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HIGH-YIELD FACTS

  • Most childhood exanthems are benign, self-limited, and require no treatment; however, they can be associated with myocarditis, encephalitis, or pneumonia.

  • Worldwide, rubeola is still a major cause of morbidity and mortality. Early recognition can control spread. Increase in rates of nonmedical vaccine exemptions have been associated with an increase in disease rates in the United States.

  • Roseola infantum is a common cause of febrile seizures in infants. A full fontanelle may be present in up to 25%.

  • Children with varicella who 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(s), and mouth. Early treatment with acyclovir will prevent progression.

The vast majority of childhood exanthems are a result of nonspecific, self-limited viral illnesses. However, recognizing their patterns and being familiar with the history and physical findings associated with these specific exanthems can be crucial to reassuring and educating families, and directing care.

The clinician should always be vigilant to recognize associated symptoms that may suggest life-threatening complications when examining children with exanthems. This chapter describes recognizable childhood exanthems, discusses risks of exposure, and describes complications to expect and serious sequelae to consider.

RUBEOLA (MEASLES)

EPIDEMIOLOGY/PATHOPHYSIOLOGY

Rubeola, more commonly known as measles, is one of the most contagious diseases known to man, with a 90% transmission rate to an unimmunized household contact. However, widespread use of live virus vaccine during the past 40 years has dramatically reduced the incidence of the disease in developed countries; the rates of parental refusal of immunizations due to nonmedical exemptions (either the parent feels the immunizations conflict with their religious or spiritual beliefs, or they object to the immunization for moral or philosophical reasons) have increased steadily in the past 20 years. Maternally acquired antibodies usually are sufficient to protect against clinical exposure in infants younger than 1 year of age. In the United States, the American Academy of Pediatrics (AAP) recommends measles, mumps, rubella (MMR) vaccination between 12 and 15 months of age, and a second dose at 5 years. In the most recent measles outbreak in the United States in 2014, approximately half of the cases were patients who were vaccine eligible but unvaccinated.1

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

CLINICAL FINDINGS

The characteristic measles rash is usually preceded by 3 days of fever to 40°C and the characteristic “three Cs”—cough, coryza, and ...

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