viral exanthems

  1. herpes type I
  2. herpes type II
  3. how herpes is transmitted
    person to person, highly contagious
  4. does there have to be lesions to transmit herpes?
    no. most transmissions occur during shedding without the presence of lesions
  5. herpes virus inactivated at what temperature?
    room temp
  6. HSV I is nongenital, but 10-20% of genital lesions
    are HSV I
  7. HSV II during childbirth
    C-section if lesions present
  8. herpes oral appearance
    small multiple papules/vesicles coalesce into large ulcerative lesion
  9. herpes oral gums
    may be red and swollen
  10. herpes oral other symptoms
    cervical lymphadenopathy, malaise, sore throat, headache
  11. 2 ways to diagnose herpes
    history, culture
  12. HSV I treatment
    valcyclovir (valtrex)
  13. herpes genital appearance
    women: vulvovaginitis, edema. multiple vesicles, erosions, ulcers, tenderness
  14. treatment for herpes is this, not that
    treatment for herpes is antivirals (like valtrex). do not use abx on herpes.
  15. herpes recurrent lesions appearance
    grouped vesicles on erythematous base...usually occurs at same site
  16. herpes prodrome
    tingling or burning beforehand
  17. herpetic whitlow
    HSV infection of finger, can give an infant if the mother has it
  18. lab tests for herpes (3)
    • culture of vesicular fluid
    • tzanck smear
    • serum antibodies
  19. herpes treatment
    ANTIVIRALS! begin at first sign of symptoms.

    • topical: penciclovir cream
    • oral: acyclovir, valcyclovir, famcyclovir
  20. herpes zoster
    shingles, reactivation of latent varicella in sensory neurons
  21. zoster is triggered by lots of things
    impaired immune system, radiation, trauma, surgery, spinal tumors, stress, lymphoma, fatigue, age
  22. zoster most common over age
  23. zoster spread by direct contact?
    very very rarely
  24. zostavax
    shingles vaccine for 60+ yrs old
  25. zoster appearance
    grouped vesicles on a tender erythematous base. unilateral, along a dermatome. crusted. thoracic.
  26. unilateral vs bilateral
    bilateral is never herpes
  27. unilateral on trunk
    could be herpes
  28. disseminated herpes zoster
    means more than 25 vesicles away from dermatome
  29. postherpetic neuralgia
    pain 4 weeks or more after herpes lesions resolve. more common with older. itch burn sharp shooting pain
  30. zoster treatment
    symptomatic treatments only (burow's, tylenol, prednisone, maybe oral valtrex)
  31. varicella zoster virus
    chicken pox
  32. chicken pox and immunity
    results in lifetime immunity
  33. chicken pox contagious from
    2 days before rash erupting
  34. varicella appearance
    starts on trunk, spreads to face and extremities, usually seen in different stages
  35. "dew drop on a rose petal"
    varicella, chicken pox.
  36. varicella prevention
    varicella vaccine
  37. HPV - 60 viral types of warts; 4 categories
    • common (verruca vulgaris)
    • flat (verruca plana)
    • plantar
    • genital (condyloma acuminata)
  38. verruca vulgaris
    common warts. most common on hands. kissing lesions, start out smooth flesh, evolve into domed growths with black dots
  39. periungal warts are hard to treat
    please don't bite them, you'll get warts in your mouth
  40. treatment for verruca vulgaris
    • salicylic acid OTC
    • liquid nitrogen
    • light electrocautery
    • canthacur
  41. verruca plana--flat warts
    pink, light brown or light yellow. slightly elevated flat topped papules, numerous on forehead, mouth, backs of hands, shaved parts
  42. verruca plana flat warts treatments
    • topical retinoid (tretinoin RetinA)
    • efudex
  43. plantar warts diagnosis (trim before treating)
    if bleeding in the middle, it's a wart. if a core in the middle, it's a corn

    also, warts hurt with lateral pinching
  44. plantar wart treatment
    only if causing pain. remove callous periodically. salicylic acid, canthacur, cryo, pulsed dye laser
  45. HPV genital--sexually and nonsexually transmitted, usually asymptomatic, aka
    condyloma acuminata
  46. HPV appearance
    skin colored pinhead papules to caulifower masses
  47. HPV after application of acetic acid
    you can see it now, white patches
  48. HPV treatments (they will clear spontaneously 20-30% of patients)
    • liquid N
    • podophyllin
    • trichloroacetic acid
    • electrodessication/electrocautery/laser
    • Aladara (imiquimod) x 16 weeks
  49. HPV prevention (2)
    • 2 vaccines: cervarix and gardasil
    • boys can get gardasil too
  50. molluscum contagiosum
    • umbilicated flesh colored dome papules, waxy
    • spread by scratching or touching
    • seen in eczema kids
    • adults can be sexually transmitted
  51. molluscum contagiosum treatments
    • (most clear spont in 6-9 months)
    • canthacur, cryo, silver nitrate paste
  52. non-specific viral rash
    most viruses cause similar appearing rashes, so they are considered one thing
  53. non-specific viral rash most common in who?
  54. viruses that can cause non-specific viral rash
    enterovirus, echovirus, coxsackie virus, EBV, HHV-6, HHV-7, parvovirus B-19, rhinovirus, adenovirus, RSV, influenza, parainfluenza
  55. exanthem
    rash because of an infection
  56. roseola infantum
    6 months-3years, high fever abrupt rash as fever resolves
  57. roseola infantum symptoms
    appears well except high fever, watch for febrile seizures. almond shaped pale pink rash. rash is everywhere. kid feels fine.
  58. erythema infectiosum aka
    • fifth's disease
    • slapped cheek
  59. erythema infectiosum aka 5ths dz, slapped cheek:
    • bright red cheeks, lacy erythema on arms
    • 5-14 yrs
  60. what area does erythema infectiosum NOT affect
    nasolabial fold
  61. lacy reticular "fish net" rash happens with
    erythema infectiosum
  62. hand foot and mouth disease appearance
    oral erosions and cloudy vesicular eruptions with red halos along mouth, hands, feet. kids under 5
  63. if a kid has hand foot and mouth disease you should do this
    isolate them 3-7 days
  64. herpangina
    viral. kind of like hand foot mouth disease but only in the mouth

    high fever can be 106
  65. rubella aka
    • german measles, 3 day measles:
    • 1. forehead to face trunk extremities
    • 2. rash disappears
    • day 3: rash fades completely
  66. defining feature of measles
    Koplik's spots
  67. measles 4th day of fever what happens
    erythematous macules and papules erupt
  68. kawasaki disease
    • acute multisystem vasculitis
    • infants, young kids
    • japan
  69. need 5 of 6 kawasaki criteria
    • FUO 5+ days
    • bilateral conjunctiva infex
    • changes in lip, oral
    • cervical lymphadenopathy
    • polymorphous exanthem with vesicles/crusts
    • changes in peripheral extremities
  70. kawasaki kids are
    REALLY sick. not just normal pink eye
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viral exanthems
viral exanthems