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Stony Brook Children’s Primary Care CurriculumRashes Caused by Infectious AgentsOctober 2019Cases created by Susan D. Walker, MD, FAAPReference: American Academy of Pediatrics. Red Book: 2018 Report of the Committee on Infectious Diseases. Kimberlin LK, et. al. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018.Goal:Understand the etiology, appearance, and treatment of pediatric infectious exanthems.Objectives: Appropriately diagnose and manage the infections listed below. ABP content specifications addressed in this module:ImpetigoRecognize the common pathogens associated with impetigoRecognize the clinical manifestations of impetigo and manage appropriatelyStaphylococcal scalded skin syndromeScabiesRecognize the clinical manifestations of scabiesPlan the appropriate management of scabiesFungal infectionsTinea corporisRecognize the clinical findings associated with pityriasis (tinea) versicolorMolluscum contagiosumRecognize the clinical findings associated with molluscum contagiosum, and manageappropriatelyVerruca vulgarisRecognize the clinical findings associated with common warts, and manage appropriatelyVaricella-zoster virusUnderstand the epidemiology of varicella-zoster virusRecognize the clinical features associated with varicella and herpes zoster infections in normal and immunocompromised children of various agesUnderstand the relationship between varicella and herpes zoster infectionPlan the appropriate management of an immunocompromised patient exposed to varicellaPlan appropriate antiviral therapy for normal and immunocompromised patients who havevaricella-zoster virus infectionPlan appropriate control measures to prevent the spread of varicella and herpes zosterMeasles virusPlan appropriate control measures to prevent the spread of measlesPlan appropriate use of intramuscular immune globulin in immunocompromised andunimmunized patients who have been exposed to measlesRecognize the clinical features associated with measles, including complicationsParvovirus B19 (erythema infectiosum)Recognize the clinical features associated with erythema infectiosumRecognize the complications of parvovirus B19 infectionHuman herpesvirus type 6 (roseola)Recognize the clinical features associated with human herpesvirus type 6 infectionRecognize the clinical features associated with echo- and coxsackievirus infection in patients ofvarious agesNeisseria meningitidis (meningococcal infections)Understand the epidemiology of Neisseria meningitidisRecognize the major clinical features associated with Neisseria meningitidis infectionPlan appropriate management for a patient with meningococcal diseaseBorrelia burgdorferiUnderstand the epidemiology of Borrelia burgdorferiRecognize the clinical features associated with Borrelia burgdorferi infectionPlan appropriate management for a patient with Borrelia burgdorferi infectionBefore your clinic session: for each of the following exanthems, describe the rash you see, give the etiologic agent, discuss any associated symptoms, and give the treatment.Hint: Redbook online is a great resource. Have fun!Case 1: Seven-year-old boy with a rash for three days. It started under his nose; he now has three discrete lesions on his cheeks, one of which looks like the photograph below: 2: 11-month-old baby with the rash seen below. He was well until a few days ago, when he developed fever to 103F. On exam, he is unhappy, and seems to be in pain when touched. 3: 13-year-old boy who developed a painful lump on his right thigh two days ago. It developed purulent drainage yesterday. 4: 15-month-old girl with the rash seen below. She also has a similar rash on her hands. Mother has an itchy rash between her fingers. 5: 15-year-old high school wrestler who developed the rash seen below three days ago. It is getting bigger. His coach told him not to come to practice without a note from the doctor. 6: 12-year-old boy who noticed the following rash over the summer. It is very mildly itchy. He has no other symptoms. 7: 5-year-old boy with “lumps”. He has 6 of the following lesions scattered on his left thigh. 8: 7-year-old girl with red cheeks which began yesterday. Today her arms and legs have the rash shown below. 9: 16-month-old girl with a fever to 103F for the past 4 days. She has also been very cranky. Today, she has no fever, but has developed the rash shown below: 10: 3-year-old girl with a fever for two days. She has been refusing to eat due to throat pain. Physical findings below: 11: 6-year-old boy with fever to 102F and mouth pain. 12: 8 year old boy with fever to 102F, sore throat, headache, and rash. 13: 9-year-old unimmunized girl with fever and malaise 5 days ago; 3 days ago developed a rash on her abdomen, which blistered and spread. 14: 18-month-old unimmunized boy here with fever, runny nose, cough, and the rash below. 15: 3-year-old boy who went on a hike a few weeks ago; Mom puled a few ticks off him later that night. He developed this rash 2 days ago; it’s getting bigger. 16: 15-year-old boy who went hiking in the woods 2 weeks ago. A few days ago, he developed fever, headache, vomiting, and malaise. The rash below started today. 17: two-year-old girl with high fever and lethargy. 18: 5-year-old boy with something on his finger that has been slowly enlarging. ................
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