Exanthems in Children

Exanthems in Children
Common in children. Clinical ranged from nonspecific

viral infections to classic viral exanthems, bacterial infection or drug allergy. viral diseases to potentially life threatening severe bacterial diseases. ADR2551

Severity varies from self-limited

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Exanthems in Children

Type of Rash
Maculopapular rash Petechiae Vesicular rash Erythematous rash Urticarial rash

Exanthems with fever

Infectious causes: bacterial, viral etc Non-infectious causes : drug rash Exanthems without fever Allergic skin diseases
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Fever with MP rash

Erythematous

Maculopapular

Urticaria

Infectious

Noninfectious

Vesicular
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Petechiae
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Fever with MP rash Exanthematous fever Infectious Bacteria Viral Others

-Erythematous

maculopapular eruption

Classic viral -Mycoplasma -Scarlet fever Others viral exanthems -Rickettsiae -SSSS -Toxic shock syndrome -Measles -Enterovirus -Meningococcemia -Rubella -Adenovirus -Leptospirosis -Roseola -Dengue virus -Infectious -Gianotte-Crosti syndrome mononucleosis 7 ADR2551 -Fifth disease

Papulovesicular eruption

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Roseolar infantum

Roseolar infantum
Etiology: herpesvirus 6 Age onset : 6 months to 3 yrs High fever for 3-5 days MP rash appears after fever declines Rash clear without hyperpigmentation

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Complication : febrile 10 convulsion

Measles
Etiology:
Measles Virus is RNA virus Genus Morbilivirus Paramyxovirus family

Age :preshool and young school age children (5-9 years), adolescent
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maculopapular rash

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Measles vs Rubella
Rubella
Incubation period Prodrome
higher

Measles
10-12 days feverStepwise
38.3 c or

12-23 days low grade fever Lymphadenopathy

Cough, coryza,conjunctivitis

Koplik spots

rash

1-5 d before rash

4 d before

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Maculopapular rash 14-17 days after after exposure ADR2551 exposure

14 days
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Rubella
Face ->Hand&Foot Rash persists
Convalescence

Measles
72 hr 5-6 days
Cough 1 wk

Rubella

Measles

24 hr 3 days

lymphadenopathy hyperpigmentation

Severity

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Measles Complications
Condition -Diarrhea -Otitis media -Pneumonia -Conjunctivitis -Encephalitis -Subacute sclerosing panencephalitis onset / 72hr 72hr 2-6

Prevention
Vaccine : MMR
- 9 - 12 months - starting school (booster)

Contact measles

- < 72 hr MMR vaccine - >72 hr - <6 days immunoglobulin IM in immunocompromised host

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Rubella
Benign diseases in children

Rubella
Low grade fever Rash :discrete pink macules and papules Rash begins on face to trunk and extremities within 24 to 48 hour Post auricular, suboccipital, post cervical 24 ADR 2551 lymphadenopathy

Harmful in pregnant women

in the first trimester :

20% chance to have congenital

rubella syndrome Eye defect : cataract, glaucoma Cardiac defect : PDA,VSD Deafness
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Rubella : Lab diagnosis

Rubella specific IgM Four fold rise in IgG antibody from the acute phase to convalescence
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Dengue fever
High fever without URI symptoms Vomiting, abdominal pain Rash on day 4 and 5 Convalescent rash is pathognomonic Lab:Hct ,Pt ,atypical L
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Erythema infectiosum

Erythema Infectiosum
(Fifth Disease)
Etiology: human parvovirus B19 Common in school-age patient Clinical : 3 stages Slapped cheeks : 1-4 days Lacy reticulate erythema on the extremities : characteristic Rash waxes and wanes for several weeks Complications Arthralgia and arthritis 8-10% Hydrops fetalis in pregnancy

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Infectious mononucleosis
Etiology : Epstein-Barr virus Clinical
Fever Sorethroat : exudative pharyngitis Hepatosplenomegaly Lymphadenopathy Rash: MP rash seen in10-20%, increased up to 80% with ampicillin or amoxycillin therapy

Infectious mononucleosis
Diagnosis
Clinical : Triad Fever Exudative pharyngitis, Cervical lymphadenopathy Lab CBC : atypical lymphocytosis>10% Anti-VCA IgM
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Staphylococcal Scalded Skin Syndrome

Staphylococcal Scalded Skin Syndrome (SSSS)

Etiology: Exfoliative toxin of S.aureus phage gr 2 Clinical
Fever with generalised erythroderma Periorificial crusting Rapid spread of bullous with severe exfoliation Nikolskis sign positive Treatment : antistaphylococcal antibiotics Complication: fluid and electrolyte imbalance

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A 1 year-old-boy has fever with rash

Kawasakis disease

Red eyes,dry cracked lip,red tongue

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Kawasaki Diseases
Acute febrile mucocutaneous lymph node syndrome Common in children under 5 years old Etiology unknown Complication :coronary dilatation and aneurysm 5-10%
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Kawasaki disease
High fever for at least 5 days 95% Bilateral conjunctiva injection 90% Change of extremities 90-95%
Erythema or edema Desquamation at tip of fingers

Change of oral cavity

Erythema, strawberry tongue

85- 95% 85-90% 60-70%

Polymorphous exanthem Cervical lymphadenopathy

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Kawasaki disease

Kawasaki disease

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Strawberry tongue

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ADR 2 551 Erythema and dry crack lips

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Kawasaki disease

Oral cavity

Kawasaki diasease
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Stevens-Johnson syndrome
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Kawasaki Diseases
Lab CBC : Leucocytosis, predominant PMN : Thrombocytosis in second weeks Elevated ESR Treatment IVIG 2gm/kg single dose ASA 30-50 mg/kg and then tapering dose to 5-10 mg/kg /day Echocardiogram for coronary involvement

Toxic Shock Syndrome

sunburnlike rash strawberry tongue

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Toxic Shock Syndrome

Etiology : staphylococcal toxin (TSS 1 &TSS 2) Clinical : hypotension, fever, myalgia, diarrhea, vomiting Rash : macular erythroderma Treatment admit and treat shock iv antistaphylococcal antibiotics
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A 4 year-old boy has fever with rash for 3 days

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Scarlet Fever
Common in school age Etiology: Streptococal
gr.A

Scarlet fever

High fever with sore

Desquamation in the
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throat Erythematous sandpaper Strawberry tongue Pastias sign second week

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Scarlet fever
Diagnosis
Clinical Throat swab culture ASO titer

Meningococcemia
Clinical : High fever meningismus, hypotension Rash : petechiae and purpura on the extremities, palms and soles Treatment : admit and immediately treat with high dose penicillin ADR2551

Treatment
days

: Penicillin for 10

Complication : rheumatic fever & AGN

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Mycoplasma Infection
Common age group 5-19 years Clinical :pneumonia, URI, bronchitis Rash Maculopapular rash
Vesicular rash Urticarial rash Stevens-Johnson syndrome

Lab diagnosis :cold agglutinin,

Mycoplasma titer

Treatment: erythromycin ADR2551

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