Fever with exanthem

Viral Exanthem

Exanthem :
Eruptions of the skin accompanied by
inflammation
Enanthem :
Eruptions of mucous membrane

Primary lesions of exanthema

Primary lesions of exanthem

Macule :
Small flat area of altered color blanch on pressure
Erythema:
Redness due to vascular dilation.
Papule :
Small solid elevation of skin of <0.5cm blanch on
pressure
Nodule :
Solid mass in skin>0.5cm in width/depth

Primary lesions of exanthem

Vesicle :
Localize elevation of skin<.5cm with clear fluid
Bullae :
Large vesicles
Pustule :
Visible accumulation of pus in the skin.
Petechie, Purpura:
Skin bleeds
Desquamation;
dry and flaky loss of surface of epidermis

Different types of exanthematous

lesions

Macular, papular or maculopapular

Vesicular, pustular
Purpuric or petechial
Nodular

Maculopapular
eruptions

Maculopapular eruptions
Infections

eg.
Drugs

*
*
*
*

Measles
Rubella
Erythema infectiosum
Enteroviruses exanthem
ECHO, Coxackie
* Epstein-Barr virus
* Scarlet fever { Bacterial }

Vesicular eruptions

Vesiculopustular lesions
Infections
* Herpes simplex
* Varicella {chicken pox, varicella
zoster}

* Coxsackie's and ECHO viruses

* Scalded skin syndrome
* Toxic shock syndrome
Drug eruption

Purpuric / Petechial
hemorrhages

Petechial / purpuric rashes

Infections
* Thrombocytopenia due to infection,
* ECHO and Coxsackie
* Bacterial endocarditis
Others: ITP, leukemia
Drugs

Measles

Measles

Etiology :
Measles virus { RNA paramyxovirus }

Epidemiology :
*Extremely contagious disease.

Clinical features

Measles { clinical
features }

Prodrome stage: { 3 C s } 3-5 days

Cough, Coryza, Conjunctivitis and fever
*KOPLIK spots. Grayish white dots with reddish
areola in the buccal mucosa opposite lower
molar
Pathognomic
Appears 12-24 hours before the rash
and disappears rapidly.

Measles { clinical
features }
Rash stage :
Temperature rises abruptly as rash
appears upto 40-40.5C
Rash typically starts on the face behind
the ear --maculopapularspreads to
neck chest ,arm and legs.Finally it
reaches lower limb on 2-3rd day.
It begin to fade in the same sequence
disappears within 7-10days

Measles {clinical features}

Convalescent phase:
*Rash disappears and leaves behind
brownish post-measles staining.
Diagnosis :

*Clinical diagnosis,lab diagnosis is rarely

needed.
Differential diagnosis : causes of
maculopapular rash.

Complications

Measles { complications }

Otitis media
Pneumonia
Encephalitis &
SSPE= late complication
SSPE= Sub-acute Sclerosing Pan-Encephalitis
Other complications
*Myocarditis
*Exarcerbation of existing TB

Measles { prophylaxis }

Active immunization:
Treatment:
Symptomatic and treatment of
complications.
Vitamin A supplementation is given in
developing countries to decrease the
morbidity and mortality against measles

Rubella

Rubella{German measles }
{3-day measles}

Etiology:
Rubella is a RNA virus
Clinical features:
*Prodrome mild catarrhal symptoms
*Rash : usually small maculopapular rashes begins
on the face , spreads quickly and clears by 3rd
day

*RETROAURICULAR/POST.CERVICAL
POST. OCCIPITAL LYMPHADENOPATHY.
Rubella infection is important for
its
teratogenic effect during pregnancy.

Complication

During childhood = rare

Arthritis
Encephalitis
Myocarditis
Infection in utero = Cong. Rubella
syndrome

Rubella { congenital infection }

Mother infected in first 3 months of

pregnancy: Risk is very high
Manifestations:
Growth retardation, cardiac
anomaly {PDA}, cataract,
glaucoma, deafness

Rubella

Diagnosis : serology and virus isolation

Prevention :

* Vaccination with MMR during childhood

* Seronegative mother may be vaccinated
after delivery.

Erythema infectiosum
(5th Disease)

Etiology : Human parvovirus B19

Clinical features:
* Age: school age children
*Rash. Maculoppular rash on cheeks
that coalesces to give slapped cheek
appearance. Rash spreads to other
parts of body.
*Mild systemic symptoms may be
present.

Clinical presentation

Asymptomatic
Slapped cheek syndrome with
typical rash
Aplastic crises. Virus affects the
RBC precursors in bone marrow
Arthritis
Fetal disease= Hydrops foetalis

Exanthem subitum
(6th Ds)

Caused by human herpes virus 6

High fever, no systemic toxicity
Fever disappears & diffuse
maculopapular rash appears

Infectious Mononucleosis

Etiology: Epstien-Barr virus

Clinical features :
*Prolong fever, malaise, anorexia
*Pharyngitis/ tonsillitis
*Lymphadenopathy
*P/A Spleenomegaly,hepatomegaly
* Few patients may have maculopapular rash
especially after use of ampicillin or amoxicillin

EB virus

Infectious mononucleosis
syndrome
Burkitts lymphoma
Nasopharyngeal carcinoma
Lymphoproliferative disease

Infectious Mononucleosis
{Lab findings }

Blood: Leucopenia, leucomoid reaction

Atypical lymphocytes
Heterophil antibodies: Monospot test
Anti-EBV antibody

Infectious Mononucleosis
{complications }

Spleenic rupture
Hematological complications
Hemolytic anemia
CNS complications:
Aseptic meningitis, encephalitis
Rare complications: Myocarditis .
Pneumonia

TREATMENT:

Bed rest, symptomatic Tt

Enteroviruses

Coxackie viruses

ECHO viruses

Enteroviruses{ manifestations}

Acute febrile illness:

Respiratory tract illnesses

*Pharyngitis, bronchitis, pneumonia

*Herpangina;
Acute onset of fever and post.
Pharyngeal ulcers

Enteroviruses{manifestations}
*Pleurodynia:
Abrupt onset of pleural pain, fever,myalgia neck pain
*Hand,foot, mouth disease;

vesicle
{mouth,hand,feet}
*Cardiac invol. Myocarditis / pericarditis

Chicken pox

Etiology: Varicella zoster, Highly contagious

disease

Presentation :
Mild constitutional symptoms
Pleomorphic Rash
Papule vesicle pustule on erythematous
base
Centripetal distribution, Enanthems also
present
Usually improves within 10 days

Papule
Vesicle
Pustule
Crusts

Complication

Bacterial superinfection
CNS:
Cerebellitis ( acute cerebellar ataxia)
Encephalitis, aseptic meningitis
Immunocompromised
Hemorrhagic lesions
Pneumonitis
DIC

Treatment
Usually no treatment
Human varicella zoster IG is
recommended for high risk
Immunocompromised
Immune deficiency
Patient on immunosuppressive drugs
Neonate exposed to varicella