PEDIATRICS
SYMPTOMS/EXAM
■ Usually ill appearing with high fevers (up to 104°F) and malaise
■ Rapid progression to coryza, cough, and conjunctivitis
■ Maculopapular rash characteristically starts on upper body and progresses
downward, becoming coalescent (see Figure 5.7).
■ Associated enanthem: Fine white spots on erythematous background
(Koplik’s spots) appear on buccal mucosa (see Figure 5.8).
DIAGNOSIS
■ Clinical diagnosis
■ Confirmation is suggested by testing serum for IgM antibody (detectable
for 1 month after rash onset) or viral cultures of urine, blood, throat, or
nasopharyngeal specimens.
TREATMENT
■ Supportive care is indicated. Vitamin A supplementation in select cases
may be associated with decreased morbidity and mortality.
COMPLICATIONS
■ Most common bacterial complication is acute purulent otitis media.
■ Bronchopneumonia, croup, diarrhea, acute encephalitis, and SSPE (suba-
cute sclerosing panencephalitis)
RUBELLA
Rubella is also known as German measles. Caused by a togavirus, it is an
important cause of congenital infection.
SYMPTOMS
Typically associated with a rash that begins on the face and spreads downward
on the body (see Figure 5.9)
EXAM
■ Tender lymphadenopathyis common.
■ Low-grade fevers < 39.0°C are common during the first few days.
DIAGNOSIS
■ Clinical diagnosis
■ Serologic confirmation only in select cases (eg, pregnant adolescent patient)
TREATMENT
Supportive care and antipyretics
ERYTHEMAINFECTIOSUM(FIFTHDISEASE)
Causative agent is parvovirus B19