Viral infectionsAcute childhood exanthems
Section snippets
Measles
Caused by a paramyxovirus, measles (rubeola) is spread by respiratory contact. It remains a significant cause of childhood mortality in developing countries, although global mortality from measles has decreased since the introduction of comprehensive immunization programmes from 873,000 deaths in 1999 to 345,000 in 2005.1 Controversial interpretation of small studies with widespread media reporting have led to a decrease in uptake of the MMR vaccine in the developed world.2 Subsequently there
Rubella
Caused by a togavirus, rubella (German measles) is spread by respiratory droplets and is most prevalent in late winter and spring. In countries with comprehensive childhood immunization and effective catch-up campaigns in adolescence and in women of child-bearing age there has been a dramatic decrease in the incidence of rubella.11 However, many countries have no anti-rubella immunization programmes and globally the incidence of congenital rubella syndrome is estimated to be over 100,000/year.12
Varicella
Varicella (chicken pox) is caused by a herpes virus, varicella-zoster virus. The highest incidence is in young children, although non-immune adults are also at risk. It is highly infectious and the chance of a second household member becoming infected is 80–95%. Although the disease is spread primarily by respiratory droplets, the vesicle fluid is also infectious.
The prodromal period consists of fever, cough, coryza and sore throat, and is followed by an intensely pruritic rash. Initially
Erythema infectiosum
Erythema infectiosum (fifth disease, slapped cheek syndrome) is caused by erythrovirus (formerly parvovirus) B19. It is spread via respiratory droplets and predominantly affects preschool children although adults can be affected.
Around half of infections with erythrovirus B19 are asymptomatic. Erythema infectiosum has a mild prodromal period with fever and malaise. The characteristic exanthem is a symmetrical erythematous rash over both cheeks, and the trunk and limbs may also develop a lacy
Roseola infantum
The first virus to be associated with roseola infantum (sixth disease, exanthem subitum) was HHV6, although it is also caused by HHV7. These viruses are spread through contact with saliva.
Roseola infantum affects infants and young children and is characterized by a high fever for about three days, which defervesces abruptly with the appearance of a pink maculopapular rash. The abrupt rise in temperature may be associated with febrile convulsions. Gastrointestinal and occasionally respiratory
Hand, foot and mouth disease
Hand, foot and mouth disease is caused by enteroviruses, most commonly Coxsackie virus A16 and enterovirus 71. It is highly contagious and is spread by the faecal-oral route, respiratory droplets and contact with skin lesions. It predominates in pre-school age children and outbreaks in nurseries are common.24 Incidence peaks in summer and autumn in temperate climates.
There is a prodrome lasting 1–2 days before the rash appears of low-grade fever, anorexia and a sore mouth. Lesions initially
Gianotti–Crosti syndrome
Gianotti–Crosti syndrome (papular acrodermatitis of childhood) was originally described in association with hepatitis B infection. The commonest cause, however, is Epstein–Barr virus (EBV), and other infectious agents have been implicated, including enteroviruses, various respiratory viruses, erythrovirus B19 and cytomegalovirus (CMV). There are a few reports of Gianotti–Crosti syndrome following immunizations.26, 27
It is generally a self-limiting condition usually lasting 10–14 days and
Unilateral laterothoracic exanthem
Also known as asymmetric periflexural exanthem of childhood, unilateral laterothoracic exanthem was described in 18 patients in 1992.28 It usually occurs in winter and early spring and is most common in children aged 1–5 years, although it has been reported rarely in adults. No single causative organism has been identified although erythrovirus B19 and EBV have been associated. It has been suggested that it is a skin eruption common to several different viruses.
There is usually a prodrome of
Pityriasis rosea
Pityriasis rosea is an exanthem of unknown cause affecting older children and young adults. A viral cause is suggested by seasonal and geographical clustering.
A sore throat can precede the exanthem, and constitutional symptoms such as headache and low-grade fever can accompany the rash. The rash is characterized by pink or red scaly oval lesions, often preceded by a single lesion, predominantly on the trunk. It can be pruritic, and treatment with antihistamines provides symptomatic relief. The
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