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  • Most childhood exanthemas are benign, self-limited, and require no treatment, but hidden in this presentation is an occasional myocarditis, encephalitis, or pneumonia.
  • Worldwide, rubeola is still a major cause of morbidity and mortality. Early recognition can control spread.
  • Roseola infantum is a common cause of febrile seizures in infants. A full fontanelle may be present in up to 25%.
  • Children with varicella that may benefit from antiviral agents include patients on corticosteroids or chronic salicylates, immunocompromised patients, and those older than 12 years.
  • Neonatal herpes has three presentations in the first 6 weeks of life: encephalitis with seizures, disseminated with a “neonatal sepsis” appearance, and those localized to the skin, eye, and mouth. Early treatment with acyclovir will prevent progression.

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The vast majority of childhood exanthems are a result of nonspecific viral illnesses. Most are benign and self-limited and resolve without any therapeutic measures. The enterovirus group including echovirus and coxsackievirus consist of nearly 80 human host infections that may cause childhood exanthemas.1 Although they rarely cause serious or life-threatening disease, some enterovirus infections can result in serious sequelae such as encephalitis and myocarditis. The clinician should always be vigilant to recognize associated symptoms that suggest life-threatening complications when examining children with exanthemas. Medication misadventures, bacterial and rickettsial disease can also cause recognizable clinical patterns. This chapter will describe recognizable childhood exanthemas, discuss risks of exposure, and provide an understanding of complications to expect and serious sequelae to consider.

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Measles still remains a leading cause of preventable childhood morbidity and mortality worldwide. Although most cases today are limited to immunocompromised patients and in developing countries where poverty and malnutrition is a factor, outbreaks still occur in developed nations.

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Epidemiology/Pathophysiology

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Measles is one of the most contagious diseases known to man with a 90% transmission rate to the unimmunized household contact. It remains a significant cause of morbidity and mortality in developing countries. In 2006, it resulted in 242 000 deaths worldwide. More than 95% of deaths occur in developing countries. Widespread use of live virus vaccine for immunization during the past 40 years has dramatically reduced the incidence of the disease in developed countries.2 Infants are usually immunized between 12 and 15 months of age. Maternally acquired antibodies usually are sufficient to protect against clinical exposure in infants younger than 1 year of age.

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Transmission of the virus is by aerosol exposure or contact with respiratory fluids. It enters the body through the respiratory tract. The incubation period ranges from 7 to 18 days after exposure, and patients are contagious for approximately 5 days starting with onset of symptoms.

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Clinical Findings

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The characteristic rash associated with measles is preceded by 3 days of fever to 40°C and the characteristic “three Cs,” cough, coryza, and conjunctivitis. Intense mucoid nasal drainage, hacking cough, and marked scleral and paplebral nonpurulent conjunctivitis are always present prior ...

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