Childhood Exanthems & Mumps

Miscellaneous Viral PathogensExanthems may be seen with multiple viral pathogens, includingenteroviruses (echoviruses, coxsackieviruses)AdenovirusEBVDengue virus and other hemorrhagic fever viruses, etc.Differential diagnosis includes other infectious etiologies (e.g. bacterial), allergic reactions or allergy-mediated disease, collagen-vascular diseases, etc.To what extent definitive diagnosis is pursued is a clinical decision.

Parvo

Parvovirus B19

A.K.A.5th DiseaseErythema Infectiosum

Characteristics

Icosahedral

ssDNA

Pathophysiology

Replication

Replication is followed by..?Where is the primary site of replication?

Viremia

Nucleus of immature erythrocyte

Clinical

Mild illness initially

Fever

Malaise

Headache

Myalgia

Other possibilities

Splenomegaly

Lymphadenopathy

Arthralgias / Arthritis

Mild leukopenia, anemia

Itching

Slap-cheek

Confluent, indurated rash

Papular-Purpuric Gloves and Socks Syndrome (PPGSS)

Acrally distributed erythema, edema, and petechial purpura (may have enanthem)Immune responses against ParvoB19 appears AFTER onset of skin eruption (different from slapped cheek)

Complications

Infection of fetus

Hydrops fetalis and death

Patients w/ hemoglobinopathy

Profound anemia

Aplastic crisis

Immunocompromised

Persistent infection

Persistent anemia

Diagnosis

Clinical presentation

Lab

PCR

Serology

Epidemiology

Transmission

Respiratory?

Prevention

No Vaccine

Treatment

No specific AV

I.V. Ig beneficial

Toga

Rubella

A.K.A.German measles3-day measles

Characteristics

Pathophysiology

Respiratory tract invasion

Local replication

Viremia

Clinical

Acute illness benign

Risk damage to fetus during pregnancy

Mild illness

Low-grade fever

UR symptoms

Lymphadenopathy

Esp. posterior cervical and postauricular

Exanthem

Begins on face

Similar to measles

Discrete

Pink-red

Fine maculopapular eruption

Enanthem

Enanthem: eruption on mucous membrane

Forscheimer spots

Most common complication

Arthralgia / arthritis

More common in womenSpread of the virus to susceptible pregnant women and their fetuses, resulting in ______...

Congenital rubella syndrome

Cardiac defects

Eye defects

Deafness

Hepatosplenomegaly

Growth retardation

Diagnosis

Clinical pres. NOT ENOUGH

Lab

Viral culture

Serology

Epidemiology

Transmission

Oral secretions

Incubation Period

2-3 wks

Avg. 16 days

Person

Young school-aged in unvaccinated pop.

Time

Seasonality?

Late winter, early spring

Prevention

Live attenuated vaccine

MMR

Treatment

No specific AV

Paramyxo

Measles (Rubeola)

AKA5-day measlesHard measles

Characteristics

Hemagglutinin

Neuraminidase

Fusion protein

Pathophysiology

Respiratory tract invasion

Followed by...

Local replication

...followed by...

Viremia

During viremia, virus infects....

WBC

Clinical

Initially

Cough

Coryza

A cold

Conjunctivitis

Fever

Exanthem

Exanthem: erythematous blanching maculopapular eruption that appears first on the hairline and exhibits centrifugal spread.Question:Spread ultimately ends up where?

Palms

Soles

Enanthem

1-3 days later, one expects...

Koplik spots

pinpoint, gray-white or bluish-white spots w/ surrounding red halos on mucuous membranes, esp. buccal mucosaLight bulb = Buzz word

Complications

Pneumonia

Encephalitis

Bacterial superinfection

Otitis media

SSPE

Subacute Sclerosing Panencephalitis

2-10 yrs after infection

Neurologic

Diagnosis

Clinical presentation

Epidemiology

Lab

Viral culture

Immunofluorescence

Serology

Epidemiology

Transmission

Saliva, oral secretions

saliva/oral secretions to respiratory tract or conjunctiva

Incubation period

7-18 days

Usu. 10 days

Person

90% attack rate

in those who are exposed and susceptible

Age: Young children > 6 mo.

Time

Note: communicable from 5 days prior to 4 days after onset of exanthemQuestions:Seasonality?Does it follow a cycle?

Mainly winter & spring

1-3 year cycles

Prevention

Live attenuated vaccine

MMR

Treatment

Supportive

Vitamin A

Ribavirin

Mumps

Characteristics

Hemagglutinin

Neuraminidase

Fusion protein

Pathophysiology

Respiratory tract invasion

Followed by...

Local replication

...followed by...

Viremia

Spread to target tissues may include:Salivary glandsCNSKidneysTestes/ovariesPancreas

Viruria

Clinical

Fever

Swelling of salivary glands

May see erythema and edema of Stensen's (AKA Parotid) duct

Persists for a week

Earache or facial pain

Possible complications

CSF pleocytosis

Symptomatic meningoencephalitis

Orchitis and/or epidydmitis

(Rare) Oophoritis

(Rare) Pancreatitis

Diagnosis

Clinical presentation

Epidemiology

Lemon juice

Causes increased salivation and painSeparates Mumps from AdenopathyLight bulb = Buzz word

Lab

Viral culture

Serology

EIAComplement fixation

Epidemiology

Transmission

Saliva, oral secretions

Incubation period

16-18 days

Person

Age: 5-15

Highest incidence rate

Time

Note: Mumps is communicable from 7 days prior to 9 days after the illness develops.Question: What can you say about seasonality?

Mainly winter & spring

Prevention

Live attenuated vaccine

MMR

Treatment

No specific AV

HHV

HHV-6 (Roseola)

Clinical

High Fever (103/104)

Infant/child has several days of high feverCan appear toxicFew abnormal findings on physical

Exanthem

How would you describe it?Where is it located? Where does it move?How long does it last?

Discrete irregular macules

Rose-pink

Neck, trunk

Face, extremities

2-48 hrs

Complications

Febrile seizures in infants

Diagnosis

Clinical presentation

Lab

PCR

Serology

Epidemiology

"Secondary cases uncommon except instituational settings"

Time

Seasonality?

Mainly fall, early spring

Incubation period

10-15 days

Prevention

No vaccine

Treatment

No treatment for Roseola

Significant reactivation disease

AV therapy