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Viral Exanthems and Enanthems

Viral Exanthems and Enanthems. Amina Ahmed, MD Pediatric Infectious Disease Levine Children’s Hospital. Adenovirus . Epidemiology Year-round; peak in winter/spring/early summer Incubation 2-14 d respiratory disease, 3-10 enteric disease Clinical Presentation Respiratory

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Viral Exanthems and Enanthems

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  1. Viral Exanthems and Enanthems Amina Ahmed, MD Pediatric Infectious Disease Levine Children’s Hospital

  2. Adenovirus • Epidemiology • Year-round; peak in winter/spring/early summer • Incubation 2-14 d respiratory disease, 3-10 enteric disease • Clinical Presentation • Respiratory • Conjunctivitis, pharyngitis (pharyngoconjunctival fever) • Exanthem- Usually mp lesions, erythematous, blanching • Enteric • Diarrhea • Cystitis • Diagnosis • DFA, culture (culture more sensitive) • PCR (blood, urine, secretions)- usually for immunocompromised population • Treatment

  3. Enteroviruses • Poliovirus 1, 2, 3 • Echoviruses • Coxsackievirus A • Coxsackievirus B • Enteroviruses

  4. Enteroviruses • Epidemiology • Peak in summer (May-October) • Incubation 3-6 days • Clinical Presentation • Fever (“fever without a source” in infants) • Respiratory- pharyngitis, URI, “summer cold,” conjunctivitis • Meningitis, meningoencephalitis • Diagnosis • Clinical • Culture, PCR (CSF typically) • Treatment

  5. EV : Hand-Foot-Mouth Disease • Exanthem • Vesiculopustular lesions on palms, soles • Enanthem • Vesicular lesions in mouth • Typically buccal mucosa, anterior mucosa • Diagnosis • Culture of oral secretions • PCR

  6. EV: Herpangina • Exanthem • None • Enanthem • Vesiculopustular lesions in mouth • Typically soft/hard palate • Not on lips (vermilion border) • Diagnosis • Culture of oral secretions • PCR

  7. Parvovirus B19 • Erythema infectiousum, Fifth Disease • Epidemiology • Incubation 4-14 days • Most contagious before onset of rash • Clinical Presentation • Fever, mild URI • Arthralgias/arthritis (especially young females) • Aplastic anemia (hemoglobinopathies) • Fetal hydrops (complication of infection during pregnancy) • Exanthem • “Slapped cheek,” circumoral pallor • Maculopapular, “lace-like,” reticular • Diagnosis /Treatment • Serology, PCR

  8. Human Herpes Virus 6 (Roseola infantum) • Epidemiology • Infants 6-24 months of age • No seasonal pattern • Incubation 9-10 days • Clinical Presentation • High fever for 3-4 days followed by rash • Pharyngitis, occipital nodes • Seizures • Exanthem • Discrete rose-red mp lesions on chest and trunk • Spread to face and extremities • Lasts hours-days • Diagnosis/ Treatment • Clinical • Serology, PCR

  9. Morbillivirus (Measles) • Epidemiology • Incubation 8-12 days • Highly contagious (droplets, airborne); 3-5 d before-4 d after rash • Late winter, early spring • Clinical Presentation • Fever, cough, coryza, conjunctivitis (prodrome) • Exanthem / Enanthem • Starts on head, spreads cephalocaudally • Coppery-red; may coalesce; desquamation • Enanthem- Koplik’s spots (before exanthem) • Diagnosis • Serology, PCR • Culture (urine) • Treatment • Prevention of superinfection with antibacterials • Vitamin A • ?Ribavirin

  10. Rubivirus (Rubella) • Epidemiology • Incubation 14-21 days • Contagious few days before to 5-7 days after onset of rash • Clinical Presentation • Typically asymptomatic in 25-50% of cases • Fever, adenopathy • Congenital rubella- cataracts, bony lesions, heart defects • Exanthem • Pinkish, maculopapular • Diagnosis / Treatment • Culture (especially congenital rubella), serology

  11. Rubella

  12. Varicella-Zoster Virus • Epidemiology • Incubation 10-21 days; contagious 1-2 d before rash onset • Late winter, early spring • Clinical presentation • Fever, URI (prodrome) • Exanthem /Enanthem • Lesions evolve: mp to vesicular to excoriated; pruritic • Hallmark- lesions in different stages (“crops”) • “Dew drop on a rose petal” • Similar lesions may involve mouth • Presentation altered by vaccination • Reactivation: zoster (dermatomal distribution)

  13. Varicella-Zoster Virus • Diagnosis • VZV DFA from lesions (rapid) • Tzanck not specific • PCR from lesion • Serology • Treatment • Acyclovir • Immunocompromised or nonimmune neonate • Encephalitis • Adults, adolescents, pregnant females • Prevention • VZV vaccine

  14. Varicella

  15. Epstein-Barr Virus • Epidemiology • Incubation 30-50 d • “Kissing disease” • Clinical presentation • Fever, pharyngitis (exudative), lymphadenopathy • Splenomegaly • Hepatitis, thrombocytopenia • Exanthem • Erythematous, mp lesions; may coalesce • May follow ampicillin use • Diagnosis / Treatment • Clinical, serology • PCR (immunocompromised host)

  16. Herpes Viruses 1 and 2 • Epidemiology • Incubation 2 d- 2 weeks • Herpes is forever • Clinical presentation • Neonatal disease • Skin, eye, mucous membranes • Meningoencephalitis • Disseminated • Primary gingivostomatitis; herpes labialis • Genital disease • Encephalitis

  17. Herpes Viruses 1 and 2 • Exanthem / Enanthem • Vesicular lesions; coalesce with time • Enanthem: friable gingiva, lesions on tongue, gingiva • May be on lips, vermilion border • Diagnosis • DFA of base of lesions (rapid) • Culture of secretions, vesicular fluid • PCR (lesions, blood, CSF) • Gold standard for meningoencephalitis • Treatment • Acyclovir, valacyclovir • Neonates, encephalitis, immunocompromised host

  18. What’s Your Diagnosis? Lesions in mouth and crossing the vermilion border. Tongue and gingiva involved

  19. What’s Your Diagnosis? • 32 year old school teacher with low grade fever, sore throat, painful swallowing • Diagnostic evaluation?

  20. What’s Your Diagnosis? • 2 year old with fever and refusal to eat • Lesions present for 2 days

  21. What’s Your Diagnosis? • 7 year old with lesions on hands; no fever • Differential diagnosis? • Diagnostic evaluation?

  22. What’s Your Diagnosis? • 4 year old with fever for 2 weeks and rash for 1 week • Differential diagnosis?

  23. What’s Your Diagnosis?

  24. What’s Your Diagnosis? • 6 year old Swiss girl with fever for 7 days • Mild sore throat • Diagnostic evaluation? • Prevention of transmission?

  25. What’s Your Diagnosis? • 4 year old Swiss girl with fever, cough, and rash • Diagnostic evaluation?

  26. What’s Your Diagnosis? • 9 year old with headache for 1 week • Diagnostic evaluation? • Treatment?

  27. What’s Your Diagnosis? • 15 year old with fever and sore throat • Differential diagnosis? • Diagnostic evaluation? • Treatment?

  28. What’s Your Diagnosis? • Diagnostic evaluation? • Treatment?

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