This document provides information on viral exanthems, including goals of recognizing a morbilliform rash and describing presentations of childhood viral exanthems. It defines exanthem and enanthem rashes and describes morbilliform rashes as composed of erythematous macules and papules resembling measles. Classic childhood exanthems are described as measles, scarlet fever, rubella, roseola, and erythema infectiosum. Two case studies are presented - one involving a child with Koplik spots and a rash consistent with measles, and another involving an unvaccinated adult woman with a rash consistent with rubella.
Staphylococcal Scalded Skin Syndrome Made Very EasyDrYusraShabbir
A brief description of a very common bacterial skin condition affecting children and adults. Characterized by fever, rash and peeling of the skin. Useful information for medical students, doctors especially dermatologists and pediatricians and nurses. Helpful information for exam preparation of USMLE, FCPS, MCPS, MRCP derma.
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
Staphylococcal Scalded Skin Syndrome Made Very EasyDrYusraShabbir
A brief description of a very common bacterial skin condition affecting children and adults. Characterized by fever, rash and peeling of the skin. Useful information for medical students, doctors especially dermatologists and pediatricians and nurses. Helpful information for exam preparation of USMLE, FCPS, MCPS, MRCP derma.
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
Erythema infectiosum made Very simple!!!!!!DrYusraShabbir
A brief description of viral infection causing the disease Erythema Infectiosum or the fifth disease. Affects infants and babies. Useful for medical students, doctors, dermatologist, and nurses. Helpful in preparing for exams. It describes the disease, and its clinical features, what happens in pregnancy and treatment timeline. Useful for USMLE, MCPS, FCPS and MRCP exams.
A brief discussion on different Viral ex anthems especially measles. In a simple and easy manner, the measles virus is explained with its clinical features, treatment, investigations, and vaccination. Helpful for clinicians, dermatologists and pediatricians. Helpful for exam preparation for FCPS, MCPS, MRCP and USMLE in the field of dermatology. Also helpful for med students and nurses.
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
Erythema infectiosum made Very simple!!!!!!DrYusraShabbir
A brief description of viral infection causing the disease Erythema Infectiosum or the fifth disease. Affects infants and babies. Useful for medical students, doctors, dermatologist, and nurses. Helpful in preparing for exams. It describes the disease, and its clinical features, what happens in pregnancy and treatment timeline. Useful for USMLE, MCPS, FCPS and MRCP exams.
A brief discussion on different Viral ex anthems especially measles. In a simple and easy manner, the measles virus is explained with its clinical features, treatment, investigations, and vaccination. Helpful for clinicians, dermatologists and pediatricians. Helpful for exam preparation for FCPS, MCPS, MRCP and USMLE in the field of dermatology. Also helpful for med students and nurses.
Measles is a highly contagious viral infection.
It is exanthematous disease with fewer, cough, coryza (rhinitis) and conjunctivitis.
Before the widespread use of measles vaccines, it was estimated that measles caused between 5 million and 8 million deaths worldwide each year.
Chickenpox -symptoms |tests |management ( medical information ) martinshaji
Chickenpox is a highly contagious viral infection that causes an acute fever and blistered rash, mainly in children.
The name may be derived from the French term for chick pea, chiche pois. Another theory is that the word 'chicken' was derived from a slang term for 'child'. Chickenpox is also known as varicella.
please comment
thank you ...
Child Healthcare addresses all the common and important clinical problems in children, including:immunisation history and examination growth and nutrition acute and chronic infections parasites skin conditions difficulties in the home and society
Child Healthcare addresses all the common and important clinical problems in children, including:immunisation history and examination growth and nutrition acute and chronic infections parasites skin conditions difficulties in the home and society
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Goals and Objectives
The purpose of this module is to help medical students
develop a clinical approach to the evaluation and initial
management of patients presenting with typical viral
exanthems.
By completing this module, the learner will be able to:
• Recognize morbilliform eruption as a prototype for viral
exanthems
• Describe classic presentations of distinctive pediatric viral
exanthems
• Provide counseling for parents of children with typical viral
exanthems
2
3. Definitions
Exanthem (exanthema)
• A rash that appears abruptly and affects
several areas of the skin simultaneously
• Greek origin “exanthema” which means “a
breaking out”
Enanthem (enanthema)
• An eruption upon a mucous membrane
3
4. Viral Exanthems
Commonly described as “morbilliform” which
means “composed of erythematous macules
and papules that resemble a measles rash.”
Viral exanthems can be difficult to distinguish
from a drug eruption. However, viral exanthems
are more common in children, and drug
eruptions tend to be more common in adults. A
thorough history will aid in the diagnosis.
4
6. Classic Childhood Exanthems
Historically, there were six childhood exanthems whose
etiologies are now well-defined:
NUMBER NAME ETIOLOGY
First Disease Measles (Rubeola) Measles virus
Second Disease Scarlet Fever Streptococcus pyogenes
Third Disease Rubella Rubella virus
Fourth Disease Duke’s Disease
No longer accepted as a
distinct disorder
Fifth Disease Erythema Infectiosum Parvovirus B19
Sixth Disease Roseola Infantum HHV-6 and HHV-7
6
8. Case One: History
Ana is 4-year-old previously healthy girl who
presents with a 1 week history of cough, runny
nose, fever, sore throat and red eyes. She went to
her pediatrician 2 days ago and was prescribed
Augmentin (amoxicillin and clavulanate) for
presumed pharyngitis.
Yesterday, Ana developed a red rash which
started on her face and has spread to her trunk.
Her mother would like to know if the rash is from
her new medication.
8
9. History Continued
Upon further questioning you discover that Ana
has never received vaccinations due to her
mother’s fear regarding autism.
The augmentin was started 24 hours before the
onset of her rash.
You also discover that a close family member
recently visited from the Netherlands, who also
developed a similar rash.
9
10. Case One: Skin Exam
Ana is an ill-appearing
child who presents with a
morbilliform rash with
erythematous macules
and papules.
Lesions have coalesced
on the face and neck.
Rash has spread to her
trunk and extremities (not
shown)
10
11. Exam Continued
Inspection of Ana’s mouth reveals, bluish-white
dots on the mucosal surface. These are called
Koplik spots.
11
13. Case One, Question 1
Based on the history and
exam, what is the most
likely diagnosis?
a. Drug Eruption
b. Erythema Infectiosum
c. Measles
d. Roseola
e. Rubella
13
14. Case One, Question 1
Answer: c
Based on the history and exam, what is the most likely
diagnosis?
a. Drug Eruption (Too soon for an exanthematous drug eruption.
Refer to the module on drug reactions for more information)
b. Erythema Infectiosum (Eruption begins with bright red cheeks
followed by a reticular eruption on the trunk and extremities)
c. Measles
d. Roseola (Tends to occur in younger children with high fevers
preceding a sudden rash that begins on the trunk)
e. Rubella (Rash tends to spread more quickly, covering the body
in 24hrs)
14
15. Measles (Rubeola)
Measles is a viral disease
Spread by respiratory droplets
Incubation period tends to be 8-12 days from
exposure to onset of symptoms
Patients are contagious from 1-2 days before onset
of symptoms (3-5 days before the rash) to 4 days
after appearance of the rash
Immunocompromised patients can be contagious
for the duration of the illness
15
16. Measles (Rubeola)
Most common in children 3-5 years old
Incidence of measles has decreased substantially
where measles vaccination has been instituted
Most cases of measles in the United States are
imported with spread to unvaccinated individuals
Measles is still common in many developing countries
(parts of Africa and Asia) and outbreaks repeatedly
occur in communities who do not accept vaccinations
(e.g. religious community in Netherlands)
16
17. Measles: Clinical Presentation
Prodrome: Fever, Malaise, Conjunctivitis, Cough,
Coryza*, Koplik spots
Exanthem: Erythematous macules and papules
begin on the face and spread cephalocaudally and
centrifugally (by the 3rd day, the whole body is
involved).
Recovery: Clinical improvement begins within 2
days of appearance of the rash. The rash tends to
fade after 3-4 days and will last around 6-7 days.
*Coryza: “head cold” with nasal congestion, rhinorrhea, sore throat
17
18. Diagnosis
Measles is a distinct clinical syndrome with the presence of
high fever, Koplik spots, characteristic conjunctivitis, upper
respiratory symptoms, and typical exanthem.
All cases of suspected measles should be serologically
confirmed and reported immediately to the local or state
health department without waiting for results of diagnostic
tests.
Testing includes:
• Serology: Anti-measles IgM and IgG, isolation of measles virus or
identification of measles RNA
• Histologic evaluation of skin lesions or respiratory secretions may
show syncytial keratinocytic giant cells
18
19. Case One, Question 2
Which of the following statements about the
treatment of measles is correct?
a. No specific antiviral therapy is recommended for
immunocompetent patients with measles.
b. Prevention of the spread of measles depends on
prompt immunization of people at risk for exposure or
people already exposed who cannot provide
documentation of measles immunity
c. Recommend supportive care with antipyretics, fluids,
and rest.
d. All of the above
19
20. Case One, Question 2
Answer: d
Which of the following statements about the treatment
of measles is correct?
a. No specific antiviral therapy is recommended for
immunocompetent patients with measles.
b. Prevention of the spread of measles depends on prompt
immunization of people at risk for exposure or people
already exposed who cannot provide documentation of
measles immunity
c. Recommend supportive care with antipyretics, fluids,
and rest.
d. All of the above
20
21. Management
Uncomplicated measles is self-limiting, lasting 10 to
12 days.
Treatment in the majority of cases is supportive
(antipyretics, fluids).
Malnutrition, immunosuppression, poor health, and
inadequate supportive care can worsen the prognosis
in any patient. In developing nations, measles is a
major cause of infant mortality.
Vitamin A supplementation has shown to be of benefit
in the treatment of measles.
21
22. Complications
Groups at increased risk for complications of measles
include immunocompromised hosts, pregnant
women, malnourished individuals, and persons at
extremes of age
Most common complications include otitis media,
pneumonia, laryngotracheobronchitis (croup), and
diarrhea. Hepatitis, thrombocytopenia, and
encephalitis occur less commonly.
Pneumonia is the most common fatal complication of
measles in children and the most common
complication overall in adults.
22
24. Case Two: History
Kylie Hinkle is 24-year-old woman who presents to
your dermatology clinic with a red rash. She has
been feeling unwell for the last 6 days with fever,
myalgias, cough and sore throat. She also reports
some tender lymph nodes on her neck. She has
taken ibuprofen for the myalgias and fever, which
has helped.
A rash started on her face yesterday and is now
spreading to her neck and trunk.
24
25. Case Two: Skin Exam
Erythematous macules and papules on the face (not
shown) and trunk (lesions are coalescing on the trunk)
25
26. History Continued
Upon further questioning you discover that
Ms. Hinkle has never received the MMR
(Measles, Mumps, Rubella) vaccine.
26
27. Case Two, Question 1
Based on the history and skin exam, what
is the most likely diagnosis?
a. Drug Eruption
b. Erythema Infectiosum
c. Measles
d. Roseola
e. Rubella
27
28. Case Two, Question 1
Answer: e
Based on the history and skin exam, what is the most likely
diagnosis?
a. Drug Eruption (Less likely, but should get more information
about NSAID use.)
b. Erythema Infectiosum (More common in children. Eruption
begins with bright red cheeks followed by a reticular eruption
on the trunk and extremities.)
c. Measles (Rash tends to spread over a period of days, not in
24 hours like this case.)
d. Roseola (Occurs in young children with high fevers preceding
a sudden rash that begins on the trunk.)
e. Rubella
28
29. Rubella
Rubella is a viral disease
Synonym: German measles, “3-day measles”
Spread through direct or droplet contact from
nasopharyngeal secretions
Infected individuals shed virus up to one week
before and two weeks after onset of disease
Appearance of the rash typically occurs 14-17
days after exposure
29
30. Epidemiology
Outbreaks occur most frequently in late
winter and early spring
School-age children, adolescents, and
young adults most often develop the
disease
The incidence of rubella has dramatically
decreased with routine vaccination
30
31. Rubella: Clinical Presentation
Many cases of non-congenital rubella are subclinical
Prodrome: low-grade fever, headache, sore throat,
conjunctivitis, rhinorrhea, cough and
lymphadenopathy. Symptoms often resolve with
appearance of the rash.
Exanthem: pruritic, pink to red macules and papules
which begin on face and spread to neck, trunk, and
extremities over 24 hours
Enanthem: 20% with petechial lesions on soft
palate and uvula (Forchheimer's sign)
31
32. Clinical Course
Adults tend to have more prodromal symptoms and
complications (although rare) compared to children
Arthritis sometimes accompanies exanthem (more
common in teenagers and adult women)
Rash begins to disappear in 2-3 days and clears the
head and neck first
Encephalitis and thrombocytopenia are potential
complications
Other rare complications include: peripheral neuritis,
optic neuritis, myocarditis, pericarditis, hepatitis, orchitis,
and hemolytic anemia
32
33. Case Two, Question 2
Based on clinical presentation, you suspect rubella
and recommend supportive treatment. What else
would you like to know about Kylie?
a. Any sick contacts
b. Have you been in close contact with any pregnant
women or immunocompromised individuals?
c. What vaccines have you had?
d. What was the date of your last period? Could you be
pregnant?
e. All of the above
33
34. Case Two, Question 2
Answer: e
What else would you like to know about Kylie?
a. Any sick contacts (Identification of infected or exposed
individuals will help control the potential outbreak)
b. Have you been in close contact with any pregnant women or
immunocompromised individuals? (Important to identify these
at risk individuals)
c. What vaccines have you had? (An important part of her health
history)
d. What was the date of your last period? (All women of child-
bearing age with suspected rubella should be screened for
pregnancy)
e. All of the above
34
35. Congenital Rubella Syndrome
Infection during pregnancy may
can result in miscarriage, fetal
death, or cause congenital
rubella syndrome which is
associated with:
– Sensorineural deafness
– Mental retardation
– Eye abnormalities
– Congenital heart disease
Cloudy Cornea
35
36. Evaluation and Treatment
Diagnosis is usually made using serology to detect
rubella-specific IgM antibody or to document a 4-fold
rise in antibody titer in acute and convalescent-
phase serum
As with measles, rubella cases should be reported to
local health departments
Treatment consists of supportive care
Control measures for rubella includes droplet
precautions and exclusion from school or child care
for seven days after the onset of the rash
36
38. Case Three: History
Keith is an 10-year-old boy
who was brought to the
pediatrician by his mother
because he developed low
grade fevers, red cheeks
and a new rash on his body.
Keith is up to date with his
vaccinations
38
40. Case Three, Question 1
Confluent, erythematous, edematous plaques on the
malar eminences - “slapped cheeks.” Erythematous
reticular eruption on the trunk and extremities
40
41. Case Three, Question 2
Based on the history and skin exam, what
is the most likely diagnosis?
a. Drug Eruption
b. Erythema Infectiosum
c. Measles
d. Roseola
e. Rubella
41
42. Case Three, Question 2
Answer: b
Based on the history and skin exam, what is the most
likely diagnosis?
a. Drug Eruption (No exposure to medications)
b. Erythema Infectiosum
c. Measles (Children with measles tend to appear more ill;
Keith has been vaccinated)
d. Roseola (Tends to occur in younger children with high fevers
preceding a sudden rash that begins on the trunk)
e. Rubella (Keith has been vaccinated; exanthem usually starts
with erythematous macules and papules on the face)
42
43. Parvovirus B19
There are many clinical presentations
associated with B19 infection (ranging from
benign to life-threatening).
Most infections are asymptomatic and
unrecognized
We will focus on Erythema Infectiosum, the
most common clinical presentation.
43
44. Diagnosis: Erythema Infectiosum
Synonyms: Fifth disease
Caused by Parvovirus B19
Modes of transmission include contact with
respiratory tract secretions, percutaneous exposure
to blood or blood products, and vertical transmission
from mother to fetus
Estimated incubation period from exposure to onset
of rash usually between 1-2 weeks
Individuals with erythema infectiosum are most
infectious before onset of the rash
44
45. Epidemiology
Most common in children 4-10 yrs old, but can affect all
ages
Tends to occur in epidemics, especially associated with
school outbreaks in the late winter and early spring
Secondary spread among susceptible household members
is common, with infection occurring in ~ 50% of susceptible
contacts
Serologic studies show increasing prevalence of antibodies
with age
• In most communities, ~ 50% of young adults and often more than
90% of elderly people are seropositive
45
46. Erythema Infectiosum: Clinical
Presentation
Prodrome: low-grade fever, malaise, headache,
pruritus, coryza, myalgias, joint pain (more
common in adult women)
Exanthem: Begins with bright red cheeks
(“slapped cheeks”) and as the facial rash fades
over 1-4 days, a symmetric, erythematous,
reticular (lacelike) eruption appears on trunk and
extremities
Eruption usually lasts 5-9 days
46
47. Diagnosis
Detection of serum parvovirus B19-
specific IgM antibody is the preferred
diagnostic test
Positive IgM test result indicates that
infection probably occurred within the
previous 2 to 4 months
47
48. Case Three, Question 3
His mother states that his older brother has a rash
mostly involving the hands and feet. Do you think
he has parvovirus?
a. No, because his older brother is likely already immune
from previous exposure
b. No, because household transmission is rare
c. No, because the brother does not have a “slapped
cheek” facial rash
d. Yes, he probably has papulopurpuric gloves-and-socks
syndrome
48
49. Case Three, Question 3
Answer: d
His mother states that his older brother has a rash
mostly involving the hands and feet. Do you think he
has parvovirus?
a. No, because his older brother is likely already immune
from previous exposure
b. No, because household transmission is rare
c. No, because the brother does not have a “slapped
cheek” facial rash
d. Yes, he probably has papulopurpuric gloves-and-
socks syndrome
49
50. Papular Purpuric Gloves and Socks
Syndrome
PPGSS presents as
painful and pruritic
papules, petechiae, and
purpura of hands and
feet, often with fever and
enanthem (oral erosions).
Unlike the typical rash of Erythema
Infectiosum, patients with this
presentation are viremic and contagious
(they should not be around those at risk).
50
51. Parvovirus B19: Special
Considerations
Pregnancy
• Infection occurring during pregnancy can cause hydrops fetalis*,
intrauterine growth retardation, pleural and pericardial effusions,
and death. The risk of fetal death is between 2% and 6.5% when
infection occurs during pregnancy.
Immunodeficiency
• Can cause chronic erythroid hypoplasia with severe anemia
Chronic hemolytic anemias
• B19 is the most common cause of transient aplastic crisis in
patients with chronic hemolytic anemias (i.e. sickle cell disease)
*Hydrops fetalis: a condition in the fetus characterized by an accumulation of fluid, or
edema, in at least two fetal compartments 51
52. Treatment
There is no specific treatment for
uncomplicated parvovirus B19 infection
Supportive therapy for relief of fatigue, malaise,
pruritus, and arthralgia may be needed
Generally resolves after 5-10 days, but can
reoccur for months upon exposure to sunlight,
hot temperature, exercise, bathing, and stress
52
54. Case Four: History
HPI: Caleb is a 9-month-old boy
who presents for evaluation of
fever and rash. His mother noted
a fever of 40˚C two days ago.
He appeared well and was
eating and playing normally, so
his mother was not alarmed.
After the fever resolved, Caleb
developed a red rash that
progressed rapidly over the past
24 hours.
54
55. Case Four, Question 1
Based on Caleb’s history and exam, what
is the most likely diagnosis?
a. Drug Eruption
b. Erythema Infectiosum
c. Measles
d. Roseola
e. Rubella
55
56. Case Four, Question 1
Answer: d
Based on Caleb’s history and exam, what
is the most likely diagnosis?
a. Drug Eruption
b. Erythema Infectiosum
c. Measles
d. Roseola
e. Rubella
56
57. Roseola Infantum
Synonyms: Exanthema subitum, Sixth disease
Caused by Human Herpesvirus 6 (HHV-6) and
less commonly Human Herpesvirus 7 (HHV-7)
Mode of transmission unknown (possibly from
nasopharyngeal secretions)
Children 6 months – 4 years
Most common exanthem before age 2
No vaccine; infection results in immunity
57
58. HHV-6
HHV-6 infection in children results in:
• Subclinical infection
• Acute febrile illness without rash
• Exanthema subitum
Seroprevalence of HHV-6 in the adult population is
greater than 95%
Reactivation in immunocompromised hosts may
cause significant morbidity
Reactivation of HHV-6 with drug exposure can lead
to drug-induced hypersensitivity syndrome (DIHS)
58
59. Roseola Infantum: Clinical
Presentation
Infection with HHV-6 results in an acute febrile illness,
lasting approximately 3 to 7 days, and can be followed by
the characteristic rash of roseola (in ~ 20% of infected
children)
Prodrome: High fever (39-40°C), palpebral edema,
cervical lymphadenopathy, mild upper respiratory
symptoms. Child appears well. As fever subsides,
exanthem appears (“exanthema subitum” means “sudden
rash”).
Exanthem: pink macules and papules surrounded by white
halos. Begins on trunk, spreads to neck and proximal
extremities. 59
60. Prognosis and Treatment
Usually benign and self-limiting
HHV-6 is known to cause febrile seizure
in children with infection, often without a
rash
Treatment may be necessary for atypical
cases with complications and in
immunosuppressed patients
60
61. Take Home Points
Exanthems are rashes that occur abruptly and affect
multiple areas of the skin simultaneously.
Morbilliform means “composed of erythematous
macules and papules that resemble a measles rash.”
Distinct viral exanthems are seen in measles, rubella,
erythema infectiosum, and roseola infantum.
Careful history taking and physical exam help
establish the diagnosis.
In the case of measles and rubella, clinical diagnosis
should be serologically confirmed and reported.
61
62. Classic Childhood Viral
Exanthems
NAME EXANTHEM & ENANTHEM
Measles (Rubeola) Erythematous macules and papules begin on the face
and spread cephalocaudally and centrifugally, Koplik
spots.
Rubella
(German measles)
Pruritic, pink to red macules and papules which begin on
the face and spread to neck, trunk and extremities over
24hrs, Forchheimer’s sign.
Erythema Infectiosum Begins with bright red cheeks and as the facial rash fades
over 1-4 days, a symmetric, erythematous, reticular
eruption appears on the trunk and extremities.
Roseola Infantum
(Exanthem subitum)
Pink macules and papules surrounded by white halos.
Begins on trunk, spreads to neck and proximal
extremities.
62
63. Acknowledgements
This module was developed by the American Academy
of Dermatology Medical Student Core Curriculum
Workgroup from 2008-2012.
Primary authors: Laura S. Huff, MD; Cory A. Dunnick,
MD, FAAD
Contributor: Sarah D. Cipriano, MD, MPH
Peer reviewers: Anna L. Bruckner, MD, FAAD; Brandon
D. Newell, MD; Timothy G. Berger, MD, FAAD
Revisions and editing: Sarah D. Cipriano, MD, MPH,
Jillian W. Wong. Last revised March 2011.
63
64. References
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Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the
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2010.
Bialecki C, Feder HM, Grant-Kels JM. The six classic childhood
exanthems: A review and update. J Am Acad Dermatol. 1989; 21:
891-903.
64
65. References
Belazarian Leah, Lorenzo Mayra E, Pace Nicole C, Sweeney Susan
M, Wiss Karen M, "Chapter 192. Exanthematous Viral Diseases"
(Chapter). Wolff K, Goldsmith LA, Katz SI, Gilchrest B, Paller AS,
Leffell DJ: Fitzpatrick's Dermatology in General Medicine, 7e:
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Folster-Holst R, Kreth HW. Viral exanthems in childhood – infectious
(direct) exanthems. Part 1: Classic exanthems. Journal of the
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Jordan J. Clinical manifestations and pathogenesis of human
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