VIRAL EXANTHEMS

EXANTHEMS
• Lesions “outside” the skin
• Rubeola
• Rubella
• Roseola Infantum
• Erythema Infectiosum
• Varicella
• Herpes Zoster
• Hand-Foot-Mouth Disease
 Rubeola (Measles)
Etiology Rubeola virus
(Family: Paramyxovirus, Genus: Morbillivirus)
Incubation Period 8-12 days
Mode of Transmission Droplets; indirectly with articles newly contaminated with
respiratory secretions; airborne
Period of 4 days prior to the rash and 4 days after the rash
Communicability appears
Immunity after infection Lifelong
 Rubeola (Measles)
STAGE
1 Primary viremia in the reticuloendothelial system
Secondary viremia in body
2 Prodrome: 3-5 days of (3C’s: conjunctivitis, coryza, cough)
Koplik spots:
- whitish lesions in buccal mucosa opposite the molar
-pathognomonic of measles, found at the soft or hard palate 24-48 hrs
only
3 Exanthematous Stage: antibody formation, viral replication, rashes appear
Final / 6th day, may show desquamation
Recovery
stage
 Rubeola (Measles)
• Fever (rash simultaneously appears w/fever)
– High until the middle of the course of the illness
• Rash appears (4th day) at the peak of high-grade fever
• Maculopapular rash
– Appears 1st in the face (includes hairline and neck)
and tends to go down to the chest and abdomen in
24 hours
 Rubeola (Measles)
• When the rash appears on the feet, the
rash on the face fades and leaves a
branny desquamation
• Koplik spots
• Cough – last to disappear
 Rubeola (Measles)
Diagnosis
•Serologic: Identification of IgM – appears 1-2
days after rash appears and detectable until 1
month
•Four-fold rise in IgG antibodies in specimens
collected 2-4 weeks interval
 Rubeola (Measles)
• IgIM given to exposed child within 5 days
of exposure; given to
immunocompromised child given every 4
weeks until epidemic subsides
• Live measles vaccine, 3 months after,
provided child is 9 months and above
• Active immunization
 Rubeola (Measles)
• Supportive treatment
• Antipyrectics for fever control
• Oral hydration
 Rubeola (Measles)
• Immunization is given subcutaneously
• Given at 9 mos (6 mos if w/outbreaks)
• MMR (1st dose: 12-15 months, 2nd dose: 4-
6 yrs old)
 Rubella (German Measles)

Etiology Rubella virus

(Family: Togaviridae, Genus: Rubivirus)
Incubation Period 14-21 days
Source of Infection Nasopharyngeal secretions, blood, feces, and urine of
infected persons
Mode of Transmission Direct contact, droplet, indirectly with recently
contaminated articles
Period of 7 days prior to about 5 days after the appearance of
Communicability symptoms

Fever and rash occur at the same time

Patient doesn’t look toxic
 Rubella (German Measles)
• Malaise: 1st sign
• Fever: 4th day, moderate grade: not as high as
in rubeola
• Generalized lymphadenopathy
– Appear 24 hrs before rash
– (post-auricular: most common)
• Conjunctivitis and coryza
• Maculopapular rash w/o desquamation
• Rash on the face disappears when it appears
on the trunk
 Rubella (German Measles)
• Rash begins in the face and spreads to
the trunk and extremities within 24 hours
(rashes on the face fades as rashes
appear on the trunk)
• Forchheimer spots
– Red bluish spots
 Rubella (German Measles)
• No specific treatment available
• Supportive – antipyrectics and analgesics
• Immunization: MMR given subcutaneously
– 1st dose at 12-15 mos
– 2nd dose at 4-6 years old
 Roseola Infantum /
Exanthem Subitum

Other name 6th disease

Etiology Human herpes 6 & 7
Age 6-24 months
Incubation Period 5-15 days
Mode of Transmission Usually respiratory secretions
 Roseola Infantum /
Exanthem Subitum
• Fever appears before rash
– 3 days high grade fever (37.9-40C) then rash
appears
• Fine discrete, rose pink, maculopapular rash
– Appears within 12-24 hrs of fever resolution
– Appear 1st on the trunk, spreads to the rest of
the body
– Disappears in 1-2 days
 Roseola Infantum /
Exanthem Subitum
Treatment:
•Supportive
•Maintain hydration
•Antipyretics for fever
Other name
Erythema
5 disease
th
Infectiosum
Etiology Human parvovirus B19
Incubation 4-28 days
Period
Mode of Respiratory tract infections, blood, vertical transmission
Transmission
Period of Before onset of illness up to the time the patient gets well
Communicability

Elementary & high school

Series of viral exanthems discovered
one after the other
 Erythema Infectiosum
• Slapped-cheek appearance: diffuse macular
erythema, first found on the cheeks going to the
trunk & proximal extemities
• Lacy, reticulated apperance
• Palms and soles are spared
• Resolves spontaneously
w/o desquamation over 1-3 wks
• Afebrile, not ill-appearing
 Erythema Infectiosum
• Diagnosis:
– AntiB19 – best marker of past infection or
immunity
– Specific IgM antibody develops rapidly after
infection & persists up to 6-8 wks
• Treatment:
– Supportive
– IV gamma globulin
– Anti-retroviral
 Varicella (Chicken Pox)
Illness usually begins 14-16 days after exposure
Age 14-16 months
Incubation Period 10-21 days
Period of Contagious from 24-48 hours before the rash appears
Communicability until vesicles are encrusted usually 3-7 days after the
onset of rash
Rash Pruritic erythematous macules
 Varicella (Chicken Pox)
• Fever lyses after 5-6 days
• Macule  papule  vesicle  pustule  crust
• Rash starts from the trunk, scalp or face
• All stages present simultaneously before all are
covered with scabs (celestial map)
• Fever and pruritus occur together
 Herpes Zoster
Uncommon under 10 yrs old
Etiology Varicella Zoster virus or herpes virus varicella
Incubation Period 10-21 days
Mode of Transmission Direct or through respiratory secretions
Rash Vesicular lesions on dermatomal areas only
Same progression as in varicella but milder

Fever may or may not be present

 Diagnosis
• Leucopenia in the first 72 hrs followed by
absolute lymphocytosis
• Four-fold rise in IgG for VZV is
confirmatory of acute infection
 Treatment
• Acyclovir infusion IV for 5 or more days
(for complicated immunocompromised)
• Isolation until all lesions have become
crusted
 Immunization
• Subcutaneous
• 1st dose: 12-15 mos, 2nd dose: 4-6 yrs
• All individuals >13 yrs w/o previous
evidence of immunity should receive 2
doses at least 4 weeks apart
 Hand, foot and mouth disease
Etiology Coxsackie A16
Incubation Period 3-6 days
Period of 2-3 days before onset to several days of illness
Communicability (2 weeks after onset of infection)
Low grade fever
Vesicles on bucal mucosa, lips, gums, palate which
ulcerate
Maculopapular rash on hands & feets, buttocks, groin,
later becoming vesicular
 Hand, foot and mouth disease
• Supportive treatment