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Pediatric Exanthems

Pediatric Exanthems. Objectives. Be familiar with the terminology to describe rashes accurately to other providers Be able to identify the rashes of Measles, Rubella, Scarlet Fever, Erythema Infectiousum, and Roseola Infantum Know the general clinical features of each of the above rashes.

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Pediatric Exanthems

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  1. Pediatric Exanthems

  2. Objectives • Be familiar with the terminology to describe rashes accurately to other providers • Be able to identify the rashes of Measles, Rubella, Scarlet Fever, Erythema Infectiousum, and Roseola Infantum • Know the general clinical features of each of the above rashes

  3. Review of Terminology of Skin Lesions

  4. The Basics of Rashes • Distribution • Localized vs. Systemic • Sun exposed areas? • Configuration • Round • Serpiginous • Coalesce • Description • Macular, Papular, Petechial • Evolution • Where it began and where it ended • Associated Findings

  5. Description of Rashes • Macule – circumscribed color change in the skin that is flat • Papule – solid, elevated area < 1 cm in diameter • Plaque – solid, circumscribed area >1 cm in diameter • Vesicle – circumscribed, elevated < 1 cm with serous fluid • Bulla – circumscribed, elevated > 1 cm with serous fluid • Pustule – vesicle with purulent material • Nodule – mass with indistinct borders, elevates over epidermis • Wheal – circumscribed, flat topped, firm elevation of skin resulting from tense edema of papillary dermis

  6. Description of Rashes PUSTULE MACULE NODULE VESICLE

  7. Definitions • Exanthem – a skin eruption occurring as a symptom of a general disease • Enanthem – eruptive lesions on the mucous membranes

  8. Classic Childhood Exanthems • Measles (Rubeola) • Scarlet Fever • Rubella (German Measles) • Filatow-Dukes Disease • Erythem Infectiousum • Roseola Infantum

  9. “1st Disease” - Measles • Paramyxovirus • At risk: • Preschool age children unvaccinated • School age children in whom vaccine failed • Season: late winter/spring • Incubation: 8-12 days • Infectious: 1-2 days before prodrome to 4 days after onset of rash

  10. Measles – clinical features • Prodrome • Day 7-11 after exposure • Fever, cough, coryza, conjunctivitis • Enanthem • Koplik’s spots appear 2 days before rash and lasts 2 days into rash

  11. Koplik’s Spots

  12. Koplik’s Spots

  13. Exanthem of Measles

  14. Exanthem of Measles

  15. Complications of Measles • Otitis Media • Bronchopneumonia • Encephalitis • Pericarditis • Subacute sclerosing panencephalitis – late sequellae due to persistent infection of the CNS

  16. “2nd Disease” - Scarlet Fever • Due to erythrogenic exotoxin-producing group A beta-hemolytic streptococci • At risk: • <10 years old • Peak 4-8 years old • Season: • late fall, winter, spring • Likely due to close contact indoors in school • Incubation period: 2-4 days • Infectious period: during acute infection, gradually diminishes over weeks

  17. Scarlet Fever – Clinical Features • Abrupt onset fever, headache, vomiting, malaise, sore throat • Enanthem • Bright red oral mucosa • Palatal petechiae • Tongue changes

  18. Strawberry Tongues

  19. Scarlet Fever - Exanthem

  20. Scarlet Fever - Exanthem

  21. Scarlet Fever - Complications • Purulent • Otitis media • Sinusitis • Peritonsillar/retropharyngeal abscesses • Cervical adenitis • Nonsuppurative sequalae • Rheumatic Fever • Acute glomerulonephritis

  22. “3rd Disease” - Rubella • Togavirus • At risk: Unvaccinated adolescents • Season: late winter/early spring • Incubation: 14-21 days • Infectious period: 5-7 days before rash to 3 to 5 days after rash

  23. Rubella – Clinical Features • Asymptomatic infection in up to 50% • Prodrome • Children: absent to mild • Adolescent & adult: fever, malaise, sore throat, nausea, anorexia, painful occipital LAD • Enanthem • Forschheimer’s spots  petechiae on the hard palate

  24. Rubella - Exanthem

  25. Rubella - Exanthem

  26. Rubella - Complications • Arthralgias/arthritis in older patients • Peripheral neuritis, encephalitis, thrombocytopenic purpura (rare) • Congenital rubella syndrome • Infection during first trimester • IUGR, eye findings, deafness, cardiac defects, anemia, thrombcytopenia, skin nodules

  27. “4th Disease” – Filatow Dukes Disease • Obsolete • Probably now better defined as another clinical entity

  28. “5th Disease” – Erythema Infectiosum • Human Parvovirus B19 • At risk: school age children • Season: sporadic • Incubation period: 4-14 days • Infectious period: up until onset of the rash

  29. Erythema Infectiosum Clinical Features • Over 50% of infections are asymptomatic • Prodrome: • Mild fever (15-30%) • Sore throat • Malaise • Adults: flu like symptoms, arthralgias/arthritis, rash in up to 40% • Hematological changes: proerythrocyte tropic virus – drop in RBC count

  30. EI: Slapped Cheek

  31. EI: Exanthem

  32. EI: Exanthem

  33. EI: Complications • Immunocompromised: • Chronic infection with severe, persistent, relapsing and remitting anemia, prolonged viral shedding • Patients with decreased RBC survival time • Hemoglobinopathies, hemolytic disease • Aplastic crises • Prolonged viral shedding • Fetal infection – hydrops fetalis (1-9% risk of death)

  34. “6th Disease” – Roseola Infantum • Human Herpes Virus 6 (and 7) • At risk: 6-36 months (peak 6-7 months) • Season: sporadic • Incubation: 9 days • Infectious period: • Virus is intermittently shed into saliva throughout life; asymptomatic persistent infection

  35. Roseola – Clinical Features • High fever for 3-4 days • Abrupt defervescence with appearance of rash • Associated seizures likely due to infection of the meninges by the virus

  36. Roseola - Exanthem

  37. Roseola - Exanthem

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