VIRAL EXANTHEMS

1. Measles
Measles virus is a single-stranded, lipid-enveloped RNA virus
in the family Paramyxoviridae and genus Morbillivirus.

Transmission:
The portal of entry of measles virus is through the respiratory
tract or conjunctivae following contact with large droplets or
small-droplet aerosols in which the virus is suspended.

Period of communicability:
3 days before to up to 4-6 days after the onset of rash.
Clinical Manifestations:

Incubation Period: 8-12 days

Prodromal phase
mild feverconjunctivitis
Photophobia
coryza
prominent cough
Increasing fever

Koplik spots
-pathognomonic
 rash begins on the forehead
(around the hairline), behind the
ears, and on the upper neck as a
red maculopapular eruption.

The It then spreads downward to

the torso and extremities, reaching
the palms and soles in up to 50% of
cases.

rash fades over about 7 days in the

same progression as it evolved,
often leaving a fine desquamation
of skin in its wake.
Treatment
Supportive
Maintenance of hydration, oxygenation, and comfort
are goals of therapy
2. Rubella
German measles or 3-day measles is a mild, often
exanthematous disease of infants and children

Rubella virus is a member of the family Togaviridae and is the

only species of the genus Rubivirus.

It is a single-stranded RNA virus with a lipid envelope and 3

structural proteins
 Transmission

Viral shedding from the nasopharynx begins about

10 days after infection and may be detected up to 2
wk following onset of the rash.

The period of highest communicability is from 5 days

before to 6 days after the appearance of the rash.
 Clinical manifestation
Incubation period: 14-21 days
Prodromal period:
low-grade fever
sore throat
red eyes with or without eye pain,
Headache
Malaise
Anorexia
lymphadenopathy
 Rash, which is variable and not distinctive.
It begins on the face and neck as small, irregular
pink macules that coalesce, and it spreads
centrifugally to involve the torso and extremities,
where it tends to occur as discrete macules

About the time of onset of the rash,

examination of the oropharynx may reveal
tiny, rose-colored lesions (Forchheimer spots)
or petechial hemorrhages on the soft palate.
 The rash fades from the face as it extends to
the rest of the body so that the whole body
may not be involved at any 1 time. The
duration of the rash is generally 3 days, and it
usually resolves without desquamation.
Treatment
supportive
mild illness that requires no care beyond
antipyretics and analgesics.
Intravenous immunoglobulin or
corticosteroids can be considered for severe,
nonremitting thrombocytopenia.
3. Varicella
Incubation Period: 10 to 21 days
Prodromal symptoms may be present, particularly in older children
and adults.
Fever
malaise
anorexia
headache, and
occasionally mild abdominal pain may occur 24-48 hours before
the rash appears.
Temperature elevation is usually moderate,
(100-102F, but may be as high as 106F)

**fever and other systemic symptoms usually resolve within 2-4 days
after the onset of the rash.
 Period of communicability: 24-48 hr before the rash is evident
and until vesicles are crusted, usually 3-7 days after onset of
rash.
Clinical Manifestations: lesions often appear first on the scalp,
face, or trunk. The initial exanthem consists of intensely
pruritic erythematous macules papular stageclear, fluid
filled vesicles
Treatment
Antiviral treatment modifies the course of the
disease

Acyclovir
20 mg/kg/dose, maximum 800 mg/dose given as 4
doses/day for 5 days

foscarnet is the only drug available for the

treatment of acyclovir-resistant VZV infections
20 mg/kg/day divided every 8 hr for up to 3 wk
4. Erythema Infectiosum
(5th disease)
Parvovirus B19, a member of the genus
Erythrovirus in the family Parvoviridae.
Parvoviruses are small DNA viruses
benign, selflimited
Transmission : Respiratory secretions, droplet/
airborne
Incubation: 4-28 days (average 16-17 days)
Erythema Infectiosum /slapped cheek
(5th disease)
Period of communicability: Before the onset
of the rash and probably not infectious after
the rash appears
prodromal phase is mild:
low-grade fever
headache
Symptoms of mild upper respiratory tract
infection
 hallmark of erythema infectiosum is the characteristic
rash, which occurs in 3 stages that are not always
distinguishable.
1.) erythematous facial flushing, often described as
slappedcheek appearance

2.)The rash spreads rapidly or concurrently to the trunk

and proximal extremities as a diffuse macular
erythema.

3.) Central clearing of macular lesions occurs promptly,

giving the rash a lacy, reticulated appearance
slappedcheek appearance
 The rash resolves spontaneously without
desquamation but tends to wax and wane over
1-3 wk.

It can recur with exposure to sunlight, heat,

exercise, and stress.

Lymphadenopathy and atypical papular, purpuric,

vesicular rashes are also described.
Treatment
Supportive therapy for relief of fatigue,
malaise, pruritus, arthralgia may be needed
Generally resolves after 5-10 days.
5. Roseola (6th disease)
Human herpesvirus 6 (HHV-6) and human
herpesvirus 7 (HHV-7)
Within the nucleocapsid, HHV-6 and HHV-7
each contain large, linear, double-stranded
DNA genomes that encode >80 unique
proteins.
Transmission: Possibly from nasopharyngeal
secretions (droplet)
Incubation: 9-15 days
Clinical Manifestations

abrupt onset of high fever, fussiness

The fever usually resolves acutely
after 72 hr (crisis) but may gradually
fade over a day (lysis) coincident
with the appearance of a faint pink or
rose-colored, nonpruritic, 2- to 3-mm
morbilliform rash on the trunk

The rash usually lasts 1-3 days but is

often described as evanescent and
may be visible only for hours,
spreading from the trunk to the face
and extremities.
 rash is variable in appearance,
location, and duration, it is not
distinctive.

Associated signs are sparse but can

include mild injection of the
pharynx, palpebral conjunctivae, or
tympanic membranes and enlarged
suboccipital nodes.
 history of 3 days of high fever in an otherwise
nontoxic 10 mo old infant with a blanching
maculopapular rash on the trunk suggests a
diagnosis of roseola.
Treatment
Benign and self-limiting
maintain hydration
may use antipyretics
Treatment may be necessary for atypical cases
with complications and immunosuppressed
patients
Specific antiviral therapy is not recommended for
routine cases of primary HHV-6 or HHV-7
infection
6. Hand-Foot and Mouth Disease
Coxsakie A16, A6, Enterovirus 71 (RNA)
Incubation: 4-6 days
Period of communicability: 1st week of
symptoms
It is usually a mild illness
with or without low-grade fever, anorexia and
malaise sore throat vesicles
 oropharynx is inflamed and
contains scattered vesicles on the
tongue, buccal mucosa, posterior
pharynx, palate, gingiva, and/or
lips ulcerate, leaving 4- to 8-
mm shallow lesions with
surrounding erythema.
 Maculopapular, vesicular, and/or pustular lesions may occur on the
hands and fingers, feet, and buttocks and groin; the hands are more
commonly involved than the feet
Lesions on the hands and feet are usually tender,3- to 7-mm vesicles that
occur more commonly on dorsal surfaces but frequently also on palms and
soles.
Vesicles resolve in about 1 wk.
Buttock lesions do not usually progress to vesiculation.
Treatment
Supportive
Analgesics, antipyretics