VIRAL EXANTH

EMS
Rabano │ Somera │ Tiburcio │ Zabala
 Exanthems
Characterized by an acute generalized eruption presenting as:
• Erythematous macules & papules (morbilliform)
• Confluent branching erythema (scarlatiniform)

Eruptions are usually due to either drugs or

viral infections

Accompanying signs may include pruritus, fever,

eosinophilia, and transient lymphadenopathy
Viral Exanthems
Measles (Rubeola)

German Measles (Rubella)

Roseola

Erythema Infectiosum

Varicella (Chicken pox)

Herpes Zoster (Shingles)

Herpes Simplex Virus (HSV)

 Measles (Rubeola)

Definition
It is a viral diseases characterized by a prodromal illness of
fever, cough, coryza and conjunctivitis followed by a
generalized maculopapular rash.

Etiology MOT Incubation Period

It is a spherical, non- Inhalation: Respiratory Incubation period is 10
segmented, negative-sense droplets days to fever onset and 14
RNA virus under the genus Direct Contact: Infected days to rash onset.
Morbillivirus secretions
 Measles (Rubeola)
Pathogenesis

Initiation Dissemination Signs and Symptoms

Infection begins when the virus is
deposited on the epithelium of the
respiratory tract, conjunctiva, and
oropharynx  proliferates and
spread to lymph nodes
It then enters the blood stream via Host response and measles virus
infected leukocytes  1’ viremia  replication  signs and symptoms
2’ viremia (5-7 days after infection). (8-12 days after infection).
 Measles (Rubeola)
Cont.

Clinical Manifestations Diagnosis

< 10 days: Fever, malaise  cough,
coryza, and conjunctivitis.
< 12 days: Koplik’s spots at Buccal
mucosa (blue-white dots)
< 14 days: Rash appears
(+/-) headache, abdominal pain,
vomiting, diarrhea, and myalgia
Koplik’s spot is a pathognomonic for
measles virus
CDC case definition requires:
Maculopapular rash (> 3 days)
Fever of at least 38ºC
Cough, coryza, and conjunctivitis
Serology detection of serum IgM and
IgG antibody

Complications Treatment & Prevention

Acute laryngotracheobronchitis  Airway Supportive measures, hydration, anti-
obstruction pyretics, vitamin A, and antibiotic
Giant cell pneumonitis (prevent 2’ bacterial infection)
Diarrhea (Children) MMR Vaccine
Post-measles Encephalomyelitis (Rare)
 German Measles (Rubella)

Definition
It is a variant of measles or scarlet fever. It causes Congenital
Rubella Syndrome (CRS) which is known to affect an infected
infant’s eyes, ears, and heart.

Etiology MOT Incubation Period

It is a single-stranded DNA Inhalation: Respiratory 14 days (range. 12-23 days)
virus under that family droplets * Clinical and subclinical
Togaviridae and genus Can cross the placenta in infections are considered
Rubivirus infected pregnant contagious
individuals
 German Measles (Rubella)
Pathogenesis

Initiation Mother to Baby CRS

Inhalation  Implantation and
replication in the nasopharynx 
Spread through lymph nodes 
Viremia  Infection of the placenta
(pregnant women)
Placental virus replication  Infects
almost all organs (effects of Rubella
are vary)
* Hallmark (fetal infection): Chronicity
Aside from the effects on the eyes,
ears, and heart, there are also transient
physical manifestations such as
thrombocytopenia with purpura (eg.
“blueberry muffin syndrome”, dermal
erythropoiesis)
 German Measles (Rubella)
Cont.

Clinical Manifestations Diagnosis

(Acquired)
Difficult because of mimicry
Generalized maculopapular rash (<3
Lab documentation (e.g., serology) is
days)
the only reliable way to confirm acute
Children: First sign
disease
Older Children and Adults: 1-5 days
Can be isolated from blood and
of prodrome precedes rash: fever,
nasopharynx (prodromal state)
malaise, upper respiratory symptoms,
lymphadenopathy, and arthralgia and
arthritis (women)

Treatment Prevention
No specific available treatment for MMR Vaccine
Rubella. Only symptom based
treatment is given for various
manifestations.
 Roseola

Other names:
• Exanthem subitum
• Sixth disease
• Roseola infantum
• Human herpesvirus 6 (HHV-6), Human herpesvirus 7
(HHV-7) infections

• Faint pink
maculopapular rash
that blanches when
palpated and generally
non-pruritic
• The mucous
membranes are spared
 Roseola
Cont.

• Caused by HHV-6, some • Rash appears within 48 hour of

cases are caused by HHV-7 defervescence
• Most common among • Begins on the neck and trunk →
children < 3 years of age spreads on the extremities, and persists
for a few hours to 2 days
 Roseola
Cont.

DIAGNOSIS:
• Clinical History and
Physical Examination TREATMENT:
• Indirect • Supportive care
immunofluorescence (hydration)
assays • Acetaminophen for febrile
• ELISA episodes
• Neutralization assays
• Immunoblot
• Viral culture
 Erythema Infectiosum

Other names:
• Parvovirus B19 Infection
• Fifth disease

Erythema of the bilateral

cheeks, which has been
likened to a “slapped
cheeks” appearance with
perioral pallor (develops
after fever)
 Erythema Infectiosum
Cont.

• Secondary to a parvovirus A more diffuse rash (often pruritic) appears on

B19 infection the trunk and extremities → lacy reticular
• Primarily affects children 3- eruption that may wax or wane with temperature
12 years old changes over 3 weeks
 Erythema Infectiosum
Cont.
DIAGNOSIS:
• Some do not require laboratory
testing (symptoms are mild and
self-limiting within 5 -7 days)
• CBC, Parvovirus B19 IgG/IgM,
OTHER MANIFESTATIONS: Parvovirus B19 viral DNA PCR,
• Petechial, papular-purpuric gloves- bone marrow biopsy
and-socks syndrome (PPGSS) ─
uncommon manifestation
• Adults with fifth disease often have
arthritis TREATMENT:
• Fetal hydrops can develop in • Supportive care
association with this condition in • NSAIDs for relief of joint
pregnant women symptoms
• Antipyretics
• Blood transfusion in cases of severe
anemia
• IV Immunoglobulin (IVIG)
treatment for
immunocompromised patients
 Varicella (Chicken Pox)

MICROBIOLOGY AND EPIDEMIOLOGY

Causative agent: Varicella Zoster Virus (VZV)
Prevalence & Incidence: Children (Age <10)
Adult (10%)
Route of Infection: mucosa of the upper respiratory tract
conjunctiva

Clinical Manifestation Clinical Manifestation Clinical Syndromes

Macules (2-3mm) into papules Pustules then forming and Malaise
then vesicles (sometimes crusting; Mild in healthy children
umbilicated), Lesions appearing in crops; May Severe with complications on
on an erythematous base involve scalp, mouth; immunocompromised adults
(“dewdrops on a rose petal”) Intensely pruritic
 Varicella (Chicken Pox)
Cont.

Diagnosis Prevention and Control Treatment

1. Usually based from “telltale rash”
2. Doubtful, laboratory tests can be
done thru: Blood test and Skin
lesions culture.
Live attenuated vaccine Healthy children: no medical treatment
1995: single dose (95% effectivity) require but antihistamine may be
2006: two doses (98% effectivity) given to relieve itching.
Protective Immunity: unknown
 Herpes Zoster (Shingles)

MICROBIOLOGY & EPIDEMIOLOGY

Reactivation of Varicella Zoster Virus
Epidemiological Factors:
 Recent chickenpox infection, weakened immune system might
wake the virus up.
 Other infection such as:

▪ Cancer, HIV, or other disease that lower body immunity

▪ Under a lot of stress
▪ Age of 50 or older
▪ Physical trauma
▪ Long-term steroids or other immunosuppressive drugs

Clinical Manifestation (Initial) Clinical Manifestation (Succeeding)

Severe pain in the area of skin or mucosa supplied by Crop of vesicles appears over the skin supplied by the
one or more groups of sensory nerves and ganglia affected nerves.
often unilateral. Most common complication inf elderly:
“postherpetic neuralgia-protracted pain”
 Herpes Zoster (Shingles)
Cont.

Diagnosis Prevention Treatment/Prevention

A rise in specific antibody titer
can be detected in the
patient’s serum by various tests,
including fluorescent antibody
and enzyme immunoassay.
Varicella Zoster Vaccine Acyclovir; prevents the development of
2006 systemic disease in varicella-
14x more potent than usual varicella infected immunosuppressed patients
vaccine. and
can halt the progression of herpes
zoster in adults.
 Herpes Simplex Virus (HSV)
INTRODUCTION

Linear, double stranded DNA Affects Involves large surface area

(HSV-1, HSV-2) Mucocutaneous surfaces
CNS Spreads via centrifugal migration
Visceral Organs through peripheral nerves
(occasionally)
 Herpes Simplex Virus (HSV)
Clinical Spectrum
• Incubation period: 1-26 days (median, 6-8 days) Your Picture Here
• Manifestations depend on:
• Anatomic site involved
• Age and immune status of host
• Antigenic type of virus

• Both viral subtypes can cause genital and oral-facial

infections, and the infections caused by the two subtypes
are clinically indistinguishable.
• Genital HSV-2 infection is twice as likely to reactivate and
recurs 8–10 times more frequently than genital HSV-1
infection.
• Oral-labial HSV-1 infection recurs more frequently than
oral-labial HSV-2 infection.
 Herpes Simplex Virus (HSV)
CLINCAL SPECTRUM
Oral-facial Infections Genital Infections
• Symptoms: • Fever, headache, malaise, and
• Fever, malaise, myalgias,
myalgias
inability to eat, irritability, • Pain, itching, dysuria, vaginal and
and cervical adenopathy (3– urethral discharge, and tender
14 days) inguinal lymphadenopathy
• Lesions: hard & soft palate, • Widely spaced bilateral lesions of
gingiva, tongue, lip, & facial the external genitalia
area
• Exudative or ulcerative
lesions of the posterior
pharynx and/or tonsillar
pillars

Herpetic Whitlow Herpes Gladiatorum

• HSV infection of the finger • HSV infection of thorax, ears, face,
and hands common in wrestlers
 Herpes Simplex Virus (HSV)
Diagnosis
• Clinical and laboratory
• Lab: virus, viral antigen, or viral DNA from scrapings from
lesions

Treatment
• Antiviral chemotherapy: Acyclovir Famiclovir,
Valacyclovir
Fin.