{"id":653,"date":"2023-01-05T13:24:52","date_gmt":"2023-01-05T18:24:52","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/?post_type=chapter&p=653"},"modified":"2023-01-18T18:32:34","modified_gmt":"2023-01-18T23:32:34","slug":"infectious-exanthems","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/chapter\/infectious-exanthems\/","title":{"raw":"Infectious Exanthems","rendered":"Infectious Exanthems"},"content":{"raw":"An exanthem is a widespread rash that can be triggered by an infection as well as other causes such as medications. Infectious exanthems are especially common in children and may have characteristic features depending on the causative organism.\r\n
\r\n

Non-Specific Viral Exanthem<\/h1>\r\n<\/div>\r\n
\r\n\r\nNon-specific viral exanthems are the most common exanthems in children. They present as red macules and papules that are blanchable (redness fades when pressure is applied), distributed widely on the trunk and extremities, and often coalesce. The rash is often associated with viral symptoms such as fever and might be difficult to distinguish from a morbilliform drug eruption. There are numerous viruses which cause non-specific viral exanthems including enterovirus, adenovirus, parainfluenza and respiratory syncytial virus.\r\n\r\n \r\n\r\n<\/div>\r\n
\r\n\r\n[caption id=\"attachment_712\" align=\"aligncenter\" width=\"300\"]\"\" Image 6.26: Coalescing blanchable macules and thin papules in non-specific viral exanthem[\/caption]\r\n\r\n
\r\n

Erythema Infectiosum<\/h1>\r\n<\/div>\r\n
\r\n\r\nErythema infectiosum, also known as \u201cfifth disease\u201d, is caused by infection with Parvovirus B19. This is a common disease of school-aged children and typically occurs during the winter and spring.\u00a0 The exanthem occurs approximately 1-2 days following a prodrome of mild fever and headache.\u00a0 It begins as a distinct \u201cslapped cheek\u201d appearance with bright red patches to both cheeks. This is typically followed by a lacy red rash on the extremities that lasts for 1-3 weeks. There is no specific treatment and affected children can attend school, as the infectious stage occurs before the rash is evident.\r\n

Measles<\/h1>\r\nWith high vaccination rates in many countries, measles is becoming a less common disease worldwide. Still, it is a cause of significant morbidity and mortality globally and is highly contagious with up to 90% of susceptible people who get exposed contracting the disease. Outbreaks continue to occur even in countries with high vaccination rates and have been seen frequently in recent years, especially in populations with high rates of vaccine avoidance.\u00a0Measles is caused by a single-stranded RNA paramyxovirus. It is transmitted by air-borne droplets from 1-2 days before the onset of symptoms until 3-4 days after the rash appears. Patients experience a prodrome of cough, coryza (runny nose), and conjunctivitis. The first skin lesions are called <\/span><\/span>Koplik spots<\/span><\/span><\/em> and are 1-2 mm blue-white macules on the oral mucosa (typically the inner cheeks). The rash appears about 2 weeks after exposure and 2-4 days after the beginning of symptoms. It is characterized by non-pruritic macules and papules beginning on the head and neck then spreading to the trunk and extremities (<\/span>cephalocaudad<\/span> spread).\u00a0Treatment is with supportive care, vaccination of any unvaccinated contacts, and Vitamin A supplementation in children who contract the disease. This supplementation has been shown to decrease mortality by 30% in children and works to strengthen the mucosal barrier in the respiratory and gastrointestinal tracts. Complications can be serious and include pneumonia, encephalitis and myocarditis.\u00a0<\/span><\/span>\u00a0<\/span>\r\n

Rubella<\/h1>\r\nAs with measles, the incidence of r<\/span>ubella has decreased significantly with the advent of routine vaccination. As a result, it is very uncommon in most of the world; however, it is still of clinical importance <\/span>due to some of its serious complications and <\/span>the risk of<\/span> fetal <\/span>infection<\/span> which can cause significant congenital abnormalities<\/span>. <\/span>A prodrome of <\/span>fever, headache and malaise is followed <\/span>5 days later <\/span>by an exanthem of \u201crose-pink\u201d macules that starts at the head an<\/span>d travels down<\/span>ward<\/span> (<\/span>cephalocaudad<\/span> spread<\/span>)<\/span>. There may also be small red dots on the soft palate accompanying the exanthem which are known as <\/span><\/span>Forcheimer<\/span><\/em> spots.<\/span><\/span> In most healthy children and adults, the disease is self-limiting and treatment is supportive.<\/span><\/span>\u00a0<\/span>\r\n

Scarlet Fever<\/h1>\r\nScarlet fever is a bacterial illness due to <\/span>toxins produced by <\/span><\/span>Streptococcus pyogenes<\/span><\/span><\/em> and was often fatal in the pre-antibiotic era. It most often occurs in children aged 4-8 and is associated with streptococcal pharyngitis (\u201cstrep throat\u201d) or impetigo (superficial skin infection with <\/span><\/span>S. pyogenes<\/span><\/span><\/em>). <\/span>It typically begins with fever, sore throat <\/span>and swollen neck glands with a distinct<\/span> exanthem<\/span> appearing 12-48 hours <\/span>following this<\/span>. The exanthem consists<\/span> of tiny pink to red spots that cover most of the body and have a characteristic \u201csand paper\u201d texture. <\/span>The tongue is often swollen and red (\u201cstrawberry tongue\u201d). <\/span>Diagnosis can be <\/span>assisted<\/span> with a throat swab showing growth of <\/span><\/span>S. pyogenes<\/span><\/span><\/em> or with anti-streptolysin-O <\/span>titres<\/span>.<\/span> The treatment of choice is penicillin for <\/span>10-14<\/span> days \u2013 a <\/span>complete<\/span> course is important to reduce the risk of complications such as rheumatic fever and post-streptococcal glomerulonephritis.\u00a0<\/span><\/span>\u00a0<\/span>\r\n

Gianotti-<\/span>Crosti<\/span> Syndrome<\/span><\/span><\/h1>\r\nGianotti-<\/span>Crosti<\/span> syndrome was initially associated with Hepatitis B infections but <\/span>more recently <\/span>has been shown in association with various<\/span> other<\/span> viral infections (EBV, CMV, adenovirus, etc.) and some non-viral infections (<\/span><\/span>S. pyogenes<\/span><\/span>, <\/span><\/span>Mycoplasma pneumonia<\/span><\/span><\/em>). <\/span>It is seen in children aged 6 months-14 years and causes <\/span>monomorphous<\/span> (all the lesions have a similar appearance)<\/span>, <\/span>fl<\/span>at-topped, pink\/brown<\/span>,<\/span> edematous (swollen) <\/span>papules most often located on <\/span>the knees and elbows <\/span>and less often<\/span> on the face and buttocks<\/span>. <\/span>T<\/span>he trunk<\/span> is typically<\/span> spared<\/span>. Lesions last for over 10 days<\/span>, but <\/span>do <\/span>not require any treatment and resolve spontaneously. <\/span>Rarely, the rash can last up to <\/span>8 weeks.\u00a0<\/span><\/span>\u00a0<\/span>\r\n

Kawasaki Disease<\/h1>\r\nKawasaki disease is a multisystem disease that generally affects children less than 5 years old. While the exact cause still remains unknown, infectious etiologies have been postulated.\u00a0 <\/span>Kawasaki disease is significant for being the number one cause of acquired heart disease among children in North America<\/span>. The classic findings <\/span>include fever lasting more than 5 days, redness <\/span>of the conjunctivae<\/span>,<\/span> unilateral cervical lymphadenopathy, swelling\/redness of the hands\/feet<\/span>, and \u201cstrawberry tongue\u201d<\/span>. An exanthem is present in ~80% of cases but <\/span>its<\/span> appearance is variable. <\/span>Most commonl<\/span>y it is <\/span>widespread <\/span>red macules and papules similar to measles,<\/span> and may favor the perineal area. <\/span>If caught early enough the treatment of choice is intravenous immunoglobulin (IVIg). Patients should be referred to cardiology to assess for any cardiac involvement.<\/span><\/span>\u00a0<\/span>\r\n\r\n<\/div>\r\n<\/div>","rendered":"

An exanthem is a widespread rash that can be triggered by an infection as well as other causes such as medications. Infectious exanthems are especially common in children and may have characteristic features depending on the causative organism.<\/p>\n

\n

Non-Specific Viral Exanthem<\/h1>\n<\/div>\n
\n

Non-specific viral exanthems are the most common exanthems in children. They present as red macules and papules that are blanchable (redness fades when pressure is applied), distributed widely on the trunk and extremities, and often coalesce. The rash is often associated with viral symptoms such as fever and might be difficult to distinguish from a morbilliform drug eruption. There are numerous viruses which cause non-specific viral exanthems including enterovirus, adenovirus, parainfluenza and respiratory syncytial virus.<\/p>\n

 <\/p>\n<\/div>\n

\n
\"\"
Image 6.26: Coalescing blanchable macules and thin papules in non-specific viral exanthem<\/figcaption><\/figure>\n
\n

Erythema Infectiosum<\/h1>\n<\/div>\n
\n

Erythema infectiosum, also known as \u201cfifth disease\u201d, is caused by infection with Parvovirus B19. This is a common disease of school-aged children and typically occurs during the winter and spring.\u00a0 The exanthem occurs approximately 1-2 days following a prodrome of mild fever and headache.\u00a0 It begins as a distinct \u201cslapped cheek\u201d appearance with bright red patches to both cheeks. This is typically followed by a lacy red rash on the extremities that lasts for 1-3 weeks. There is no specific treatment and affected children can attend school, as the infectious stage occurs before the rash is evident.<\/p>\n

Measles<\/h1>\n

With high vaccination rates in many countries, measles is becoming a less common disease worldwide. Still, it is a cause of significant morbidity and mortality globally and is highly contagious with up to 90% of susceptible people who get exposed contracting the disease. Outbreaks continue to occur even in countries with high vaccination rates and have been seen frequently in recent years, especially in populations with high rates of vaccine avoidance.\u00a0Measles is caused by a single-stranded RNA paramyxovirus. It is transmitted by air-borne droplets from 1-2 days before the onset of symptoms until 3-4 days after the rash appears. Patients experience a prodrome of cough, coryza (runny nose), and conjunctivitis. The first skin lesions are called <\/span><\/span>Koplik spots<\/span><\/span><\/em> and are 1-2 mm blue-white macules on the oral mucosa (typically the inner cheeks). The rash appears about 2 weeks after exposure and 2-4 days after the beginning of symptoms. It is characterized by non-pruritic macules and papules beginning on the head and neck then spreading to the trunk and extremities (<\/span>cephalocaudad<\/span> spread).\u00a0Treatment is with supportive care, vaccination of any unvaccinated contacts, and Vitamin A supplementation in children who contract the disease. This supplementation has been shown to decrease mortality by 30% in children and works to strengthen the mucosal barrier in the respiratory and gastrointestinal tracts. Complications can be serious and include pneumonia, encephalitis and myocarditis.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

Rubella<\/h1>\n

As with measles, the incidence of r<\/span>ubella has decreased significantly with the advent of routine vaccination. As a result, it is very uncommon in most of the world; however, it is still of clinical importance <\/span>due to some of its serious complications and <\/span>the risk of<\/span> fetal <\/span>infection<\/span> which can cause significant congenital abnormalities<\/span>. <\/span>A prodrome of <\/span>fever, headache and malaise is followed <\/span>5 days later <\/span>by an exanthem of \u201crose-pink\u201d macules that starts at the head an<\/span>d travels down<\/span>ward<\/span> (<\/span>cephalocaudad<\/span> spread<\/span>)<\/span>. There may also be small red dots on the soft palate accompanying the exanthem which are known as <\/span><\/span>Forcheimer<\/span><\/em> spots.<\/span><\/span> In most healthy children and adults, the disease is self-limiting and treatment is supportive.<\/span><\/span>\u00a0<\/span><\/p>\n

Scarlet Fever<\/h1>\n

Scarlet fever is a bacterial illness due to <\/span>toxins produced by <\/span><\/span>Streptococcus pyogenes<\/span><\/span><\/em> and was often fatal in the pre-antibiotic era. It most often occurs in children aged 4-8 and is associated with streptococcal pharyngitis (\u201cstrep throat\u201d) or impetigo (superficial skin infection with <\/span><\/span>S. pyogenes<\/span><\/span><\/em>). <\/span>It typically begins with fever, sore throat <\/span>and swollen neck glands with a distinct<\/span> exanthem<\/span> appearing 12-48 hours <\/span>following this<\/span>. The exanthem consists<\/span> of tiny pink to red spots that cover most of the body and have a characteristic \u201csand paper\u201d texture. <\/span>The tongue is often swollen and red (\u201cstrawberry tongue\u201d). <\/span>Diagnosis can be <\/span>assisted<\/span> with a throat swab showing growth of <\/span><\/span>S. pyogenes<\/span><\/span><\/em> or with anti-streptolysin-O <\/span>titres<\/span>.<\/span> The treatment of choice is penicillin for <\/span>10-14<\/span> days \u2013 a <\/span>complete<\/span> course is important to reduce the risk of complications such as rheumatic fever and post-streptococcal glomerulonephritis.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

Gianotti-<\/span>Crosti<\/span> Syndrome<\/span><\/span><\/h1>\n

Gianotti-<\/span>Crosti<\/span> syndrome was initially associated with Hepatitis B infections but <\/span>more recently <\/span>has been shown in association with various<\/span> other<\/span> viral infections (EBV, CMV, adenovirus, etc.) and some non-viral infections (<\/span><\/span>S. pyogenes<\/span><\/span>, <\/span><\/span>Mycoplasma pneumonia<\/span><\/span><\/em>). <\/span>It is seen in children aged 6 months-14 years and causes <\/span>monomorphous<\/span> (all the lesions have a similar appearance)<\/span>, <\/span>fl<\/span>at-topped, pink\/brown<\/span>,<\/span> edematous (swollen) <\/span>papules most often located on <\/span>the knees and elbows <\/span>and less often<\/span> on the face and buttocks<\/span>. <\/span>T<\/span>he trunk<\/span> is typically<\/span> spared<\/span>. Lesions last for over 10 days<\/span>, but <\/span>do <\/span>not require any treatment and resolve spontaneously. <\/span>Rarely, the rash can last up to <\/span>8 weeks.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

Kawasaki Disease<\/h1>\n

Kawasaki disease is a multisystem disease that generally affects children less than 5 years old. While the exact cause still remains unknown, infectious etiologies have been postulated.\u00a0 <\/span>Kawasaki disease is significant for being the number one cause of acquired heart disease among children in North America<\/span>. The classic findings <\/span>include fever lasting more than 5 days, redness <\/span>of the conjunctivae<\/span>,<\/span> unilateral cervical lymphadenopathy, swelling\/redness of the hands\/feet<\/span>, and \u201cstrawberry tongue\u201d<\/span>. An exanthem is present in ~80% of cases but <\/span>its<\/span> appearance is variable. <\/span>Most commonl<\/span>y it is <\/span>widespread <\/span>red macules and papules similar to measles,<\/span> and may favor the perineal area. <\/span>If caught early enough the treatment of choice is intravenous immunoglobulin (IVIg). Patients should be referred to cardiology to assess for any cardiac involvement.<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n","protected":false},"author":1682,"menu_order":27,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-653","chapter","type-chapter","status-publish","hentry"],"part":590,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/chapters\/653","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/wp\/v2\/users\/1682"}],"version-history":[{"count":3,"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/chapters\/653\/revisions"}],"predecessor-version":[{"id":1536,"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/chapters\/653\/revisions\/1536"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/parts\/590"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/chapters\/653\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/wp\/v2\/media?parent=653"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/pressbooks\/v2\/chapter-type?post=653"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/wp\/v2\/contributor?post=653"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/wp-json\/wp\/v2\/license?post=653"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}