eschar at site. |
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How do you treat rickettsialpox?
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Doxy or chloramphenicol
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What is the most common ricketsial disease in the U.S.?
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M/C is rickettsia rickettsii -- RMSF
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What is the epidemiology of RMSF?
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Most common rickettsial illness in the US
Highest incidence in kids ages 5-9 North Carolina and Virginia – highly endemic Among children living in southeastern & southern US, 12% had positive R. rickettsii antibody titers Throughout US – except Maine and Vermont |
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Name the vector for RMSF
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Western US, Canada:
Dermacentor andersoni (wood tick) Eastern US: Dermacentor variabilis (dog tick) |
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What % of RMSF pts do NOT recall a tick bite?
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40%
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Describe the exanthem of RMSF?
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Appears on day 3-5 of illness
Discrete, erythematous, blanching macules, papules - Spread centripetally (start on extremities, spread centrally) - Initially on ankles, wrists, palms, soles Evolve into petechial macules, papules - May become hemorrhagic, +/- focal necrosis |
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How do you diagnosis RMSF?
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Indirect fluorescent antibody (IFA) test is most widely used diagnostic examination
- Detects anti-R.rickettsi IgM and IgG - usually present 10 to 14 days following acute infection |
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TOC for RMSF?
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Doxy!!
Risk of dental staining in kids < 8 yo, is far outweighed by risk of RMSF; unlikely to occur with short courses. Chloramphenicol (use in pregnant pts) |
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Cause of Qfever
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Coxiella burnetti
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How is Qfever transmitted
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Contact w/ infected domestic animals (cattle, sheep, goats)
Inhalation of contaminated aerosols |
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Tx for Q-Fever
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Doxy, FQs, or Co-trimoxazole
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Cause and vector of Human monocytic ehrlichiosis?
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Caused by: Ehrlichia chaffeensis
Vector: Lone star tick (amblyomma americanum) |
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Cause and vector of Human granulocytic ehrlichiosis?
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Caused by: Anaplasma phagocytophilum
Vector: Ixodes scapularis (NE & upper midwestern U.S.), Ixodes pacificus (west coast) |
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TOC for ehrlichiosis?
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Doxy
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