Infectious disease skin rash


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for medical students , master of FM and PEDO

Infectious disease skin rash

  3. 3. 1- NON SPECIFIC General measures  Bed rest.  Diet: Symptomatic treatment:  For fever: Sponging with tap water and antipyretics but avoid over­ dosage and prolonged use.  For constipation, headache Supportive measures:  Fluids for dehydrated patients
  4. 4. RASHESRashes can be classified as: Macular, maculopapular eruptions Papulo-vesicular or bullous eruptions Petechial or hemorrhagic eruptions. Ulcerative eruptions Nodular eruptions.
  6. 6. Vesiculo-papular Urticaria Post-Allergen as insect bite Very itchy papules→vesicles→exco -riation and 2ry infection No scalp No mm Over the extensor surfaces, palms, soles
  7. 7. C/P Describe distribution: maximum, other areas Itchy MM
  8. 8. Iry lesions Macule: Flat lenticular size circumscribed area (<5 mm- <1cm) of change in skin color Papule: small lenticular size (<5mm- 1cm)Circumscribed elevation of the skin Nodule: Solid, circumscribed elevation of the skin whose greater part is beneath skin surface (felt more than seen)
  9. 9. Vesicle: collection of clear fluid(<5mm in diameter) Bulla: like vesicle, but > 5 mm Pustule: Collection of Pus
  10. 10.  Patches : large lesion due to gathering of macules Plaque: flat topped palpable lesion (gathering of papules)
  11. 11. Non blanchingHgic rash Petechiae are less than 2 mm in diameter Purpuric lesions vary from 2 mm to 1 cm Ecchymoses are larger than 1 cm.
  12. 12.  Wheal: Transient, slightly raised lesion with pale center and pink margin. Seen in urticaria. Telangectasia: Dilated capillaries visible on skin surface
  13. 13. Maculo-papular DD
  14. 14. What is the lesion A child with rash (red macules, red papules, vesicles) over the trunk and few over the face and scalp. History of sneezing and cough one day before
  15. 15. Vesiculopapular Rash Chicken pox (varicella) Herpes zoster Herpes simplex Hand-foot-mouth syndrome Impetigo Scabies urticaria
  16. 16. Varicella (Chickenpox) V-Z Virus Transmission: 1- skin contact 2- droplets 3- air born transmission Contagiousness : 1-2 d before rash till all lesions are crusted All ages Most 2-8 ys
  17. 17. Clinical Manifestations of Chicken Pox Incubation period 11-21 days. Catarrhal stage: mild fever and malaise precede the typical rash by 24 hours. infective The rash starts by small red papules that pass into vesicles on an erythematous base. infective It starts on the trunk and spreads to the face, scalp and extremities. Pruritis is usually present. Vesicles produce a crust that falls with no scar. NON infective
  18. 18. Varicella CP 1- Prodroma: mild 2- rash: skin: pleomorphic, centripetal itchy tear drop vesicles, scabs mm: conj, oral, vagina
  19. 19. Chicken Pox Pleomorphic: pleomorphic macules papules tear drop vesicles scabs (crusts)
  20. 20. Chicken Pox pleomorphic
  21. 21. Start at trunkThen face and scalp centripetal
  22. 22. centripetalStart at trunkThen face and scalp
  23. 23. Mucus Membrane
  24. 24.  It is a droplet infection and infectivity occurs 24 hours before, and up to scaling of all rash ( usually 7 days after the appearance of the characteristic rash) . Dry scales are non-infective.
  27. 27. Complications Skin: 2ry bacterial infection Hgic varicella Blood complications: ITP, internal hge, purpura fulminans CNS: encephalitis, cerebellitis, transverse myelitis, GBS, cranial ns palsy as optic neuritis or bell’s Respiratory: laryngitis, virus pn Liver: Reye, hepatitis Heart: all 3 Renal: GN Extremities: arthritis , myositis Eyes : keratitis
  28. 28. TT of Varicella (Chickenpox) 1- non specific 2- specific: acyclovir 3- complications treatment: AB, IV acyclovir REYE SYNDROMEprophylaxis: active ( LA vaccine) > 1y age SC once passive (VZIG) within 6 days of exposure
  29. 29. Herpes zoster Same virus VZ in immune persons Very painful vesicles Along dermatome of peripheral nerves Unilateral unimorphic
  30. 30. Herpes simplex infectionsSee stomatitis DD
  31. 31. WHAT IS THE LESION  4-year-old boy presented with a 5-day history of mild fever and malaise and a 3-day history of a vesicular rash involving his hands , feet, tongue , and buttocks.
  32. 32.  . This clinical picture is highly characteristic of hand, foot, and mouth disease, Typical skin lesions are elliptical vesicles surrounded by an erythematous halo. .
  33. 33. Hand – Foot – Mouth Syndrome Coxsackie virus A16 or enterovirus 71 contagious childhood illness starts with a fever, then painful mouth sores and a non-itchy rash with blisters on hands, feet, and sometimes buttocks and legs follow
  34. 34. TREATMENT OF HFMS The patient was treated supportively at home without medication. At follow-up 1 week later, his systemic symptoms had improved and the skin lesions were resolving
  35. 35. Impetigo Staph or streptococcus No constitutional signs Starting peri-oral or nasolabiol folds No mm
  36. 36. Impetigo  red sores or blisters that can break open, ooze, and develop a yellow- brown crust.  Impetigo can be spread to others through close contact or by sharing items like towels and toys. Scratching can also spread it to other partsTT: 1- AB local (ointment) of the body 2- oral AB ( 10 days for streptococcus)
  37. 37. Vesiculo-papular Urticaria Post-Allergen as insect bite Very itchy papules→vesicles→exco -riation and 2ry infection No scalp No mm Over the extensor surfaces, palms, soles
  38. 38. Scabies Itchy more at night Mostly covered areas and interdigital Pleomorphic + burrows Positive history of contacts
  39. 39. Maculo-papular DD Measles GM R infantum E infectiosum I Mono Scarlet fever collagen disease drug rash
  40. 40. MEASLES RubeolaWhat causes the disease? Measles is caused by a virus called Morbillivirus, a paramyxovirus RNA virus IP: 10 days
  41. 41. Maculopapular Rash Measles GM R infant E infect ScarletAE RNA virustransm Droplets, contact with articlesIP 1-2 wk (10d)Prodrom +ve fever, conj, cough, cc, LNenanthm Koplik’s before rashexanthm With feverCPT RESP/ CNS/SKIN/ITP/GIT/A NERGYTT NON SPECIFIC isolationPROPH VACCINE 6MO Ig G
  42. 42. Fever Catarrhal stage Fever Red eyes: (bloody shot eyes) Conjunctivitis photophobia Sneezing , running nose Sore throat Cough General malaise Body aches Koplik’s spots
  43. 43. Fever (3-5 days after the onset of catarrhal stage) Enanthem stage :1-Small red spots on the soft palate .2- Small red spots on the hard plate .3- Koplik’s spots on the buccal mucosa .
  44. 44. Fever (3-5 days after the onset of catarrhal stage) KOPLIK’S SPOTS on buccal mucosa .{tiny white spots inside the mouth }
  45. 45. When is my child infectious? From 4 days (2 to 5 days) before the rash appears until about 4 days after the rash has started — which is often when it starts to disappear
  46. 46. RASH ( on the 5th day of the illness )Exanthem stage : Fever Rash :  Type : Maculopapular rash  Site: general mainly at the hair line of face  forehead  back of the neck  behind the ears
  47. 47. Rash appears around the fifth day of the disease may last 4 to 7 days usually starts on the head and spreads to other areas, maculopapular rash appears as both macules (flat, discolored areas) and papules (solid, red, elevated areas) that later merge together (confluent)
  48. 48. ( on the 5th day of the illness ) RASH shape  Blotchy  Irregular  Large red patches  Varying size and shape  Characteristically coalesces (geographic pattern}  With mild itching
  49. 49. End by Desquamation : (Branny)
  50. 50. MeaslesI Day Before the Rash
  51. 51. Measles Rash : Face
  52. 52. Measles RashOn Dark Skin
  53. 53. MEASLES
  54. 54. End by Desquamation : (Branny)
  55. 55. How to manage MeaslesPROPHYLAXIS:During routine immunization:  Measles vaccine alone.  Or combined with German measles and mumps vaccine (MMR) in the second year.TREATMENT: SPECIFIC + NON SPECIFIC  No available antiviral drugs are effective against measles.  Symptomatic treatment  Antimicrobials for complications as otitis media and pneumonia.
  56. 56. Complications1- Respiratory 2- Activation of latent complications : pulmonary T.B Otitis media Measles pneumonia Secondary bacterial broncho pneumonia
  57. 57.  3- Neurological 5- Digestive tract : complications :  Diarrhea  Encephalomyelitis  Vomiting  Aseptic meningitis  Dehyration  Subacute sclerosing panencephalitis  Acidosis  Cancrum oris 4- skin and MM  Ulcerative stomatitis - Hemorrhagic rash - Bleeding from mucus 6- Impaired immunity . membranes
  58. 58. GERMAN MEASLESIP: 2-3 weeks the rubella virus which is a togavirus.
  59. 59. Maculopapular Rash Measles GM R infant E infect ScarletAE RNA virustransm Droplet IntrauterineIP 2-3 wProdrom No/mild cc + LNenanthm Mildexanthm MildCPT Cong infection/ITP/arthritis/CNSTT NON SPECIFICPROPH Vaccine/ IgG
  60. 60. GERMAN MEASLES Mild short catarrhal stage The rash starts around the hairline and affects the face and neck first. It will then spread to the body and the arms and legs. the rash a fine appearanceIP: 2-3 weeks
  61. 61. Rash + Enlarged lymph nodes
  62. 62. Congenital Rubella Syndrome: It represents a type of congenital viral infection. The rubella virus can cross the placenta and infect the fetus resulting in either death or severe malformations.
  63. 63. CONGENITAL RUBELLA MR, microcephaly, hydrocephalus, CP Cataract, microphthalmia SNHL CCD: PDA, ASD JODM CHRONIC RUBELLA: up to a year
  64. 64. Congenital rubella syndrome
  65. 65. When is my child infectious? A person with rubella will be infectious from one week before the rash starts until 4 days after the rash has started. However, newborn children who are infected may be infectious for a few months
  66. 66. What to do in a case of Measles & German MeaslesActive vaccination either alone or in combinationwith measles and mumps (MMR) after the firstyear of age, pregnant women should NEVERreceive the vaccine.Pregnant mothers should avoid exposure torubella.No specific treatment.Symptomatic treatment and antibiotics forsuperadded bacterial infections.
  67. 67. Management of Pregnant Women Exposed toRubella:Do an antibody test immediately as an emergencymeasure:  If found to be immune, she is reassured and pregnancy continued.  If found to be susceptible then serial, antibody tests are done, if it shows subclinical infection abortion is induced.  If abortion is not accepted, immune serum globulin (ISO) is indicated.
  68. 68. INFECTIOUS MONONUCLEOSIS (glandular fever)occurs inadolescents andyoung adult.Caused by Epstein-Barr virus (EBV).The onset is usuallyinsidious andoccurs after anincubation periodof 4 to 14 days.
  69. 69.  Diagnosis of Infectious Mononucleosis
  70. 70.  Diagnosis of Infectious Mononucleosis (cont.)
  71. 71. 4- SCARLET FEVER bacterial toxin of GABHS See later
  72. 72. 5th disease
  73. 73. What is your Diagnosis? A 5-year-old boy presents to clinic with an afebrile rash involving his extremities and trunk for three days . Past history revealed the boy had mild fever that resolved without sequelae one week prior. His rash began three days prior with flushed cheeks and then spread
  75. 75. Maculopapular Rash Measles GM R infant E infectiosum ScarletAE Parvovirus B 19, DNAtransm DROPLETIP 1-2 WKProdrom RASH WITHOUT FEVER Recur with hot showers, exercise, sunenanthm WBC normal Low reticulocyteexanthm SLAPPED CHEEKS, general MP rash of lacy like , itchyCPT 1- aplastic crises 2- ITP 3- arthralgia, arthritisTT Asymptomatic IV IgG in aplasiaPROPH
  76. 76. Fifth disease (slapped cheek) Erythema Infectiosum  Parvovirus B19 (DNA)*  A contagious and usually mild illness that passes in a couple weeks,  Spread by coughing and sneezing, its most contagious the week before the rash appears
  77. 77.  starts with flu-like symptoms, followed by afebrile , asymptomatic rash: 1st stage: a face “ slapped cheeks” with circum-oral pallor
  78. 78.  2nd stage: body rash., reticulated lacy erythematous eruption on the proximal extremities, buttocks and trunk
  79. 79.  The third phase lasts one to three weeks and consists of the reticulated lacy lesions intermittently recurring especially when provoked by warm temperature, sunlight, emotion or exercise
  80. 80. Treatment rest, fluids, and pain relievers (do not use aspirin if your child has fever), but watch for signs of more serious illness
  81. 81. 6th Disease
  82. 82. ROSEOLA INFANTUM6th Rainbow after Storm
  83. 83. Maculopapular Rash Measles GM R infant E infect ScarletAE Human herpesviruses 6,7transm dropletIP 1-2 w (10 days)Prodrom High fever up to FCenanthm Wbc increased then decreasedexanthm Generalized MP No post stain LNCPT 1- FC 2- EncephalopathyTT Asymptomatic Gancyclovir : immune deficiency, encephalopathyPROPH
  84. 84. 6 th Human Herpes Viruses 6* IP: 10 day Age Most cases present within the first 2 years of life, with peak occurrence in infants aged 9-21 months.
  85. 85. F Seizures (6-15%) CP Diarrhea (68%) Cough (50%) Fever (often up to 40°C) 3days before rash Rash (fades within a few hours to 2 d) Maculopapular or erythematous Typically beginning on the trunk and may spread to involve the neck and extremities Nonpruritic Blanches on pressure Listlessness , Irritability
  86. 86. CPT Extremely rare manifestations Encephalitis, fulminant hepatitis, hemophagocytic syndrome, and disseminated infection with HHV-6
  87. 87. What is the lesion? A child with fever, throat pain, halitosis and generalized erythema. Oral exam showed red tongue and tonsils
  88. 88. SCARLET FEVER By : Bacteria toxin Fever + tonsillitis + rash
  89. 89. Maculopapular Rash Measles G M E infect R infant ScarletAE virus Erythrogenic toxin of : GABHStransm droplet DROPLETIP 1 – 2 wk 2-3 wk 1 -2 wk 1-7 days ( 3 days)Prodrom severe mild Fever; chivering, headache Tonsillitis : throat pain, fetor oris Abd pain, V, D Rash Rainbowenanthm Koplick,s no Without After RED TONSILS WITH MEMBRANE RED PHARYNX WITH MEMBRANE fever storm TONGUE: white then red strawberriesexanthm severe Mild – moderate Generaslized erythema fade on p Goose skin Pastia line Circumoral pallor End with peeling towards fingersCPT All congenital infection ---- FC Local IMMEDIATE Remote DELAYED AGN. RH FEVERTT AB FOR 10 DAYS SYMPTOMATICPROPH LEUCOCYTOSIS, +ve culture ASOT, Ag detection
  90. 90. G Erythema Better felt Sandpaper like Fade on pressure
  91. 91. Generalized Erythema Better felt than seen
  92. 92. Pastia lines
  93. 93. Scar let FeverFinely nodularerythematous rashwithsandpaper orgoose-flesh texture
  94. 94. End by Desquamation peeling
  95. 95. Treatment 1- specific: AB for 10 days 2- non specific 3- treatment of complicationsComplications: ACUTE LATE 1-Local 1- A Rheumatic F 2-Systemic 2- ADGN
  96. 96. Maculo - Papular Rash Measles GM E infect R infant ScarletAE virus Erythrogenic toxin of : GABHStransm dropletIP 1 – 2 wk 2-3 wk 1 -2 wk 1-7 days ( 3 days)Prodrom severe mild Feverenanthm Koplick,s no Rash Rainbow RED TONSILS WITH strawberry tongue Without After fever stormexanthm severe Mild – moderate Generaslized erythema fade on p Better felt than seenCPT All congenital infection ---- FC Local IMMEDIATE Remote DELAYED AGN. RH FEVERTT Symptomatic AB FOR 10 DAYS SYMPTOMATIC
  97. 97. Sweat rash  The result of blocked sweat ducts, heat rash looks like small red or pink pimples. Appearing over an infants head, neck, and shoulders
  98. 98. INFECTIOUS MONONUCLEOSIS Fever Exudative tonsillitis Generalized lymphadenopathy Splenomegaly ± hepatomegaly Rash Other manifestations
  99. 99. MUMPS (EPIDEMIC PAROTITIS) Viral infection Incubation period 14- 24 days Moderate rise of temperature but hyperpyrexia may be encountered. One or both parotids may enlarge. The swelling usually subsides in 7-10 days
  100. 100. raising the lobule of ear and extending anteriorto it.The swelling is tender and the pain increases bysour drinks
  101. 101.  Mumps
  102. 102. MUMPS
  103. 103. What to do in a case of MumpsTreatment Symptomatic and supportive. Analgesics to relieve pain. The mouth should be kept clean and a fluid diet is needed until swelling subsides. .
  104. 104. Thank u