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Some Important Viral Exanthems in Children

  1. Measles (Rubeola, Morbilli)
    1. The term measles is thought to come from Latin “misellus” or “misella”, a diminitive of Latin “miser” meaning miserable
    2. It is caused by measles virus (a paramyxovirus, RNA virus)
    3. Incubation period is 10 – 11 days
    4. Measles, is a universal highly contagious disease of children. It has a characteristic prodrome of 3-4 days that consists of high fever, cough, coryza, a striking palpebral conjunctivitis with photophobia and Koplik’s spots, which precede the appearance of florid generalized macular and popular rash
    5. The first lesion to appear on the soft palate as blochy erythema, but the most appear as tiny white lesions surrounded by an erythematous ring (grain of sands)
    6. Koplik’s spots precedes the onset of generalized rash by 1-2 days, remain for two to three days and are usually heavily clustered on the mucosa opposite the second molar
    7. The purplish red rash on the body appears first behind the ears and over the forehead, and then spreads slowly to involve the entire body by third day. The eruption extends downwards over the neck, shoulders and trunk and then distally over the upper and lower extremities
    8. Uncomplicated measles runs a self limited course lasting about 10 days
    9. There is no specific therapy for measles
  2. Rubella (German Measles)
    1. Rubella virus is a togavirus, commonly recovered from pharynx
    2. Incubation periods is 14 – 21 days
    3. Rubella is a common communicable infection of children and young adults characterized by a short prodromal period; enlargement of cervical, subocciptial and postauricular glands and a rash of approximately 2 to 3 days duration
    4. An enanthem Forschheimer’s sign is present in up to 20% of patients during the prodromal period or on the first day of the rash. Dull – red macules or petechiae are confined to the soft palate
    5. The disease has rare sequelae apart from devastating effect on the fetus
  3. Exanthem Subitum (Sixth Disease, Roseola Infantum)
    1. Caused by Human herpes virus type 6 (DNA virus)
    2. Incubation period is 10 – 15 days
    3. Most common exanthema with fever in children under age group of 2 years
    4. Prodromal fever is usually high. Fever drops on fourth day
    5. Convulsions and lymphadenoapthy may accompany it
    6. Clinically, a morbilliform erythema consisting of rose coloured discrete macules appears on the neck, trunk and buttocks
    7. Often there is a blanched halo around the lesions
    8. The lesions resolve in 1 to 2 days
    9. Other common associated findings include otitis media, diarrhoea and meningoencephalitis
    10. In adults HHV – 6 infection resembles otitis mononucleosis
    11. Treatment – acyclovir, ganciclovir
  4. Erythema Infectiosum (Fifth Disease) 
    1. Exanthematous disease occurring in patients with primary human parvo virus B 19 infection (DNA virus)
    2. Incubation periods is 4 – 14 days
    3. More commonly seen in school children
    4. Infection is spread by respiratory droplets during the prodrome
    5. Constitutional symptoms are absent or very minimal
    6. “Slapped cheek” appearance (1 to 4 days)
    7. Erythematous popular eruption over the upper and lower extremites spreading to trunk. Assumes a lace – like or reticulated appearance as it fades
    8. Recurrent evanescent stage (for weeks or months) is performed seen in older children and adolescent
    9. Adults may present with atypical rash and arthritis
    10. Complication – Hydrops foetails (maternal infection) and Aplastic crisis
    11. Treatment – supportive

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