Pediatric Infections W/ Fever And Rash

Front 1

Infections with fever and rash:
Tell me about measles (Rubeola)

Back 1

ssRNA positive sense with a glycolipid envelope virus for which humans are the only host.
Effect upper respiratory and regional lymph nodes during initial low-titer viremia, then spread out in secondary viremia lasting 5-7 days.
Histological: large multinucleated gian cells and syncytium formation in respiratory and reticuloendothelum.
Phases:
Incubation: contagious for 2 days prior to symptoms
Prodromal: 3 days, cough, coryza, conjunctivitis(stimson line), pathognomonic Koplik spots
Exanthematous: Often high fever. Macular rash (petechial or hemorrhagic) starts on head and works downward, may be accompanied by otitis media, lymphadenitis, spenomegaly, mesenteric lymphadenopathy, abdomenal pain, diarrhea. Liver involvement adults. pneumonia possible(giant cell version is fatal.)
Recovery: Rash disappears in the same pattern as it started with desquamination.
Tx: IV ribavirin for severe cases, Vitamin A for malnourished infants.

Front 2

Infections with fever and rash:
Tell me about German, or 3 day, Measles (Rubela)

Back 2

ssRNA paramyxovirus for which humans are the only host.
Like Rubeola, it has a primary and secondary viremia.
In utero infection, congenital rubella syndrome, has significant morbidity.
Infectious from 2 days to 5 days after rash. Congenital cases may shed through secretions for up to a year!
The pattern of the rash is similar to measles, but less so. Lymphadenopathy, and rose colored spots on soft palate(20%). Self resolving polyarthritis. accompanied by flu like symptoms.
Labs are not usually helpful, WBC may be low, rarely thrombocytopenia. IgM antibodies are increased.
Tx: none specific, supportive care. Excellent prognosis

Front 3

Infections with fever and rash:
Tell me about Roseola Infactum (Exanthem Subitum)

Back 3

Caused by human herpesvirus type 6 (HHV-6) and HHV-7; large enveloped dsDNA virus infecting mature mononuclear cells develop a life-long latent infection.
* Major cause of febrile illness in infants.
Characterized by: High fever, often >40C, abrupt onset lasting 3-5 days, maculopapular, rose colored rash that may fade rapidly. Upper respiratory and nasal symptoms, erythematous tympanic membranes, and cough. May have GI symptoms and appear irritable and toxic.Routine labs are non-specific and not diagnostically helpful.
Watch for encephalitis: mononuclear cell predominance, elevated protein w/ normal glucose.
Tx: none specific, suppportive care. Exxcellent prognosis

Front 4

Infections with fever and rash:
Tell me about Eythema Infectiosum (Fifth disease)

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Caused by Human parvovirus B19 ssDNA.
Benign and pretty common in healthy kids, but due to affinity for RBCs, kids with hemolytic diseases are affected badly with aplastic anemias.
with a 4-14 day incubation this illness kicks off with a mild fever, malaise, and myalgia with head ache. The rash starts out as a "slapped cheek rash" wit ha macropapular trunk rash after 1-4 days, giving way to a lacy reticulated rash for 2-40 days.
Labs may show reticulocytopenia. PCR assay will detect. Serology will detect antibodies specific to parvovirus
Tx: no specific therapy, supportive care. Beware kids that other blood issues

Front 5

Infections with fever and rash:
Tell me about varicell-zoster virus infections (chicken pox and zoster)

Back 5

Varicella-zoster virus(VZV and enveloped, icosahedral dsDNA virus with only humans as a host.
Primary, Chicken pox(varicella) is the primary manifestation and secondary viremia is manifested as zoster(shingles). Highly communicable with a 90% secondary attack rate.
Prodromal symptoms offever, malaise, anorexia precede characteristic rash of small red papules with a regioal lymphadenopathy. Zoster in adults can present acute dermatomal pain and occular involvement must be prevented.
Tx. for varicella include noaspirin antipyretics, cool baths and careful hygeine. Early tx with antivirals can prevent complications, but is not recommended for healthy children.
T. of zoster is based on antivirals famciclovir and valaciclovir, not acyclovir.
VZV can be complicated in the already ill, worsening lesions and neurologic repeating outbreaks can be problematic.