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Fever with exanthem
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Viral Exanthem
Exanthem : Eruptions of the skin accompanied by
inflammation Enanthem : Eruptions of mucous membrane
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Primary lesions of exanthema
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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
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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
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Different types of exanthematous lesions
Macular, papular or maculopapular Vesicular, pustular Purpuric or petechial Nodular
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Maculopapular eruptions
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Maculopapular eruptions
Infections
* Measles* Rubella
* Erythema infectiosum* Enteroviruses exanthem
eg. ECHO, Coxackie* Epstein-Barr virus* Scarlet fever
{ Bacterial }Drugs
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Vesicular eruptions
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Vesiculopustular lesions
Infections* Herpes simplex* Varicella {chicken pox, varicella
zoster}
* Coxsackie's and ECHO viruses* Scalded skin syndrome * Toxic shock syndrome
Drug eruption
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Purpuric / Petechial hemorrhages
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Petechial / purpuric rashes
Infections* Thrombocytopenia due to
infection, * ECHO and Coxsackie* Bacterial endocarditis
Others: ITP, leukemia
Drugs
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Measles
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Measles
Etiology : Measles virus { RNA paramyxovirus }
Epidemiology : *Extremely contagious disease.
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Clinical features
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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.
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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
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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.
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Complications
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Measles { complications } Otitis media Pneumonia Encephalitis &
SSPE= late complicationSSPE= Sub-acute Sclerosing Pan-Encephalitis
Other complications *Myocarditis *Exarcerbation of existing TB
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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
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Rubella
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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.
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Complication During childhood = rare Arthritis
EncephalitisMyocarditis
Infection in utero = Cong. Rubella syndrome
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Rubella { congenital infection }
Mother infected in first 3 months of pregnancy: Risk is very high
Manifestations: Growth retardation, cardiac
anomaly {PDA}, cataract, glaucoma, deafness
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Rubella
Diagnosis : serology and virus isolation
Prevention :
* Vaccination with MMR during childhood* Seronegative mother may be vaccinated
after delivery.
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Erythema infectiosum(5th Disease)
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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.
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Clinical presentation
Asymptomatic Slapped cheek syndrome with
typical rash Aplastic crises. Virus affects the
RBC precursors in bone marrow Arthritis Fetal disease= Hydrops foetalis
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Exanthem subitum (6th Ds)
Caused by human herpes virus 6 High fever, no systemic toxicity Fever disappears & diffuse
maculopapular rash appears
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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
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EB virus
Infectious mononucleosis syndrome
Burkitt’s lymphoma Nasopharyngeal carcinoma Lymphoproliferative disease
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Infectious Mononucleosis{Lab findings }
Blood: Leucopenia, leucomoid reaction Atypical lymphocytes Heterophil antibodies: Monospot test Anti-EBV antibody
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Infectious Mononucleosis {complications }
Spleenic rupture Hematological complications
Hemolytic anemia CNS complications:
Aseptic meningitis, encephalitis Rare complications: Myocarditis .
Pneumonia
TREATMENT: Bed rest, symptomatic Tt
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Enteroviruses
Coxackie viruses
ECHO viruses
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Enteroviruses{ manifestations}
Acute febrile illness: Respiratory tract illnesses
*Pharyngitis, bronchitis, pneumonia *Herpangina; Acute onset of fever and post.
Pharyngeal ulcers
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Enteroviruses{manifestations}
*Pleurodynia: Abrupt onset of pleural pain, fever,myalgia neck pain
*Hand,foot, mouth disease;
vesicle {mouth,hand,feet}
*Cardiac invol. Myocarditis / pericarditis
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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
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Papule
Vesicle
Pustule
Crusts
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Complication
Bacterial superinfection CNS:
Cerebellitis ( acute cerebellar ataxia)Encephalitis, aseptic meningitis
ImmunocompromisedHemorrhagic lesionsPneumonitis
DIC
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Treatment
Usually no treatment Human varicella zoster IG is
recommended for high risk Immunocompromised
Immune deficiency Patient on immunosuppressive drugs Neonate exposed to varicella