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Transcript
EXANTHEMS Patricia A. Treadwell, M.D. Professor of Pediatrics Indiana University School of Medicine FACULTY DISCLOSURE I have the following financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. :Investigator- Novartis I do intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. i HAND-FOOT-AND-MOUTH DISEASE HFMD Usually occurs in children less than 10 years off age Fever HFMD Classically Coxsackie virus A16 Human Enterovirus 71 Coxsackie virus A10, A10 or A5 Other Coxsackie viruses T i ll incubation Typically i b ti is i 3-6 3 6 ddays Dyer JA. Pediatr Ann 2007;36:21-29. HFMD - exanthem Vesicular eruption Lesions often on lateral fingers and toeswith i h an elliptical lli i l shape h Erythematous surround May be particularly localized to areas of inflammation HFMD - enanthem Vesicles in the oral cavity rupture to become ulcers Most M commonly l on the h llaterall aspects off the tongue HFMD - treatment Encourage fluid intake Fever control Analgesics VARICELLA Varicella-Zoster Varicella Zoster virus Prodrome of fever, headache and malaise Highly contagious Incubation 10-21 day y range g VARICELLA - exanthem Tear drop shaped vesicles on an erythematous base “Dew-drop “D d on a rose petal” l” The lesions spread from the trunk to the extremities Lesions p progress g to pustules p and later crusted lesions VARICELLA - enanthem Vesicular lesions occur which may become pustular Vesicles V i l which hi h rupture may become b ulcers l VARICELLA - treatment Monitor fluid intake Reduce fever Antihistamines Antivirals especially if immunocompromised Role of vaccine to pprevent disease Mann M, et al: Pediatrics 2008;122:e744-751. SCARLET FEVER Streptococcus pyogenes Erythrogenic toxin Pharyngitis and eruption Fever Incubation 2-5 days SCARLET FEVER - exanthem Erythema accentuated in fold areas Pastia’s sign “Sand-paper” type eruption Desquamation q SCARLET FEVER - enanthem Erythematous oropharynx Exudates (Cervical lymphadenopathy) Petechiae of soft palate p Strawberry tongue SCARLET FEVER - treatment Monitor fluid intake Reduce fever Analgesics Penicillin Clindamycin Erythromycin UNILATERAL LATEROTHORACIC EXANTHEM Unilateral laterothoracic exanthem A.K.A. Asymmetrical periflexural exanthem h off childhood hildh d Described in 1962 Usually in children, reports in adults are rare UNILATERAL LATEROTHORACIC EXANTHEM Eczematous papules of unilateral axilla and flank Then Th spreadd to other h areas off body b d Unusual viral exanthem-reported associated with parvovirus B19 and Epstein Barr virus along with others UNILATERAL LATEROTHORACIC EXANTHEM Topical corticosteroids for inflammation Antipruritics for itching REFERENCES Chuh AA AA, et al: Unilateral mediothoracic exanthem: a variant of unilaterothoracic exanthem Cutis 2006;77:29-32. exanthem. 2006;77:29 32 Scheinfeld N: Unilateral laterothoracic exanthema h with i h coincident i id evidence id off Epstein Barr virus reactivation: Exploration off a possible ibl link. li k Dermatol D l Online O li J 2007;13:13. GIANOTTI CROSTI SYNDROME GIANOTTI-CROSTI Associated with viral illness Virus-associated exanthem Most often in children aged 2-6 years of age Generalized lymphadenopathy may be seen Infrequently pruritic May last 6-8 weeks GIANOTTI CROSTI SYNDROME GIANOTTI-CROSTI Clinical findings: -Papular lesions Urticarial lesions -Urticarial -Less often, vesicular or papulovesicular -More concentrated on the arms and legs -Can be seen on the trunk, but less dense -Koebner phenomenon GIANOTTI CROSTI SYNDROME GIANOTTI-CROSTI Viruses associated with Gianotti-Crosti Gianotti Crosti -Epstein-Barr -Hepatitis Hepatitis A,C AC -Cytomegalovirus -Human Human herpesvirus 6 -Coxsackievirus A16,B4, B5 -Rotavirus Rotavirus -Parvovirus B19 GIANOTTI CROSTI SYNDROME GIANOTTI-CROSTI Viruses associated with Gianotti-Crosti Gianotti Crosti syndrome-continued -RSV RSV -Echovirus -Enterovirus Enterovirus -Rubella and Mumps virus -Parainfluenza Parainfluenza virus -HIV GIANOTTI CROSTI SYNDROME GIANOTTI-CROSTI Bacteria associated with Gianotti-Crosti Gianotti Crosti syndrome -Bartonella henselae -Beta-hemolytic streptococci -Borrelia Burgdorferi -Mycoplasma y p pneumoniae p Gianotti-Crosti syndrome has been reported follwing some immunizations, however is not a contraindication to giving those immunizations GIANOTTI-CROSTI SYNDROME -Treatment Treatment Topical corticosteroids (one report of worsening- does not pose a contraindication) Oral antihistamines if patient has pruritus. GIANOTTI-CROSTI SYNDROMEReferences Fastenberg M, M et al: Acral Papules: Gianotti-Crosti Syndrome. Pediatr Ann 2007;36:800 804 2007;36:800-804. Xia Y, et al: Pruritic Acral Rash in a Child. Gi Gianotti-Crosti iC i Syndrome. S d A Fam Am F Physician 2008;78:103-105. MEASLES (RUBEOLA) Caused by a paramyxovirus, paramyxovirus an RNA virus Highly contagious prior to the use of the vaccine Uncommon with widespread use of the vaccine Prodrome of cough, coryza, conjunctivitis and Koplik’ss spots Koplik Fever Incubation 10-14 10 14 days MEASLES - exanthem A maculopapular eruption beginning at the scalp line->hairline->forehead-> retroauricular >face neck->then retroauricular->face, neck >then spreading downward Fades F d over a 72 hhour period i d Brownish discoloration noted after fading MEASLES - enanthem Koplik Koplik’ss spots -white or bluish-gray specks -1 1 mm in size -typically on buccal mucosa opposite lower molars May see erythematous papules on the palate Posterior pharynx often erythematous MEASLES - treatment Monitor fluid intake Monitor respiratory status Reduce R d fever f Vitamin A in children 6 months to 2 years and d those th who h have h an immunodeficiency i d fi i 2006 Red Book. AAP Committee on Infectious Disease INFECTIOUS MONONUCLEOSIS Epstein-Barr Epstein Barr virus Prodrome of headache, malaise, fever and pharyngitis h ii Incubation 33-49 days Exanthem occurs in 35% patients Accompanying Strep pharyngitis in 20 20-25% 25% INFECTIOUS MONONUCLEOSIS - exanthem e anthem Erythematous maculopapular lesions Initially on the trunk and then spreads Areas of confluence can occur Pruritus F d iin 33-44 days Fades d Ellen Rimsza, M, et al: Pediatr Clin North Am 2005;52:9-24. INFECTIOUS MONONUCLEOSIS - enanthem Macules or petechiae of the palate Erythema of the oropharynx Findings of Strep pharyngitis when present INFECTIOUS MONONUCLEOSIS - treatment Monitor fluid intake Reduce fever Analgesics If Strep p pharyngitis p y g is present, p , treat with appropriate antibiotics ROCKY MOUNTAIN SPOTTED FEVER Caused Ca sed by b Rickettsia Ri k tt i rickettsii i k tt ii Typically history of tick exposure Incubation 2-14 days ROCKY MOUNTAIN SPOTTED FEVER Fever Severe headache Confusion Nausea and vomiting g Photophobia ROCKY MOUNTAIN SPOTTED FEVER - exanthem Exanthem present in 90 % patients Erythematous macules and papules initially Later, petechial or purpuric lesions Lesions occur initially y on the palms p and soles, then spread centrally ROCKY MOUNTAIN SPOTTED FEVER Supportive therapy may be necessary Doxycycline Chloramphenicol ROCKY MOUNTAIN SPOTTED FEVER References FEVER-References Chen LF LF, et al: What What’ss New in Rocky Mountain Spotted Fever? Infect Dis Clin North Am 2008;22:415-432. 2008;22:415 432 Flicek BF. Rickettsial and Other TickB Borne Infections. I f i C i Care Crit C Nurs N Clin Cli North Am 2007;19:27-38.