Download Exanthem of infectious origin

EXANTHEM OF INFECTIOUS ORIGIN
Exanthem = acute eruption of skin efflorescenses in multiple sites, due to the systemic effects of a
microorganism on the skin.
Enanthem = eruption of similar etiology on the mucous membranes.
Exanthematic infections – infectious diseases with exanthem as an obligatory, prominent and characteristic
symptom:
(Czech – Latin – English name)
spála - scarlatina - scarlet fever
spalničky - morbilli - measles, rubeola
zarděnky - rubeola - German measles, rubella
pátá nemoc - megalerythema infectiosum - Fifth disease, erythema infectiosum
šestá nemoc - exanthema subitum – Sixth disease, exanthem subitum, roseola infantum
plané neštovice – varicella - chickenpox
pravé neštovice – variola – smallpox
In many other infections (viral, bacterial, fungal, parasitic) exanthem occurs facultatively.
Diagnostic procedure: history, physical findings, laboratory tests
History:
Personal history: age, vaccination, previous diseases, allergy
Epidemiological data: season, contacts, travelling
History of current illness: prodromes, progression, administered drugs
Physical findings:
exanthem - morphologic types of skin lesions (macula, papula, urticaria, vesicle,
bulla, pustula, nodus... (see in dermatology), their colour and
presence or abscence of haemorrhage (purpuric lesions)
- development of the rash (onset, progression, distribution, fading,
hyperpigmentation, peeling...)
other symptoms – fever, lymphadenopathy, catarrhal symptoms,
arthralgias, hepatomegaly, spleenomegaly, meningeal syndrom...
Laboratory tests:
blood count + differential count of leukocytes
throat swab culture
serology
liver tests
others – X-ray, lumbar puncture, biopsy
The noninfectious processes often include skin rash and fever and should be considered in the initial evaluation,
as well as drug reactions.
Morphologic classification of exanthems:
1.
Macular and/or papular exanthem
scarlet fever
measles
rubella
Fifth disease
Sixth disease
Arcanobacterium haemolyticum infection
staphylococcal toxic shock syndrom
Kawasaki syndrom
infections of adenovirus, enterovirus (Coxsackie, ECHO, enteroviruses 68-71), EBV – infectious mononucleosis
initially meningococcus infection, rickettsioses
Dengue fever, typhoid fever
parasitic infections – scabies, cercaria dermatitis
STD – HIV primary infection, secondary syphilis
2.
Vesiculobullous exanthem
chickenpox + herpes zoster
smallpox
herpes simplex virus infection + eczema herpeticum Kaposi
impetigo
ECHOvirus, Coxsackievirus infection – „hand-foot-mouth disease“
(erythema multiforme)
3. Difusse erythema
scarlet fever?
scalded skin syndromes
toxic shock syndrom
4. Nodular lesions
disseminated fungal infections, nocardiosis, atypical mycobacterium infections
(erythema nodosum)
5. Petechial purpuric eruptions
DIC – meningococcus infection, severe sepsis, viral hemorrhagic fevers, tropical malaria
ricketsioses, ECHOvirus, Coxsackievirus infections, atypical measles