Sandbox:Ifeoma Anaya: Difference between revisions

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{{SK}} Exanthema subitum; sixth disease; roseola infantilis; baby measles; three-day fever; rose rash of infants
==Roseola Infantum==
==Overview==
==Historical Perspective==
Previously known as "Roseola infantilis", the oldest known description of the disease dates as far back as 100 years ago by John Zahorsky, M.D in his publication in 1913  . Described as a symptom-complex of febrille erythema occuring in infants and not to be categorized alongside the erythema group of skin diseases. However, no clear-cut description was given to differentiate it from other pediatric skin eruptions . While the disease has been recognized for almost a century, Human Herpes Virus type 6 (HHV-6) was discovered in 1986 .
==Pathophysiology==
Mode of transmission is still not fully understood however it has been speculated that it is primarily via saliva and commonest form of transmission is from mother to child  . Viral replication occur mostly in CD4+ T cells and incubation period is between 9-10 days .
High levels of Metalloproteinase 9 and Tissue Inhibitor of Metalloproteinase 1 has been shown to disrupt the blood-brain barrier and thus, the cause of the febrille seizures observed in some infants infected with the virus .  More severe disease pathology can be seen in the immunocompromised because it remains latent in the lymphocytes and monocytes after primary infection  . 
==Causes==
Disease is caused by HHV-6 and less commonly by HHV-7 which are members of the '''''Herpesviridae''''' family . HHV-6 has a linear, double-stranded DNA genome . The HHV-6 has its primary variant, HHV-6B which is the associated with Roseola infantum while the other variant, HHV-6A has not been associated with any disease(s) .
==Epidemiology and Demographics==
Children are the most commonly infected. Newborns have passive antibodies to HHV-6 passed on to them from their mother which wanes by 4-6 months . By 12 months of age, incidence of the disease is about 40%, this increases to 77% by 24 months . Primary infection peaks between 9-21 months of age .
==Natural History, Complications and Prognosis==
Classical finding of Roseola infantum is very high fever which can be higher than 39°C . This fever lasts for 3-5 days and can be accompanied by other symptoms like malaise, conjuctivitis, inflammed tympanum, anorexia, irritability, lymphadenopathy, cough, etc <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. On sudden disappearance of the fever (3-5 days later), small, rose-pink, non-pruritic, blanching, maculopapular rashes appear first on the trunk and then spreads to the neck, face and extremities <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. This usually lasts 1-2 days and ends the infection period <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
Complications seen during primary infection include febrille seizures, rhabdomyolysis, myocarditis, Guillain-Barre Syndrome <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. Limbic encephalitis seen in immunocompromised individuals post stem cell transplantation is an established long-term complication as a result of reactivation of HHV-6B virus .
Roseola infantum is a self limiting infection with very good prognosis and few complications <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Diagnosis==
This is basically clinical. A well taken history and physical exam gives away the diagnosis of Roseola infantum and differentiates it from other viral exanthems.
==Treatment==
Usually supportive with antipyretics for fever and general discomfort, continued fluid intake to replace insensible losses from high temperatures, and rest. There is currently no vaccine for HHV-6 and no antiviral treatment for primary infection <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Prevention==
Hand washing is encouraged to prevent spread <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Differentiating Roseola Infantum from other Diseases==




Revision as of 22:36, 15 September 2020

Infectious Disease Causative Organism Non-Infectious Disease
Viral Measles

German Measles

Erythema infectiosum

Roseola infantum

Herpangina

Hand-foot-and-mouth disease

Molluscum contagiosum

Chickenpox

Rubeola

Rubella

Parvovirus B19

Human Herpes Virus 6 & 7

Coxsackie virus

Coxsackie virus

Poxvirus

Varicella Zoster virus

Vasculitis Kawasaki Disease

Henoch-Schőnlein Purpura

Juvenile Rheumatoid Athritis

Juvenile Dermatomyositis

Bacterial Meningococcemia
 Neisseria meningitidis

Hemophilus influenzae

Streptococcus pneumoniae

Adverse drug reactions Erythema multiforme

SJS

TEN

RMSF Rickettsia rickettsii
HUS Enterohemorrhagic E.coli (EHEC)
Scarlet Fever Streptococcus pyogenes (Group A Streptococci, GAS)
Disseminated gonococcal disease in adolescents Neiserria gonorrhoea
SSSS

TSS

Staphylococcus aureus
Lyme disease Borrelia burgdorferi
Relapsing fever Borrelia recurrentis
Protozoan Babesiosis Babesia microti
Fungal Histoplasmosis

Blastomycosis

Coccidiodomycosis

Paracoccidiodomycosis

Histoplasma capsulatum

Blastomyces dermatitidis

Coccidioides immitis

Paracoccidioides brasiliensis

Fever + Rash Morphology Disease
Non-blanching lesions a. Meningococcemia

b. Rocky Mountain Spotted Fever (RMSF)

c. Hemolytic Uremic Syndrome (HUS)

d. Henoch-Schőnlein Purpura (HSP)

Blanching rash a. Kawasaki disease

b. Juvenile Rheumatoid Arthritis

c. Juvenile Dermatomyositis

Vesicular or bullous lesions a. Erythema multiforme

b. Steven-Johnson-Syndrome (SJS) and Toxic Epridermal Necrolysis (TEN)

c. Staphylococcal Scalded Skin Syndrome (SSSS)

d. Disseminated gonococcal disease in adolescents

e. HSV I & II

Umbilicated papules and pustules a. Molluscum contagiosum

b. Varicella/Chickenpox

Sandpaper rash a. Scarlet fever
Viral syndromes a. Measles (Rubeola)

b. Rubella (German measles)

c. Erythema infectiosum (Parvovirus B-19)

d. Herpangina (Coxsackie)

e. Hand-foot-and-mouth disease (Coxsackie)

f. Roseola infantum (Human Herpes Virus types 6 or 7)

Unclassified/Limited to certain geographical areas a. Babesiosis

b. Blastomycosis

c. Coccidiodomycosis

d. Histoplasmosis

e. Colorado Tick Fever

f. Lyme disease

g. Relapsing fever

h. Colorado Tick Fever

őőThere are several types of skin rashes classified based on size, consistency, color, etc. Below are some of the common ones encountered in clinical practice.

Type of Rash/Lesion Description
Macule flat, circumscribed, usually <1cm in diameter
Papule raised/elevated lesion <1cm in diameter
Maculopapular combination of both macules and papulus
Nodule papule in deeper dermis or subcutaneous tissue
Pustule circumscribed raised lesion containing purulent material
Vesicle circumscribed elevated skin lesion usually <1cm containing fluid
Bulla Bigger vesicle (>1cm and containing fluid)
Purpura non-blanching papules or macules due to extravasation of RBCs
Petechiae non-blanching pinpoint unraised spots usually measuring <2mm in size


classification
SCC
BCC
Melanoma

Practice here


Mitosis in neuroendocrine tumor. Source: Wikimedia commons
Classification of Waldenstrom macroglobulinemia (WM) and Related Disorders
Criteria Symptomatic WM Asymptomatic WM IgM-Related Disorders MGUS
IgM monoclonal protein + + + +
Bone marrow infiltration + + - -
Symptoms attributable to IgM + - + -
Symptoms attributable to tumor infiltration + - - -

Bowen's disease Microchapters

Overview

Historical Perspective

Pathophysiology

Causes

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

Treatment

Prevention

Differentiating Bowen's disease from other Diseases






References

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