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ViralExanthems and Enanthems

Togaviridae!! (ss+RNA, enveloped) = Rubivirus
Can cause transplacental infection (TORCH) cataracts and microcephaly mostly eradicated
now due to immunization
o Vaccinate mom at least 28 days before getting pregnant do not vaccinate during
Erythematous maculopapular rash that begins on face and spreads caudally
Erythematous spots on soft palate = Forcheimmers sign
Adult versions can develop arthritis (swollen wrists), classically have posterior and occipital
lymph node enlargement

HUMAN PARVOVIRUS B19 (Fifth Disease)
Erythema infectiosum Parvovirus B19, ssDNA enveloped virus
Occurs more in winter and spring
Classically attacks pts with hemoglobinopathies (in pt w/ sickle cell for example)
Significant risk for anemia!! Attacks RBCs (affinity for erythroid progenitor cells) receptor =
Erythrocyte P antigen
Slapped cheek appearance
Diagnosis based on clinical presentation; definitive diagnosis based on PCR for DNA
Risk of hydrops fetalis (edematous baby, heart failure) in infected pregnant woman
Papular pruritic gloves and socks syndrome (PPGSS) more than half of cases are linked to
Parvovirus B19

HHV 6 (and sometimes 7) = linear dsDNA enveloped virus tropic for B-lymphocytes!
Infection usually occurs in first 6 mos 2 years of age
Fever presents before rash! Fulminant fever for 3-5 days, then rash develops
Abrupt onset of high fever, cervical lymphadenopathy, URT symptoms risk for febrile seizures
and/or encephalopathy
Pt often put on antibiotics for fever, usually Amoxicillin often confused for allergy to drug b/c
child develops rash after taking antibiotic

Paramyxoviridae (ss RNA, enveloped)
Swelling of salivary glands - Parotitis
Can have rash

Chicken pox
HHV-3 (linear dsDNA enveloped virus)
Vesicular lesions become umbilicated = dark spot in center of lesion
Lesions at different stages of healing
Virus infects DRGs lies latent
Live attenuated vaccine available

MEASLES (Rubeola)
Paramyxoviridae (ss-RNA, enveloped)
3 Cs and a P: Cough, Conjunctivitis, Coryza and Photophobia + rash that follows
Coryza inflammation of mucous membranes
Kopliks spots (red lesions in oral mucosa with white spot in center) = Enanthema
SSPE = rare CNS sequelae of measles infection
Live attenuated vaccine available; Vitamin A for treatment

Variola virus - Poxviridae (linear dsDNA, enveloped)
Largest most complex virus replicates entirely in cytoplasm
Guarnieri bodies cytoplasmic inclusions where virus is replicating and assembling acquires
Highly contagious
Rash starts on hands, face and forearms moves to trunk and lower limbs
Synchronous vesicular rash: Macules papules vesicular pustules scabs

Occupational hazard for those working w/ animals (cows, sheep, goats)
Both cause single, nodular/vesicular lesion, usually on fingers
Orf is poxvirus from sheep and goats sheep shearers at risk!

Poxviridae transmitted by contact or fomites
Nodular to wartlike lesions w/ central caseous plug mostly on trunk, genitalia and proximal
Histology: Epidermis has molluscum bodies cytoplasmic inclusions