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Exanthem – widespread rash
There are six childhood exanthems. Four of them are viral.
- 1st disease – Rubeola (measles)
- 2nd disease – Scarlet fever (Strep)
- 3rd disease – Rubella (german Measles)
- 4th disease – Exfoliative Staph infections
- 5th disease – Erythema infectiosum
- 6th disease – Roseola
Rubeola (Measles)
- 1st disease
- Highly contagious
- Respiratory droplet transmission
Clinical Presentation
- Fever greater than 104.0
- Cough
- Runny nose – rhinitis, coryza
- Conjunctivitis
- Rash
- Red, flat maculopapular pruritic rash
- Beginning on the face and then spreading
- May feel bumpy
Labs, Studies and Physical Exam Findings
- Koplik’s spots are pathognomonic and are seen 2-3 days after onset
- Small white spots inside the mouth
- There are tests for serum IgM and salivary IgA
Treatment
- Prevention – MMR vaccination (Measles, Mumps, Rubella)
- Supportive care
- Monitor for complications like
- Bronchitis
- Pneumonia
Rubella (German Measles)
- Caused by the Rubella virus
- Third Disease
- One of the TORCHES – 90% chance of passing virus to fetus
- Congenital rubella syndrome
- Transmitted through large droplets
Clinical Presentation
- Rash
- Begins on the face
- Pink raised spots
- Fever about 100.0
- Sore throat
- Fatigue
- Swollen glands
- Joint pain in adults
Treatment
- Prevention – MMR vaccination (Measles, Mumps, Rubella)
- Vaccine is live so it is not given to pregnant woman if they test negative for antibodies
- Declared eliminated by the CDC in the USA in 2004
- Supportive treatment
- Congenital disease requires significant management of complications
Erythema Infectiosum
- Parvovirus B19
- AKA 5th disease, Slap Cheek syndrome
- Transmitted through respiratory secretions
- Once the rash appears the child is no longer contagious
Clinical Presentation
- Initially cold like symptoms
- Fever
- Headache
- Runny nose
- After initial symptoms pass a bright red lacy rash appears mostly on the cheeks.
- Rash spreads to arms, trunk and legs.
Treatment
- Supportive care
Roseola
- Patients are usually 6 months to 2 years old
- HHV 6 and HHV 7
Clinical Presentation
- Sudden high fever up to 104.0
- Rash
- Occurs several days later as the fever is improving
- Red rash which begins on the trunk and spreads to the legs and neck.
- Non pruritic
- lasts about 2 days
Treatment
- Supportive care
Mumps
- Caused by the mumps virus
- Cases should be reported to public health
- The virus is spread through respiratory secretions and close contact with infected individuals.
- Complications include orchitis, oophoritis, pancreatitis, and meningoencephalitis
- Orchitis is painful and rarely leads to fertility issues
Clinical Presentation
- Fever
- Headache
- Muscle aches
- Painful swelling of the parotid glands which is usually bilateral
Labs and Studies
- Typically a clinical diagnosis
- PCR
- Serology
Treatment
- Prevention – MMR vaccine (measles, mumps, rubella)
- Supportive care including fluids and OTC pain medication
Rabies
- Caused by the Rabies virus
- Found in the saliva of infected animals and is transmitted through bites or scratches
- The most common animals that transmit rabies are dogs, cats and bats
Clinical Presentation
- Initial Symptoms
- Pain and paraesthesia at the site of infection
- Fever
- Headache
- Muscle aches
- Fatigue
- Later neurologic symptoms
- Agitation
- Confusion
- Hydrophobia
- Hallucinations
- Paralysis
- Encephalitis
Labs and Studies
- Skin biopsy with fluorescent antibody testing
- Polymerase chain reaction (PCR) testing of fluid or tissue samples
Treatment
- Once symptoms occur death usually occurs within 3-10 days
- Pre Exposure for at risk occupations
- Human diploid cell rabies vaccine (HDCV)
- Three IM injections given on day 0, day 7 and day 21
- Postexposure
- Thoroughly irrigate the wound with soapy water
- Rabies vaccine and rabies immunoglobulin
