12 Rashes
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diagnosis based on timing of rash relative to fever and prodrome
no real diagnosis and no real treatment
slapped cheek disease, fifth disease
path: parvo B19
symptoms: slapped cheek, fever and rash at same time. Lacy rash in glove stocking distribution
diagnosis: clinical
treatment: support
f/u:
Can go back to school immediately
if Hgb problems, aplastic crisis
hydrops fetalis: if mom pregnant with another kid, isolate from current B19 kid
aka rubeola
path: paramyxovirus
Symptoms
fever and rash same time, begin on face, spread to trunk and arms. Also rash clear top to bottom
prodromes: cough, coryza (runny nose), conjunctivitis, koplik spot (white dots in mouth)
diagnosis: clinical
treatment: supportive
prevent: MMRV vaccine. Give Vitamin A to prevent secondary pneumonia
f/u: develop subacute sclerosing panencephalitis. Post measles pneumonia staph aureus from destroying elevator.
aka rubella
path: rubella
symptoms
fever and rash
rash on face, then spread to trunk and arms
prodrome: generalized and posterior LAD
diagnosis: clinical
treatment: support
prevention: MMRV
path: HHV 6
symptoms
prodrome: high spiking fever, >104
rash: after fever breaks
rash: starts on trunk and expands outward
diagnosis: clinical
treatment: supportive, control fevers with acetaminophen
f/u: febrile seizures, viral otitis media
path: varicella
adult: shingles
baby: chickenpox
symptoms
rash without fever
diffused, vesicules on erythematous base, in different stages of healing (eruption, ulceration, crusting)
itchy, painful, all over body
shingles: immunocompromised due to aging, >60. Painful prodrome, vesicular rash inside dermatome, do not cross midline. Control pain. Shingles vaccine
diagnosis
clinical
don't do Tzank for chickenpox. Only use for herpes
don't do PCR
treatment
kid: supportive
prevention: do not do pox parties. Use MMRV
mumps virus
pt: pubertal males
symptoms: parotid swelling, orchitis
diagnosis: clinical
treatment: supportive
prevention: MMRV
f/u: infertility if orchitis
Cox A
pt: varicella looking
symptoms: only hands, feet, mouth. Herpangina
diagnosis: clinical
treatment: supportive
prevention: no vaccine..
Herpes
Sulfa and seizure drugs
Mycoplasma
treatment: short course steroids
Mono like fever and pharyngitis:
HIV
EBV: monospot only good for > 4yo because no good immune IgG against heterophile antibody.
CMV
Strep
vesicles or ulcers
culture vesicle, mucous membranes, PCR for herpes
start acyclovir
bullous lesions same time
