Infectious disease

Measles (Rubeola)
· Cause: Measles virus.
· Prodrome: Severe cough, coryza, conjunctivitis,fever. Koplik’s spots on buccal mucosa.

· Lesions: 0.1-1.0 cm confluent dark-red to purplish macules and papules

· Distribution: Starts on face and behind ears, spreads to trunk and ext.
· Treatment: Prevention with MMR vaccine! If not immune, Ig can be
used within 6 days of exposure.

German Measles (Rubella)

· Cause: Rubella virus.
· Prodrome: Mild sx: malaise, headache, mild fever, lymphadenopathy.
· Lesions: Pinpoint to 1.0 cm rosy/ pink maculo-papules. Sometimes
coalescing.
· Distribution: Starts on face/ neck spreads quickly to trunk/ ext.
· Treatment: Prevention with MMR vaccine! Note: Congenital rubella
syndrome in pregnancy.

Scarlet Fever
· Cause: Streptoccocal toxin.
· Prodrome: Sudden onset fever and pharyngitis. N/V, HA, abdominal
pain, strawberry tongue, Pastia’s lines.
· Lesions: Innumerable pinpoint scarlet papules producing sandpaper
texture to skin
· Distribution: Starts on face/ neck spreads to trunk/ ext. May progress
to desquamation.
· Treatment: Penicillin.

Erythema Infectiosum (Fifth Disease)

· Cause: Parvovirus B19.
· Prodrome: Mild or absent. Low-grade fever, sore throat.
· Lesions: "Slapped cheek" - coalescing red papules on cheeks; "net pattern
erythema" - fish net erythema beginning on extremities, extending to
trunk.
· "Recurrent phase": May fade and reappear repeatedly.
· Treatment: None.

Roseola Infantum (Sixth Disease)

· Cause: Human Herpes virus 6.
· Prodrome: Sudden onset high fever (103-106F), mild to mod
lymphadenopathy.
· Lesions: Appear after fever subsides. Numerous pale-pink almond
shaped macules.
· Distribution: Start on trunk and neck, become confluent, then fade in
hours to days.
· Treatment: Reassurance, temperature control.

Infectious Mononucleosis
· Cause: Epstein-Barr virus.
· Prodrome: Malaise, pharyngitis, fevers, palatal petechiae, lymphadenopathy,
organomegaly.
· Lesions: Macules or papules, morbilliform.
· Distribution: Trunk, upper arms, may involve face, less frequently distal
ext.
· Treatment: Symptomatic. AVOID ampicillin (development of rash).

Herpes Simplex
· Cause: HSV-1 (usually oral) and HSV-2 (usually genital).
· Prodrome: Fever, localized pain, tender lymphadenopathy, mild paresthesias or
burning at site.
· Lesions: Grouped vesicles on an erythematous base which erode and
ulcerate.
· Distribution: Oral or genital mucous membranes, recurrence via
dorsal roots and peripheral nerves. May appear on any skin surface.
Fingers: Herpetic whitlow.
· Treatment: Acyclovir: Decreases viral shedding, new lesion formation
and severity of symptoms. Alternatively famicyclovir and valcyclovir.

Varicella (Chicken Pox)

· Cause: Varicella-zoster virus.
· Prodrome: Mild in children, more severe in adults. Low-grade fevers,
malaise, H/A.
· Lesions: 2-4 mm erythematous papule which develops into a vesicle;
"dewdrops on a rose petal". Late lesions with crust.
· Distribution: Starts on trunk (centripetal distribution), then spreads to
face/ ext. Many stages of lesions.
· Treatment: Prevention with vaccine. Usually no treatment in children.
Acyclovir in severe cases or adults.

Hand-Foot Mouth Disease

· Cause: Coxsackie virus.
· Prodrome: Mild sx. Low-grade fevers, sore throat, malaise. Occasionally
submandibular/ cervical LAD.
· Lesions: 90% have aphthous like oral lesions. 3-7mm erythematous
macules with surrounding erythematous pustules
· Distribution: Palms, soles, dorsal aspects of fingers/ toes, oral
mucosa. Occasionally on face, buttocks, legs.
· Treatment: Reassurance.

Scabies
· Cause: Sarcoptes scabiei var. hominis mite.
· Prodrome: Pruritus around infestation sites, usually nocturnal. Relieved temporarily by
scratching.
· Lesions: Linear, curved S-shaped burrow. Pink-white, slightly elevated with
vesicle at one end. May be discrete pinpoint vesicles, papules or
pustules.
· Distribution: Most often in finger webs, flexor wrists, sides of hands/
feet, genitals.
· Treatment: Permethrin cream, lindane (Kwell), Ivermectin.

Lyme Disease
· Cause: Borrelia burgdorferi (Ixodes tick bite).
· Prodrome: Intermittent constitutional flu-like sx, malaise, fevers, regional
lymphadenopathy.
· Lesions: Erythema migrans at bite site, beginning as a small papule which expands to a
large ring. May have multiple concentric rings.
a. Borrelia lymphocytoma: Bluish-red nodule on ear-lobe or nipple;
usually in European strains
b. Acrodermatitis chronica atrophicans: Erythematous atrophic plaques
on extensor surfaces of hands, feet, elbow and knees; usually in
European strains
· Treatment: Doxycycline or amoxicillin. May also use ceftriaxone.

Rocky Mountain Spotted Fever

· Cause: Rickettsia rickettsii (dog ticks).
· Prodrome: Abrupt onset of fever, headache, myalgia, vomiting.
· Lesions: Discrete blanching macules that become petechial in 2-4 days.
Start approximately 4 days after onset of fever
· Distribution: Starts on wrists/ ankles, spreads to palms/ soles, then
becomes generalized.
· Treatment: Doxycycline. Alternative: Chloramphenicol.

Cat-Scratch Disease
· Cause: Bartonella (Rochalimaea) henselae - thought to be from cat fleas
· Prodrome: Mild sx. of generalized aching, malaise, anorexia.
· Lesions: Erythematous macule at contact site that evolves to a non-pruritic papule and
vesicle. Regional lymphadenopathy appears in 1-2 weeks.
· Treatment: Supportive in mild; Bactrim or rifampin in severe cases