Exanthema in children symptoms and treatment. Manifestations of viral exanthema in children

Exanthema- skin rash of a viral nature, is a local reaction of the human body to the virus. The nature of the rash can be different depending on the pathogen. On the patient's skin, blistering rashes, grouped vesicles, spots and papules, a red rash that looks like lace can form.

Causes

The etiology of erythema is diverse, there is an opinion that the cause of rashes may be the action of pathogenetic mechanisms:

• viruses with blood flow enter the tissues of the body, which leads to damage to the skin and the appearance of a rash. This principle is typical for enteroviruses, herpes virus type I and the like;
• exanthema appears due to the reaction of the immune system to the pathogen. This principle is typical when a rash occurs during rubella.

Rubella, measles, herpes type 6 viruses, Epstein-Barr virus, enterovirus, cytomegalovirus have a characteristic rash in the form of papules and spots on the skin. Bubble rash on the skin is formed with the herpes virus type 1, Coxsackie virus, herpes viruses, which provokes the development of chicken pox and herpes zoster.

Viruses that provoke redness on the skin and a papulo-vesicular rash provoke adenoviruses, enteroviruses, hepatitis C and B viruses.

Parvovirus B19 manifests itself as a characteristic rash on the skin in the form of a lace.

Symptoms of exanthema

Depending on the causative agent, the manifestations of exanthema may differ.

With a sudden exanthema, the causative agent of which are herpes viruses of types 6 and 7, patients have a fever, irritability, an increase in the cervical and occipital lymph nodes, a runny nose, swelling of the eyelids, diarrhea, a small injection in the pharynx, sometimes an exanthema in the form of a small maculopapular rash on the soft sky. The rash appears when the temperature drops.

The cause of the development of viral exanthema are rubella virus, parvovirus, Epstein-Barr virus, hepatitis B virus. Typical manifestations of viral exanthema: fever, flu-like symptoms, swelling of the lymph nodes, indigestion, fever, mucosal lesions.

Sudden exanthema caused by herpes viruses 6,7 manifests itself in the form of a sharp increase in body temperature in children, characteristic rashes on the body and causeless diarrhea.

Diagnostics

For the diagnosis of exanthema, it is necessary to conduct the following studies:

1. Complete blood count: leukopenia with relative lymphocytosis.

2. Serological tests aimed at detecting antibodies of the IgM, IgG class to HHV type 6 and serum PCR for HHV-6.

3. Differential diagnosis in order to exclude rubella, enterovirus infections, otitis, meningitis, measles, bacterial pneumonia, sepsis.

Classification

1. Drug exanthema - develops as a result of taking or contact with various drugs. After taking antibiotics, barbiturates, anti-tuberculosis drugs, sulfanilamide drugs.

2. Sudden exanthema - the causative agent of this disease is herpes viruses 6 and 7 types. Most often occurs in children over the age of 2 years. The child has a sharp rise in temperature, diarrhea may occur. After a few days, the rash and all associated symptoms disappear on their own.

3. Viral exanthema in most cases occurs in infants. The causative agents are herpes viruses, measles and enteroviruses. The patient has a fever, rashes look like papules, red spots, or depending on the pathogen.

4. Children's exanthema occurs in children with measles, rubella and scarlet fever. In children, there is a violation of digestion, the body temperature rises, the rashes have a characteristic pinkish tint.

Patient's actions

A physical examination by a doctor is required.

Exanthema treatment

The specific treatment of exanthema depends on the pathogen. Therapy is symptomatic.

With a viral infection, therapy is prescribed taking into account the age of the patient and the degree of development of the disease. Most often, therapy is aimed at relieving the symptoms of the disease, antiviral drugs are used in tablet form or in the form of ointments. The patient is shown bed rest and isolation from the peer group.

With enterovirus and paravirus infections, special therapy has not been developed, treatment is symptomatic in order to alleviate the general condition of the patient.

Complications

Complications are quite rare, with the exception of children with reduced immunity. In the future, the patient develops lifelong immunity to HHV-6, HHV-7.

Prevention of exanthema

Prevention methods have not yet been developed. It is recommended to isolate the patient until the disappearance of the clinical manifestations of the disease.

Exanthema(Greek Exantheo: "I bloom") - the sudden simultaneous appearance of identical skin changes in a generalized distribution.

The etiology is diverse, with viruses (2/3 of cases) and bacteria playing a special role. Medications and autoimmune diseases rarely cause exanthems in childhood. Eczematous diseases in a broad sense, primarily papular/papulopodequamative forms (eg, eczematous Lichen ruber, Pityriasisrosea, Pityriasis lichenoides acuta et varioloformis, Pityriasis lichenoides chronica) will not be considered here.

While many eczematous diseases (especially classical childhood diseases) are manifestations of infections caused by certain pathogens, for other clinically distinguishable disease patterns, such as Gianotti-Crosti-Syndrom, viruses of completely different groups are pathogens. The etiology of other eczematous diseases, such as neonatal exanthema, Kawasaki syndrome, and unilateral laterothoracic exanthema, first described in 1992, has not yet been elucidated.

Three pathogenetic mechanisms seem to be involved in the development of viral exanthema:
1. Viruses enter the skin through the blood and cause tissue damage (varicella, Herpes simplex, enteroviruses).
2. The reaction of infectious agents with circulating and cellular immune factors causes the appearance of exanthema (masern, rubella)
3. Even without the presence of infectious agents, circulating "immune factors" cause exanthema (acute urticaria, Stevens-Johnson-Syndrom, Putpura fulminans).

The reasons for the tropism of some viruses to certain localizations on the skin and mucous membranes (for example, Hand-Fuss-Mund-Erkrankung) are not known. It is also necessary to determine the mechanisms of adhesion and phagocytosis as causative factors.

Toxins cause the symptoms of bacterially caused exanthema. Along with the direct influence of the toxin, superantigens (toxic shock syndrome) are also at the center of the pathogenetic event.

The clinical picture with morphology, ordering and difference of exanthems often already turns out to be diagnostic; history and physical examination (presence of concomitant symptoms, as well as the age of the child are other important diagnostic criteria. If in doubt, laboratory tests (serological) can be performed to confirm the diagnosis.
Knowledge of exanthematous diseases in childhood is of great importance for the identification of life-threatening diseases and for the implementation of preventive measures (for example, pregnant women without an appropriate AK should stay away from children with rubella).

MACULOSIS/PAPULOSIS/MACULOPAPULOSIS EXTREME

Exanthema in childhood is most often manifested in macular or maculopapular form. Viruses are the main pathogens (approximately 2/3 of cases, and along with non-polioenteroviruses, respiratory viruses (adeno-, rhino-, parainfluenza-, respiratory syncytial and influenza viruses), Ebstein-Barr viruses, HHV 6- and HHV 7 viruses and parvovirus B 19.

Viruses of classic childhood diseases such as cytomegalovirus and hepatitis are rarely the cause of macular or maculopapular exanthema. In the differential diagnostic plan, medicinal, bacteriotoxic exanthems, as well as Kawasaki syndrome, should be taken into account.

Table 1 Viral ecchanthemas in childhood (macular/papular/maculopapular)
Disease/causative agent	Season	Ekhanthema distribution	Prodrome	Associated symptoms
Measles / Rubeola -viruses (family Paramyxoviruses)	Winter spring	1. Face retroauricular 2. Spread from skull caudally	Fever, vision, cough, conjunctivitis, spots Koplick	Fever, photophobia, cough
Rubella viruses ( Togavren)	Winter spring	1. Face, retroauricular 2. Spread caudal from the skull	Not	Lymphadenopathy
Infectious mononucleosis/main viruses Epstein-Barr	Perennial	Trunk, limbs	Fever, neck pain, adenopathy	Lymphadenopathy, hepatosplenomegaly
Gianotti-Crosti-Sindrome a VEB, CMV, hepatitis B, Coxsackie A 16	Perennial	Cheeks, limbs, buttocks	Not	Swelling of the lymph nodes is possible, sometimes pruritis
Erythema subitum/Parvovirus B19	Winter autumn	Emphasized on the neck and torso	high fever	Lymphadenopathy
Erythema infectiosum/Parvovirus B19	Winter spring	Face, Streckseiten proximal limbs, rarely trunk	Not	Polyarthritis/polyarthralgia, flu symptoms swollen lymph nodes
Handschuh-Socken-Syndrome/ Parvovirus B19	Spring Summer	Arms, legs, torso	Not	Fever, swelling of the lymph nodes, arthralgia, pruritis and burning sensation palplantarno, lesions of the mucous (oral)
a - papules or papulovesicles

Classic childhood diseases

MEASLES

Synonyms: Rubeola (English only synonym, German Rubola: rubella), Morbilli

Epidemiology. Measles shows seasonal fluctuations with an increase in the winter and early spring months. Highly contagious measles viruses are transmitted by airborne droplets (talking, coughing, sneezing) mainly in the prodromal stage. The incubation period to the prodromal stage is 10 days, after 4 days exanthema develops. Since the introduction of live measles vaccination in 1967, there has been a shift towards younger adulthood, along with a general decline in incidence.

Etiopathogenesis. Measles viruses are RNA viruses from the paramyxovirus family. Virus replication occurs in keratinocytes and the endothelium of the superficial dermis leading to the appearance of pathognomonic giant cells (Warthin-Fenkedey-Zellen"). T-cells are at the center of the pathogenetic process.

Clinic. The prodromal stage, 4 days preceding the exanthema, is characterized by high fever, runny nose, dry cough, and typical photophobia occurring with severe conjunctivitis. The day before the appearance of exanthema on the buccal mucosa, near the exit ducts of the parotis, whitish-grayish flat papules with erythematous Halo (Koplik-Flecken) appear 1-2 mm in diameter; at the same time, a dark red enanthema is determined on the soft palate.

Retroauricularly, a maculopapular exanthema begins to appear on the borders of the hair on the forehead and on the neck and spread caudally, showing a tendency to merge. When, after 3 days, it reaches the distal parts of the lower extremities (most often without affecting the feet and palms), the cranial healing begins, proceeding with gentle desquamation, and additionally, after 1-2 weeks, capillary hemorrhages may appear.

Patients who were vaccinated with still-killed measles viruses (before 1967) and later infected with natural measles viruses present the so-called atypical measles pattern, which is characterized by an accentuated, often hemorrhagic exanthema on the extremities and severe pneumonia. There are no Koplik spots.

Complications. Measles infection results in a transient weakening of T-cells for 1-2 months, manifested in the skin test as a reduced response to the Recall antigen. Clinically, this can manifest as otitis media (the most common complication), pneumonia (most often bacterial, in immunosuppressed patients with viral giant cell pneumonia), or encephalitis.

With encephalitis, three forms should be distinguished:
Immunosuppressed patients develop acute progressive infectious encephalitis.
1. In immunocompetent patients, acute postinfectious encephalitis most often occurs, which appears already during exanthema and is considered as an autoimmunological reaction.
2. Rarely, subacute, sclerosing panencephalitis (SSPE) develops after several years. This can be caused by the remaining, structurally altered measles viruses that have escaped the control of the immune system.

In developing countries, measles infection often leads to protein-losing enteropathy, which is the most common cause of death.

Diagnostics. A clinic with a typical prodromal stage (always look for pathognomonic Koplik spots) and exanthema with a tendency to merge always indicates the diagnosis. IgM-AK to measles viruses are detected at the earliest on the 3rd day of exanthema (ELISA). Mucosal scrapings give at the beginning of the exanthema giant cells pathognomonic for measles ("Wartin-Finkeldey-Zellen").

Therapy. Measles therapy is symptomatic (bed rest, antipyretics, topical eg Lotio alba). Complications require interdisciplinary cooperation.
It is recommended to carry out prophylactic vaccinations from the 12th month of life, the first from school age, the second (live vaccines). Passive immunoglobulin immunization is administered intravenously in immunosuppressed patients within 6 days of exposure.
In severe cases, oral intake of vitamin A justifies itself.

Differential Diagnosis. Other classic childhood illnesses such as rubella, Erythema infectiosum and scarlet fever, as well as drug-induced exanthems and morbilliform exanthema in infectious mononucleosis are excluded. In palmoplantar lesions, Lues II should always be ruled out.

RUBELLA

Synonyms: Rubella, Rubeola (only in German a synonym, in English Rubeola: measles), German measles

Epidemiology. Most rubella occurs in the spring. Transmission occurs by droplets, and its contagiousness is less than that of measles. The time of infection is 2 to 3 weeks. Vaccination (from 12 months of age) significantly shifts the timing of rubella towards young adulthood. Up to 10% of fertile women, however, do not show any antibodies against rubella viruses; because of this, there is a danger of embryopathy (Gregg's syndrome).

Etiopathogenesis. Rubella viruses are RNA-togaviruses and enter the bloodstream through respiratory mucosa. The spread of viruses and the antigen-antibody reaction in the skin may explain the appearance of exanthema.

Clinic. The leading symptom is an increase in lymph nodes occipitally and retroauricularly. Millet papular exanthema begins retroauricularly and spreads like measles craniocaudally, however, does not tend to coalesce. The general condition, characterized by moderate fever (up to 38°C) and a flu-like symptom that precedes the exanthema in the form of a prodrome, does not cause concern. Rubella infection is often asymptomatic.

Complications. Very rarely, children may develop encephalitis and arthralgia/arthritis. Infection, especially in the early stages of pregnancy, poses a risk to children (80% in the first trimester, 30% in the second trimester). In the first weeks of pregnancy, it can cause abortion, later infections are associated with miscarriage and the development of Gregg-Syndrom (a triad of deafness, heart disease and cataracts). Another significant symptom is congenital thrombocytopenic purpura.

Diagnostics. Enlargement of the lymph nodes is an indication of the diagnosis. Serologically (ELISA) the diagnosis is confirmed; it is possible to isolate the virus from secrets (nasopharyngeal, urine).

Therapy. Simple topical therapy is sufficient (eg Lotio alba). Preventive measures include isolation of children for a week after the onset of exanthema. Children with congenital rubella should be isolated for a longer time, as they can shed the virus in secrets for up to a year.

According to the STIKO vaccination recommendations, the first vaccination, together with that against measles and mumps, is given from the 12th month of life, the second from the 6th year of life. Re-vaccination is carried out between 11 and 18 years of age in children and adolescents who have not previously received vaccinations or with insufficient protective vaccination.

For rubella infections during early pregnancy, consideration should be given to the possibility of complications that may lead to a decision to terminate the pregnancy; if pregnant women without an appropriate amount of antibodies come into contact with patients with rubella, then the possibility of treatment with rubella immunoglobulins is considered.

Differential Diagnosis. In the differential diagnostic plan, exanthems of another infectious genesis (classic childhood diseases, Lues II) are considered, as well as drug-induced exanthems.
Other congenital infections such as toxoplasmosis, syphilis, cytomegalovirus, and Herpes simplex, which also present with thrombocytopenia, are also included in the differential diagnosis of congenital rubella.

EXANTHEMS CAUSED BY ENTEROVIRUS

Epidemiology. Two-thirds of exanthems in the summer and autumn months are caused by enteroviruses (family of picornoviruses). Usually, young children are affected. Enteroviruses are ubiquitous and are mainly transmitted by the fecal-oral route, less often through the respiratory tract. Incubation time is 3-8 days.

Etiopathogenesis. Enteroviruses are single-stranded RNA viruses. The classical division covers the group coxsackie-A viruses (23 types), coxsackie-B viruses (6 types) and echoviruses (of which 34 types belong to non-polioenteroviruses). According to the previous classification, 67 serotypes were identified. The newly isolated types (so far 68-71) are expected to increase this number.

Clinic. Enteroviral infection gives a very wide symptomatic spectrum. Along with lesions of the respiratory and gastrointestinal tracts with specific complaints of fever, the organ systems of the eye, heart, and central nervous system (in older children) are mainly affected.
More than 30 serotypes are associated with one exanthema (most often A16, Echo 9, B5, A9, Echo 11-31, enterovirus 71).
Morphologically, exanthems are characterized by great variability. Most often, they first take on a macular/maculopapular form, later becoming urticarial, vesicular, hemorrhagic, or pustular.
But only hand-foot-mouth disease (coxsackie A16) is considered type-specific, giving the appearance of vesicles on the reddened basic Morphe and therefore will be discussed in the section "vesical exanthema".
Exanthems caused by enteroviruses are often accompanied by fever, weakness, head and neck pain.

Complications. Rarely, enterovirus infection is accompanied by complications such as encephalitis, myopericarditis, pneumonia, or polio-like symptoms.

Diagnostics. Due to the cross-reactions of the four serotypes, virus isolation is considered the most reliable diagnostic method (urine, stool, cerebrospinal fluid, nasal and nasopharyngeal secretions).

Therapy. Therapy is symptomatic and should be determined in severe cases with multiple organ involvement in cooperation with a pediatrician. Isolation measures are not required.

Differential Diagnosis. In the differential diagnostic plan, it is necessary to take into account infections caused by Herpes simplex, meningococci and Kawasaki syndrome.

EXANTHEMS CAUSED BY THE HERPES VIRUS

Varicella(see below)
Vesicles representing the main morph of the examination of the varicella are transferred to the section "vesicular exanthema".

INFECTIOUS MONONUCLEOSIS

Synonyms: Pfeiffer glandular fever, "kissing disease" ("kissing disease")

Epidemiology. After infection of epithelial cells in the nasopharyngeal space, the Epstein-Barr virus is transmitted with saliva, and viral particles can be shed for several more years. Incubation time is 10-50 days. The age of maximum manifestation is school age and young adulthood. In adulthood, the average lesion rate is 100%.

Etiopathogenesis. Ebstein-Barr virus is a virus from the group of herpes viruses (double-stranded DNA viruses) best studied in terms of pathogenesis. Initially, the reproduction of viruses occurs mainly in the epithelium of the oral cavity. The target cells in further development are B-lymphocytes, which express virus-encoded antigens on their cell membrane. These membrane antigens cause a T-killer reaction, which is one of the main causes of subsequent organ changes. While HHV 4 (Ebstein-Barr) is described as the most common cause of mononucleosis, HHV 5 (cytomegaly), HHV 6, HHV 7, parvovirus B19, and rubella viruses are less commonly considered pathogens.

Clinic. Fever, headache, weakness, pharyngitis, exudative tonsillitis and lymphadenopathy (neck, armpits, groin) determine the prodromal stage of infectious mononucleosis. Hepatomegaly with jaundice, arthralgia and myalgia may accompany the disease. In 10% of patients on the 5th day of the disease, most often a morbilliform, often severely itchy exanthema develops, with particular severity on the face and trunk. Less common are urticarial, hemorrhagic, Gianotti-Crosti- or EEM-like exanthems. A characteristic symptom of infectious mononucleosis is facial edema, which occurs in approximately 1/3 of patients at 1 week of illness. At the end of the first week of the disease, 50% of patients can be diagnosed with petechiae in the region of the transition zone of the hard and soft palate.

Complications. Rare complications can be pancytopenia, peri- and / or myocarditis (change in the T-wave on the ECG), meningoencephalitis, the formation of autoantibodies, and the development of lymphoproliferative diseases. There is an association with malignant lymphomas and nasopharyngeal carcinomas. With hepatosplenomegaly, one should be aware of the possible rupture of the spleen.

Diagnostics. In the blood picture with leukocytosis 12000-18000 ml, lymphocytosis (70-80% of patients) and thrombocytopenia (50% of patients) are noted. Through interaction with virus-infected B-lymphocytes, T-lymphocytes are activated and morphologically atypical lymphocytes (mononucleosis cells) appear in the blood smear.
Confirmation of the diagnosis is carried out serologically (indirect immunofluorescence).
The Paul-Bunell test detects so-called heterophilic AKs (sheep erythrocyte agglutinating antibodies) in the serum of infected EBV. Isolation of EBV viruses is possible from oropharyngeal saliva.

Therapy. Therapy is symptomatic and should be aimed at preventing possible complications (management for hepatosplenomegaly). With itching, the use of antihistamines is effective.

Excessive hypertrophy of the tonsils and thrombocytopenia respond well to the administration of steroid drugs. The general condition improves significantly. Frequently used therapy with ampicillin or amoxicillin is useless and is almost always associated with the appearance of morbilliform "ampicillin exanthema". Its pathogenesis is unclear. 1-2 days after the use of antibiotic therapy, morbilliform exanthema begins to appear on the trunk and then its generalization occurs. Note the pronounced tendency to merge, which sometimes resembles that of measles.
Prophylactically justified general hygiene measures (thorough washing of hands). Until now, there is no vaccine.

Differential Diagnosis. In the differential diagnostic plan, diseases occurring with pharyngotonsillitis (streptococcal infections, diphtheria, cytomegaly), lymphadenopathy (toxoplasmosis), hepatitis (viral hepatitis), as well as lymphomas and leukemias are considered.
Exanthema caused by Epstein-Barr viruses is not typical and differs in differential diagnosis from exanthema caused by other viruses and drugs (rubella, measles, exanthema caused by Echo-, Coxsackie- and hepatitis viruses).

The diagnosis of "ampicillin exanthema" is unlikely to present difficulties (history, symptoms).

GIANOTTI-CROSTI-SYNDROM (GCS)

Synonyms: Acrodermatitis papulosa eruptiva infantilis, Infantiles acrolokalisiertes papulovesikuloses Syndrom, Crosti-Gianotti-Syndrom

Epidemiology. Gianotti-Crosti-Syndrom is a disease of young children (2 to 6 years of age). Its contagiousness is small, the type of transmission has not been studied.

Etiopathogenesis. GCS was originally described as an exanthema associated with hepatitis B. This exanthema was later contrasted with an identical non-hepatitis B exanthema (Crosti-Gianotti-Syndrom, Infantiles acrolokalisiertes papulovesikuloses Syndrom). Today, these diseases are lumped together as GCS, for which hepatitis B infection has become less frequently associated. Epstein-Barr viruses were the most commonly isolated. Subsequently, GCS has been described in association with HHV6, cytomegalovirus, Coxsackie, parvovirus B19, and parainfluenza. GCS was observed in the form of a reaction to vaccinations, primarily diphtheria-whooping cough, diphtheria-tetanus-pertussis-poliomyelitis.
Spongiosis, edema of the papillary dermis and perivascular lymphocytic inflate led to a typical papular-papulovesucular exanthema, which is presumably explained as infectious-allergic.

Clinic. In an untroubled general condition, children develop exanthema in predisposed areas of the cheeks, extremities, often affecting the feet and hands and the buttock area. Millet-like, lichenoid, red papules or papulovesicles appear with a tendency to merge, which are only sometimes accompanied by itching. The exanthema persists for two to eight weeks. Rarely, generalized lymphadenopathy and hepatitis develop with elevated levels of liver enzymes.

Complications. Hepatitis, encephalitis, and anaphylactoid purpura are fairly rare complications.

Diagnostics. A typical exanthema (morphology, distribution) simplifies the diagnosis. Hepatitis serology refers to a diagnostic that can count on detecting hepatitis-associated antigens only 10 days after the onset of exanthema.

Therapy. Treatment is not required. When detecting hepatitis-associated antigens, care should be taken to keep children at risk away from those who are sick.

Ddifferential diagnosis. Neurodermatitis, Lichen ruber, and lichenoid drug exanthema may morphologically resemble Gianotti-Crosti-Syndrom, but are associated with severe itching. Pityriasis rosea predominantly affects the trunk along the Spalt lines of the skin.

EXANTHEMA SUBITUM

Synonyms: Roseola infantum, three-day fever

Epidemiology. Exanthema subitum is one of the most common exanthems in early childhood. Transfer in the form of a drip infection. Incubation time 5-15 days. The time of maximum manifestation is between 6 and 24 months of age. At the age of 4 years, almost all children have antibodies.

Etiopathogenesis. The causative agents of Exanthema subitum belong to the group of human herpes viruses (double-stranded DNA viruses) and are characterized by T-cell lymphotropia. The human herpes virus 6 (HHV 6) is the causative agent of Exanthema subitum, in 10% of cases an association with HHV 7 is established. Viruses infect mononuclear cells and stimulate the production of pro-inflammatory cytokines (interleukin-1b and tumor necrotizing factor a). Based on different growth characteristics and apparent pathogenic activity, HHV 6 A and HHV 6 B variants can be distinguished.

Clinic. In the field of a sudden onset and persisting for 3-6 days of fever (39-40.5 ° C), in children, a decrease in temperature occurs and most often a discrete macular exanthema appears with a predominant lesion of the neck and trunk. It regresses after a few hours to 2 days. The children are generally in good health, with a rare cough, runny nose, or abdominal pain (diarrhea). On physical examination, lymphadenopathy and pharyngotonsillitis are often noted, with pink papules the size of a needle head. In the uvula and soft palate. In a third of infants, protrusion of the anterior fontanelle is noted.

Complications. The most common complication is febrile seizures (in almost 10% of patients). Rare complications include encephalitis, hepatitis, retinitis, pneumonia, and thrombocytopenic purpura.

Diagnostics. The blood picture shows leukopenia with relative lymphocytosis. Serological tests (IgM, 4-fold increase in IgG) confirm infection. However, serological cross-reactivity should be taken into account. Reactivation of HHV 6 antibodies in HHV 7 infection has been described.
Viral particle detection (EM, PCR) does not prove the presence of HHV infection, as viruses are also identified in asymptomatic individuals.

Therapy. Treatment is symptomatic. Isolation measures are not required. Pay attention to complications.

Differential Diagnosis. Diagnostic is not the morph of the exanthema, which can also be caused by other viruses (adeno- and enteroviruses, rubella and parainfluenza), but a typical course.

Exantheme im Kindesalter. Exantheme durch Viren. Monatsschr Kinderheilkd. 147:1036-1052

Translation from German - Yu.M. Bogdanov, Department of Pediatrics, FPC, Northern Medical University, Arkhangelsk

Today we will consider such a disease as exanthema. What it is? What are its causes and symptoms? What are the treatments? These and other questions will be discussed in detail in the article.

Exanthema is a skin rash that appears with various viral ailments. Most often, viral exanthems develop in children. In adolescence or adulthood, pathology is quite rare. Children such as rubella, chickenpox, measles and others are almost always accompanied by a rash.

The reasons

The etiology of this pathology is very diverse. It is generally accepted that the formation of a rash is influenced by one or two pathogenetic mechanisms:

Exanthema (the photo below gives an idea of ​​​​it) appears as a result of damage to the skin tissue by viruses that are carried with the bloodstream. Thus, the herpes virus type 1, enteroviruses, etc. develop.

A rash is formed due to a reaction between the body's immune cells and the causative agent of the disease. According to this principle, a rash occurs with rubella.

Rashes, consisting of spots and papules, occur when:

rubella;

herpes type 6, which provokes the development of roseola;

Epstein-Barr virus;

cytomegalovirus, which causes the development of cytomegaly;

enterovirus.

Bubble rashes appear when:

herpes viruses type 1;

herpes viruses, which cause chicken pox and shingles;

coxsackievirus, which causes viral pemphigus.

Viruses that provoke a papulo-visicular rash and reddening of the skin include:

adenoviruses;

viruses that cause hepatitis B and C;

enteroviruses.

Parovirus B19 is manifested by widespread erythema, outwardly resembling lace.

Clinical picture

The type of infection that provoked the formation of rashes affects how the viral exanthema manifests itself.

Measles

Measles is caused by infectious agents belonging to the paramyxovirus family. Erythema in this case occurs on the 4-5th day of the disease. Before the appearance of skin rashes, the patient develops a dry cough, body temperature rises, feverish conditions are observed.

The occurrence of exanthema is preceded by the formation of gray-white spots on the mucous cheeks. Initially, rashes appear on the face and neck. Viral exanthema has the appearance of papules, which often merge with each other. Gradually rashes cover the whole body. When the rash spreads to the hands and feet, the rash on the neck and face begins to disappear. With measles, exanthema does not appear on the soles and palms.

Rubella

Rubella is caused by viruses belonging to the group of RNA-togaviruses. With this disease, it develops spreading in the same way as measles. The main difference is that the elements of rashes with such a pathology never merge.

The general condition of the patient may not be disturbed, however, some patients have an increase in temperature and a moderately severe fever.

Enteroviruses

Entneroviruses belong to the group of RNA viruses. The diseases they cause have a wide spectrum of symptoms. For example, with many faces, digestive disorders, respiratory symptoms, and fever develop.

In some cases, the disease occurs only enterovirus exanthema. Other signs may be absent. Enteroviral exanthema also has a wide variability. It can manifest as papules, vesicles, pustules or vesicles with hemorrhagic contents.

Infectious mononucleosis

This disease is caused by the Epstein-Barr virus, which is part of the group of herpetic viruses. Infectious exanthema in this case manifests itself in the same way as with measles, the only difference is severe itching.

Roseola

This disease develops as a result of infection with herpes of the 6th and 7th types. The first symptoms of the disease are a sudden increase in temperature, the appearance of fever, loss of appetite, and indigestion. Such as cough and runny nose, most often absent.

The temperature drops on the 4th day and a rash appears. The exanthema in this case has the appearance of a small-dotted pink rash. First, rashes appear on the abdomen and back, then the rash covers the entire body. Itching is absent, fusion of elements is not observed.



Diseases that develop when infected with the herpes simplex virus

As a rule, the primary infection with the herpes simplex virus occurs in early childhood. A symptom of infection is stomatitis, and with relapses of the disease, a bubble exanthema appears on the nose or lips (infection with a type 1 virus). Herpesvirus type 2 infection occurs most often through sexual contact at a young age. Signs of the disease are exanthema on the skin of the genitals and buttocks.

Shingles and chicken pox

Such childhood infectious diseases are caused by a virus that is part of the herpetic group. After the penetration of the virus into the body, a typical infection develops. After recovery, the virus does not leave the body and is in a latent state. Decreased immunity can provoke a recurrence of the infection and cause shingles.

The symptom of exanthema in this case is a blistering rash that spreads throughout the body with chicken pox and is located along the nerves with shingles. When combing the rash, secondary infection is often observed, as a result of which the rash becomes purulent.

Diseases caused by parovirus B19

Only in 20% of patients, infection with parovirus B19 leads to the formation of a characteristic exanthema. Initially, the skin of the cheeks becomes reddened, then a rash forms, which looks like a lace or garland. As a rule, rashes are localized on the skin of the extremities, less often on the trunk. In some cases, severe itching may occur.

When infected with parovirus B19, the exanthema has an undulating course - it can disappear for a while and reappear. The rash is often accompanied by flu-like symptoms and joint pain.

If an exanthema is found, a photo of skin rashes characteristic of a particular disease will be shown to you by the doctor.



Diagnostics

Diagnosis of viral diseases, which are characterized by the appearance of exanthema, includes a thorough study of clinical manifestations and analysis.

It is also necessary to take into account the following characteristics of rashes:

form and appearance;

edge sharpness;

size and tendency to merge;

amount;

changes in the skin (reddened, cyanotic, unchanged);

the nature of the appearance of the rash (simultaneous, gradual, wavy).

Viral exanthema in a child is manifested as follows:

the rash appears on the 2nd day of illness or later;

rashes are preceded by an increased body temperature, its decrease is observed with the first elements of the rash;

catarrhal symptoms are often absent;

most often, viral exanthems are manifested by vesicular and maculopapular rashes.

The doctor prescribes a blood test by ELISA, which makes it possible to detect antibodies to the antigen of an infectious agent in the blood.



Treatment

With such a phenomenon as exanthema, treatment is symptomatic. Therapeutic measures depend on the diagnosis.

Rubella and measles require symptomatic treatment and bed rest. It is extremely important to prevent the addition of secondary infections, as a result of which complications such as otitis media, encephalitis, and pneumonia may develop.

With chickenpox, it consists in preventing suppuration; for this purpose, aniline dyes are used to lubricate the elements of the rash.

With shingles, the drug "Acyclovir" is administered, the treatment regimen is selected by the doctor on an individual basis and depends on the general condition and age of the child.

For the treatment of ailments that develop when infected with the herpes virus, drugs such as Valacyclovir, Acyclovir, Farmciclovir are used.

When infected with paraviruses and enteroviruses, there is no specific therapy. Therefore, treatment consists in relieving the symptoms of the disease and alleviating the patient's condition.



ethnoscience

Exanthema - what is it and what traditional methods of treatment are used, we found out. Traditional medicine recipes are no less effective in combating this phenomenon.

Baths with the addition of a decoction of bran, starch will help eliminate itching during rashes. The water temperature should not be higher than 37-38 ºС. Baths with infusions of medicinal herbs, such as celandine, calendula, chamomile, string, are also effective. For the preparation of infusion, you can use a mixture of these plants. Brew 100 g of herbs (or a mixture of herbs) with a liter of boiling water. Leave to infuse, then strain the infusion and pour into the bath.

Sudden exanthema - what is it?

It is a viral disease characterized by sudden onset and short duration. Most often, sudden exanthema develops in children from six months to 2 years. In rare cases, older children, adolescents and adults are infected.

Sudden exanthema develops when infected with herpes virus 6 (HHV-6), in rare cases, with herpes virus 7 (HHV-7). From person to person, exanthema is transmitted by contact and airborne droplets. The incubation period of the disease lasts 7-8 days.

Symptoms

Signs of infection depend on the age of the patient. The disease is manifested by fever, irritability, swollen lymph nodes in the neck, runny nose, swelling of the eyelids, diarrhea. The rash occurs 12-24 hours after the fever. Localized rashes on the neck, abdomen, back, limbs. The skin becomes reddish in color and becomes temporarily pale when pressed. The rash does not cause any inconvenience: it does not hurt or itch. These rashes are not contagious, disappear after 3-4 days and do not return. Older children develop symptoms such as high fever for several days, runny nose, diarrhea. Rashes appear less frequently in older adults.

Therapeutic activities

Although sudden exanthema is quite common, the correct diagnosis is rarely made. The reason for this is the rapidity of the disease.

During a physical examination, first of all, the elements of the rash are studied. Sudden exanthema is characterized by small pink spots that disappear with diascopy and papules 1-5 mm in size. Also, the elements of the rash rise slightly above the surface of the skin.

Blood tests revealed leukopenia, granulocytopenia, eosinopenia. The PCR method is used to determine the virus. A culture method is used to detect the active virus in the blood.

With the development of complications of sudden exanthema, consultations of a pediatric cardiologist, pediatric gastroenterologist, and pediatric neurologist are required. In addition, additional studies such as abdominal ultrasound, ECG, EEG and others may be prescribed.



If the temperature does not deliver any comfort to the child, then there is no need for treatment. Comfortable conditions should be created in the room where the patient is located. Don't put too many things on your baby. Excess clothing can cause a rise in temperature.

In some cases, a sudden exanthema against a background of elevated temperature is accompanied by convulsions. Among children aged 1.5-3 years, they are quite common (5-35% of children with sudden exanthema experience this phenomenon). Most often, seizures are not dangerous, although they look quite frightening.

What should parents do when a child has seizures?

Try to be calm and calm the child.

Keep any sharp objects out of sight and lay the baby on its side so saliva can flow out of the mouth.

Place a pillow under the baby's head.

Wait for the cramps to pass.

Very often, children after convulsions are drowsy and sleep, this is normal. After an attack, the doctor must examine the child.

Complications

After a sudden exanthema, in very rare cases, any complications develop, with the exception of those children whose immune system is weakened. A healthy immune system develops lifelong immunity to HHV-7 and HHV-6. However, it is still worth contacting a doctor with a sudden exanthema. A child with a fever and rash should be kept away from other children before being seen by a doctor.

Prevention and prognosis

Preventive measures are to protect against infection with various viruses. In order to prevent infection with rubella or measles, it is necessary to vaccinate. To prevent the development of exanthema in herpes infection, antiviral agents are used. However, the virus itself remains in the body for life, therefore, with a decrease in immunity, it can become more active and provoke a relapse of the disease.

Conclusion

From this article, you learned about such a phenomenon as exanthema - what it is, its causes, symptoms, treatment methods. We hope you find this information useful. Be healthy!

Sudden exanthema occurs in children for various reasons, accompanied by unpleasant sensations, serious deterioration in well-being.

In order for the baby to recover as soon as possible, you need to immediately begin treatment.

What does geographical language mean in a child? Learn about it from ours.

Concept and characteristics

Sudden exanthema in children - photo:

Sudden exanthema is acute infectious disease.

Occurs in young children. It is caused by the herpes virus types 6 and 7.

It is characterized by skin rashes and fever. The child has a high temperature. In most cases, children 1-3 years old are affected. This pathology is transferred once, during the recovery period, the baby develops a strong immunity to the disease.

The disease is transmitted by contact and airborne droplets. The disease occurs most often in autumn and winter.

Despite the high temperature, the sick do not have a cough and runny nose.

What is the pathogen and how is it transmitted?

The causative agent of the disease are herpes viruses 6 and 7 types. Belong to the family herpesviridae, kind Roseolovirus. As soon as the pathogen enters the body, it begins to actively influence, causing the disease. Transmitted by airborne droplets and contact.

How does pneumonia manifest itself in children? find out right now.

Types and forms

Experts distinguish several forms of the disease:

1. Light. The rash is not distributed throughout the body, the temperature rises slightly, quickly returns to normal.
2. Medium. Eruptions covered the whole body, but the temperature does not rise above 38 degrees. The condition is normalized after taking medication.
3. heavy. Red spots have a very bright shade, cover the entire body. The temperature rises to 39-40 degrees, without medication it is impossible to normalize the condition. Fever can be life-threatening for the patient.

The disease is divided into two types: with fever and without it. The first kind appears high fever and seizures. There are no other symptoms.

The second type can appear without fever, but the pharyngeal wall becomes inflamed, red spots on the body are very bright and take longer to pass.

Causes and risk group

The disease occurs for the following reasons:

• penetration into the body of the pathogen. Occurs when contact with the patient;
• disorders in the immune system. If she weakened, the child's body is vulnerable;
• hypothermia. When hypothermia significantly increases the likelihood of illness;
• recently transferred colds. The body of a child after colds is weakened, the pathogen easily penetrates into it and develops rapidly.

The risk group includes children who often get colds, are prone to disorders of the gastrointestinal tract.

Often a disease occurs in children suffering from.

However, any child whose immunity is weakened can get sick with this disease.

Symptoms and clinical picture

The disease is quite simple to determine, since it has pronounced symptoms:

1. Temperature rise. Observed in the first 3-5 days.
2. Rash. Gradually spreads throughout the body. Spots can be both pale and bright.
3. Chills. The child may feel cold even if the room is warm.
4. Inflammation of the posterior pharyngeal wall. This is manifested by hoarseness in the voice, sore throat.
5. Diarrhea. Accompanied by abdominal pain.
6. Edema of the eyelids. The child has slightly swollen eyelids. On the 5th-8th day of illness, the puffiness disappears.

Symptoms of the disease also include weakness, decreased performance. The child plays less, feels drowsiness and lethargy. Sleep problems may occur.

Diagnostics

To confirm or refute the diagnosis, the following diagnostic methods are used:

1. Inspection patient. First, a specialist examines the child, examines the spots on the body.
2. Blood analysis. Needed to detect the virus in the body.
3. Analysis of urine. Helps in establishing a diagnosis.

These methods are quite enough to establish the diagnosis. Usually viral and enteroviral exanthema is diagnosed at the first visit to the doctor.

Folk remedies

To improve the patient's condition, to eliminate the symptoms of the disease, it is recommended to use chamomile infusion.

To do this, mix a tablespoon of this plant and a glass of boiling water.

The solution is infused for two hours, then filtered. It is used in the morning and in the evening for half a glass.

It is recommended that the child take a bath with decoction of celandine. To do this, mix a tablespoon of the plant and a glass of boiling water. The product is infused for an hour, then filtered and added to the collected water in the bath.

The baby is bathed in the resulting liquid for at least twenty minutes. Take this bath 3-4 times a week. It will save the child from skin rashes, puffiness, and improve overall well-being.

During treatment, the child should be given plenty of fluids: tea, compotes, drinking water. This will help normalize the condition of the child, speed up recovery.

Forecast and prevention

The disease disappears without a trace in 90% of cases. Complications occur only in children with serious disorders of the immune system. In this case, the rash will last for 2-3 weeks, inflammation of the posterior pharyngeal wall may occur, and a cough will appear.

Even with complications, it will be possible to get rid of the disease in three weeks.

With a favorable course of the disease and without complications you can recover within 5-8 days.

There are no negative consequences after recovery. The child is completely healthy. The disease leaves no trace.

Prophylaxis of the disease is inappropriate because it doesn't reappear. The baby develops strong immunity to this disease. Nevertheless, it is recommended to give the baby vitamin complexes from time to time, feed him only healthy food and avoid hypothermia.

This disease appears suddenly, but passes quickly with timely treatment. Thanks to the measures taken, the baby will recover quickly.

How does chickenpox manifest itself in children? is on our website.

Sudden exanthema. What it is? And how dangerous is it for your child? Learn about it from the video:

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If a red or pink rash appears on the child's skin, it may be an exanthema (see photo). The disease is viral, rarely bacterial origin.

In adults, unlike children, the causes of such a rash are autoimmune or drug-induced, that is, non-infectious. The types, symptoms and features of the treatment of exanthema in children are described below.

What it is?

Exanthema is an infectious pathology that affects infants and children at an early age. After the child has been ill, the body develops lifelong immunity, so the percentage of recurrence or recurrence of the disease is extremely low.

Children's exanthema - symptoms and treatment

Non-infectious exanthema is rarely diagnosed in children. Infectious acute rashes are united by the common official name "sudden exanthema". Its other names are pseudo-rubella, baby roseola.

Sudden exanthema used to be also called the sixth disease, but this concept is outdated. The causative agent is predominantly viruses, and bacteria in about one in five cases. The concept of "sudden exanthema" also applies to the type of roseola caused by the herpes virus type 6.

The viral rash of exanthema is characterized not only by its acute, sudden manifestation, but also by the three-day period of temperature increase preceding this. As soon as the fever passes, rashes appear on the skin.

Viral and allergic exanthems are similar in manifestations, so it is important in diagnosis to recognize and distinguish them. Otherwise, the treatment may be chosen incorrectly, which is fraught with complications.

Types of disease

There are three types of children's exanthema:

1. sudden;
2. viral;
3. Enteroviral as a subtype of viral.

In fact, these are varieties of the same pathology caused by infections, but they are distinguished by the type of pathogen and the nature of the manifestations.

photo of a rash in a child (enlarged)

This pathology of a viral nature affects infants and infants. It is always accompanied by an increase in body temperature, and after its normalization, a rash appears. The rash is maculopapular, similar to rubella.

In adults, this type of exanthema never occurs, therefore, when such signs appear in them, careful differential diagnosis is required.

Sudden exanthema in children owes its name to a sharp, unexpected appearance. But in practice, doctors often call it three-day fever or baby roseola.

The causative agent of the disease is the herpes virus type IV from the genus Roseolovirus (HHV-6) - it is transmitted by contact and airborne droplets. The frequency of morbidity in children is usually higher in autumn and spring.

Once in the body, the virus remains in it for life, remaining in an inactive state in the blood and body fluids. Re-disease does not occur, but an adult can pass the pathogen to a child.

During pregnancy, the mother can transmit the virus to the fetus through the fetoplacenta - from her circulatory system to the child's system. The incubation period of exanthema (hidden) after infection is 10 days.

Symptoms of sudden exanthema in a child

• At the first stage, against the background of a good general condition, the temperature rises;
• In the future, the child becomes irritable, restless;
• The occipital and cervical lymph nodes are enlarged;
• Runny nose, diarrhea, swelling of the upper eyelids and redness of the conjunctiva may appear;
• On the 2-3rd day after the onset of the fever, the temperature begins to subside, the general state of health returns to normal, and at this moment rashes appear on the skin;
• The elements of the rash are small (2-3 mm in diameter), itching is absent;
• Spots are characterized by the disappearance of color when pressed against the skin.

Rashes affect mainly the upper half of the body, the face and stay on the skin for up to 3 days, after which they disappear without a trace. A longer course is characteristic of the erythematous form of exanthema (when an allergy joins).

Complications of childhood roseola are extremely rare and can only be caused by immune disorders.

Viral exanthema in children

In diseases of viral etiology in childhood, exanthema often develops, similar in manifestations to a measles-like drug rash. In its course, papules and red spots on the body can be provoked by:

• Influenza viruses, adenovirus, rhinovirus infection in winter;
• Enteroviral pathogen in the summer;
• Herpetic infection at any time of the year.

Depending on this, viral exanthema in children can manifest itself in different ways, that is, the symptoms depend on the etiology (clinical polymorphism). The main infections and the nature of the rash are presented in the table:

Pathogen	Characteristic symptoms
Enterovirus	Many dense small papules, generalized rash, that is, affecting most of the body, intoxication of the body
Epstein-Barr virus	Measles-like rash, marked swelling of the eyelids, pharyngitis
Rotavirus, rubella	Slightly raised pink spots above the surface of the skin, prone to merging with each other
Adenovirus	Itchy patches, keratoconjunctivitis
Gianotti-Crosti Syndrome	Numerous confluent vesicles arranged asymmetrically on the body
parvovirus B-19	Rash on the cheeks, resembling lace or a fishing net, but the disease is sometimes hidden

A common symptom of exanthema of viral etiology is an increase in regional lymph nodes, which are painless when palpated. A complicated form of viral exanthema in newborns is manifested by febrile convulsive readiness and tension of open fontanelles, which indicates an infection of the brain.

The duration of viral exanthema usually does not exceed 4-5 days. During the course of the disease, the rash may become more intense under the influence of high physical activity, emotional stress, sunlight and hot water.

Enteroviral exanthema

This form of viral exanthema is caused by ECHO viruses. This includes a whole group of intestinal viruses that can cause diarrhea, aseptic meningitis, gastroenteritis, and respiratory diseases.

Enteroviral infectious exanthema is accompanied by fever and symptoms of intoxication. In newborns, it develops as a result of the pathogen entering the body through the placenta from the mother's bloodstream.

Symptoms:

• Fever (39°C and above);
• Signs of intoxication - weakness, nausea and vomiting, headache and muscle pain, drowsiness, diarrhea;
• Diffuse rash that does not have a specific localization on the body.

Rashes often appear after the temperature normalizes, but sometimes with enteroviral exanthema they are combined in time with fever - this is one of the hallmarks. The rash may be:

1. Measles-like - dense papules, rise above the skin, often localized symmetrically, up to 1 cm in size and more;
2. Vesicular - small vesicles up to 3 mm with redness in the center, more often affect the hands and feet, sometimes the tongue and oral mucosa;
3. Petechial - rarely occurs, such spots do not respond to pressure (do not discolor), do not itch, do not form bubbles, crusts and noticeable elevations, sometimes they can fester, disappear after 4 days.

drug exanthema

Such a rash is caused by taking antibiotics and looks like papules, blisters, initially localized in the upper body. Then rashes appear on the skin of the extremities.

A characteristic symptom is itching. If the rash has affected the area around the eyes, there is a high probability of angioedema.

Treatment of exanthema in children, drugs

If there is a suspicion of childhood roseola, you should contact your pediatrician or infectious disease specialist. With exanthema in children, the treatment is as follows:

• Bed rest;
• Drink plenty of fluids to speed up the elimination of toxins;
• Taking antipyretic drugs of the paracetamol group during a fever;
• For infants - frequent attachment to the mother's breast, since milk contains a high percentage of antibodies necessary to fight the disease;
• With exanthema caused by chickenpox, the vesicles are disinfected with brilliant green (1% solution), an aqueous solution of methylene blue (1%), calamine lotion or 5% cycloferon liniment;
• In severe form of enteroviral exanthema in children, glucocorticoid agents are prescribed for oral administration (Prednisolone 40 mg per day for seven days);
• With sudden exanthema (herpes origin), oral administration of Acyclovir 1 g once a day is indicated;
• Antihistamines are needed only in the presence of itching and allergies, which are extremely rare with children's exanthema.

It is important to observe the quarantine regime, as a child with a rash is contagious. The same condition is the basis for the prevention of infection.

Forecast

If there are no autoimmune disorders, the treatment of the disease ends with a complete recovery - the prognosis of the exanthema is favorable. Having been ill once, the child acquires strong immunity for life.