B3: Childhood Exanthems & Mumps

Childhood Exanthems & Mumps

Miscellaneous Viral Pathogens

Exanthems may be seen with multiple viral pathogens, including

Differential diagnosis includes other infectious etiologies (e.g. bacterial), allergic reactions or allergy-mediated disease, collagen-vascular diseases, etc.

To what extent definitive diagnosis is pursued is a clinical decision.

HHV

HHV-6 (Roseola)

Significant reactivation disease

AV therapy

No treatment for Roseola

No vaccine

"Secondary cases uncommon except instituational settings"

10-15 days

Mainly fall, early spring

Febrile seizures in infants

2-48 hrs

Neck, trunk

Face, extremities

Rose-pink

Discrete irregular macules

High Fever (103/104)

Paramyxo

Mumps

Note: Mumps is communicable from 7 days prior to 9 days after the illness develops.

Question: What can you say about seasonality?

Age: 5-15

Highest incidence rate

16-18 days

Lemon juice

Possible complications

(Rare) Pancreatitis

(Rare) Oophoritis

Orchitis and/or epidydmitis

Symptomatic meningoencephalitis

CSF pleocytosis

Swelling of salivary glands

May see erythema and edema of Stensen's (AKA Parotid) duct

Earache or facial pain

Persists for a week

Viruria

Spread to target tissues may include:

Measles (Rubeola)

AKA

Ribavirin

Vitamin A

Supportive

Note: communicable from 5 days prior to 4 days after onset of exanthem

Questions:

1-3 year cycles

Mainly winter & spring

Age: Young children > 6 mo.

90% attack rate

in those who are exposed and susceptible

Incubation period

7-18 days

Usu. 10 days

Saliva, oral secretions

saliva/oral secretions to respiratory tract or conjunctiva

Immunofluorescence

SSPE

Subacute Sclerosing Panencephalitis

Neurologic

2-10 yrs after infection

Otitis media

Bacterial superinfection

Encephalitis

Pneumonia

1-3 days later, one expects...

Koplik spots

pinpoint, gray-white or bluish-white spots w/ surrounding red halos on mucuous membranes, esp. buccal mucosa

Light bulb = Buzz word

Exanthem: erythematous blanching maculopapular eruption that appears first on the hairline and exhibits centrifugal spread.

Question:

Spread ultimately ends up where?

Soles

Palms

Initially

Conjunctivitis

Coryza

A cold

Cough

Followed by...

...followed by...

During viremia, virus infects....

WBC

Fusion protein

Neuraminidase

Hemagglutinin

Toga

Rubella

A.K.A.

Live attenuated vaccine

MMR

Time

Seasonality?

Late winter, early spring

Person

Young school-aged in unvaccinated pop.

Incubation Period

2-3 wks

Avg. 16 days

Oral secretions

Viral culture

Clinical pres. NOT ENOUGH

Most common complication

Arthralgia / arthritis

Congenital rubella syndrome

Growth retardation

Hepatosplenomegaly

Deafness

Eye defects

Cardiac defects

Enanthem

Enanthem: eruption on mucous membrane

Forscheimer spots

Exanthem

Fine maculopapular eruption

Pink-red

Discrete

Begins on face

Similar to measles

Mild illness

Esp. posterior cervical and postauricular

UR symptoms

Low-grade fever

Risk damage to fetus during pregnancy

Acute illness benign

Respiratory tract invasion

Local replication

Parvo

Parvovirus B19

A.K.A.

Treatment

I.V. Ig beneficial

No specific AV

Prevention

No Vaccine

Epidemiology

Transmission

Respiratory?

Diagnosis

Lab

Serology

PCR

Clinical presentation

Clinical

Complications

Immunocompromised

Persistent anemia

Persistent infection

Patients w/ hemoglobinopathy

Aplastic crisis

Profound anemia

Infection of fetus

Hydrops fetalis and death

Papular-Purpuric Gloves and Socks Syndrome (PPGSS)

Slap-cheek

Confluent, indurated rash

Mild illness initially

Other possibilities

Itching

Mild leukopenia, anemia

Arthralgias / Arthritis

Lymphadenopathy

Splenomegaly

Myalgia

Headache

Malaise

Fever

Characteristics

Pathophysiology

Replication

Nucleus of immature erythrocyte

Viremia

ssDNA

Icosahedral