Viral exanthems

doi:10.1016/0045-9380(83)90002-6

Current Problems in Pediatrics

Volume 13, Issue 6, April 1983, Pages 5-44

https://doi.org/10.1016/0045-9380(83)90002-6 Get rights and content

Abstract

In this monograph I have tried to present several aspects of viral exanthematous diseases that allow for diagnosis. With a systematic approach to the diagnosis, the physician frequently can make a specific diagnosis and nearly always can assign illness to the correct category. Accurate diagnosis is useful because it prevents unnecessary therapy and apprehension in some patients, allows definitive therapy in others, and, most important, it is fun and scientifically rewarding for the physician.

References (30)

J.D. Cherry et al.
A clinical and serologic study of 103 children with measles vaccine failure
J. Pediatr.
(1973)
J.D. Cherry et al.
Atypical measles in children previously immunized with attenuated measles virus vaccines
Pediatrics
(1972)
M.A. Strassburg et al.
Rubella outbreak among hospital employees
Obstet. Gynecol.
(1981)
A.M. Lerner et al.
Infections due to coxsackievirus group A, type 9, in Boston, 1959, with special reference to exanthems and pneumonia
N. Engl. J. Med.
(1960)
J.D. Cherry
Newer viral exanthems
J.D. Cherry
Cutaneous manifestations of systemic infections
H.A. Wenner
Virus diseases associated with cutaneous eruptions
Prog. Med. Virol.
(1973)
H.A. Wenner et al.
Virus diseases associated with cutaneous eruptions
Prog. Med. Virol.
(1963)
W.H. McNeill
Plagues and Peoples
W.H. McNeill
Plagues and Peoples
R.E. Hope-Simpson et al.
A respiratory virus study in Great Britain: Review and evaluation
Prog. Med. Virol.
(1969)

J.D. Cherry et al.

Exanthem and enanthem associated with mumps virus infection

Arch. Environ. Health

(1966)

J.D. Cherry

Measles

J.D. Cherry

Rubella

Cherry J.D.: Contemporary infectious exanthems of children and adults, in Meyer R.D. (ed.): Infectious Diseases. New...

P.A. Brunell

Varicella-zoster infections

Cited by (23)

Herbal-based resources against exanthematous viral infections and other viral diseases
2022, Coronavirus Drug Discovery: Druggable Targets and In Silico Update: Volume 3
Infectious diseases can involve virtually every organ and every part of the body in humans. There are few infectious illnesses that have become almost synonymous with the term childhood disease. These illnesses occur mostly in children, and one bout of infection usually provides life-long immunity. Such infectious diseases that mostly belong to childhood often categorized as the exanthematous viral infections. These diseases are chickenpox, German measles, measles, and other similar viral infections which when reported produces skin eruptions and mumps. Despite several types of research and progress made in science for immunization and drug development against them, many of the viruses lack preventive vaccines and efficient antiviral therapies, which are often affected by the generation of viral escape mutants. Thus, identifying plant-based natural novel antiviral drugs is of critical importance. An attempt has been in the present communication to provide one-placed studies on plants that could provide preventive measures against viral infections and also help the researchers to look for plant-based curative measures for viral infections occurring in humans.
Oral and cutaneous manifestations of viral and bacterial infections: Not only COVID-19 disease
2021, Clinics in Dermatology
Citation Excerpt :
Typical herpangina-like lesions in the whole mouth, except for the posterior aspect of the pharynx, are detected in CV-A16 or A5 infections, whereas vesicular pharyngitis may occur in CV-B5. CV-A9 and CV-A4 are rarely associated with herpangina-like lesions in the mouth.32,33 Enteroviruses may also produce a maculopapular eruption or HFMD, often associated with systemic symptoms.7,34,35
Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.
T Lymphocytes as Measurable Targets of Protection and Vaccination Against Viral Disorders
2019, International Review of Cell and Molecular Biology
Citation Excerpt :
An exanthem is a widespread eruptive skin rash that may be associated with fever or other systemic symptoms. More than 50 infectious agents causing exanthems have been identified (Cherry, 1983), where more than 70% of recorded cases of combined fever and widespread rash in pediatric populations were caused by viral infections, relative to the 20% resulting from bacterial infections (Goodyear, Laidler, Price, Kenny and Harper, 1991). Correct diagnosis of these skin manifestations, resulting from direct inoculation of the infectious agent onto the cutaneous surface, or by dissemination from a distant site, is a main research theme on viral exanthems.
Continuous epidemiological surveillance of existing and emerging viruses and their associated disorders is gaining importance in light of their abilities to cause unpredictable outbreaks as a result of increased travel and vaccination choices by steadily growing and aging populations. Close surveillance of outbreaks and herd immunity are also at the forefront, even in industrialized countries, where previously eradicated viruses are now at risk of re-emergence due to instances of strain recombination, contractions in viral vector geographies, and from their potential use as agents of bioterrorism. There is a great need for the rational design of current and future vaccines targeting viruses, with a strong focus on vaccine targeting of adaptive immune effector memory T cells as the gold standard of immunity conferring long-lived protection against a wide variety of pathogens and malignancies. Here, we review viruses that have historically caused large outbreaks and severe lethal disorders, including respiratory, gastric, skin, hepatic, neurologic, and hemorrhagic fevers. To observe trends in vaccinology against these viral disorders, we describe viral genetic, replication, transmission, and tropism, host-immune evasion strategies, and the epidemiology and health risks of their associated syndromes. We focus on immunity generated against both natural infection and vaccination, where a steady shift in conferred vaccination immunogenicity is observed from quantifying activated and proliferating, long-lived effector memory T cell subsets, as the prominent biomarkers of long-term immunity against viruses and their associated disorders causing high morbidity and mortality rates.
The challenge of diagnosing atypical exanthems: A clinico-laboratory study
2012, Journal of the American Academy of Dermatology
Citation Excerpt :
Infectious etiology, especially from viral infection, was more prevalent in the spring/summer (χ2 = 10.32, P = .0013); notably, exanthems due to bacterial infections were more frequent in the fall/winter (χ2 = 10.771, P = 0.0010). Picornavirus infections showed a summer prevalence, confirming earlier findings by Cherry,8,9 the group of Goodyear et al,4 and our own group.2 Fourth, it was important to note the body area affected by the exanthem.
Although atypical exanthems pose a severe diagnostic challenge, they have not been studied widely.
To identify the clinical features, laboratory parameters and other characteristics that help establish the etiology of atypical exanthems.
We collected the following information from 260 consecutive patients with atypical exanthems, including 108 children and 152 adults: demographic data, exanthem and enanthem morphology, clinical symptoms, month of outbreak and total duration. Throat, rectal, and vesicle swabs as well as urine and skin samples were examined for bacterial and viral signs. Serologic studies were performed for the most common infectious agents.
Seven morphological patterns were identified: macular erythema, papular erythema, macular-papular erythema, erythematovesicular, macular-papular erythema with petechiae, erythema with pustules, and urticarial. Ninety-four cases were due to viruses, 38 to bacteria, 65 to drugs, 3 to parasites, and one to viruses-plus-drugs. Nineteen of the 25 cases with a petechial pattern had an infectious etiology (12 viral and 7 bacterial) and only 4 were iatrogenic. Sixty-one of 69 patients with enanthems were infectious (57 viral and 4 bacterial), 6 were iatrogenic, and 2 remained undiagnosed. The petechial pattern was infectious in 80% of cases (14 viral and 2 bacterial). Four cases were iatrogenic. During the spring and summer, 60% of exanthems were infectious and 21% were iatrogenic. Picornavirus infections exhibited summer prevalence (57%), peaking in July.
There were a variable number of patients with each of the morphological patterns.
Morphological patterns, seasonal occurrence, and enanthem are key for etiological diagnosis of atypical exanthems.
Pediatric exanthems
2000, Primary Care - Clinics in Office Practice
Diseases of the oral mucous membranes
1996, Current Problems in Dermatology
Many systemic diseases have manifestations on the oral mucous membranes. In this review, we discuss a prototypical disease, lichen planus (LP), in detail. Oral lichen planus (OLP) is common, affecting 1% to 2% of the population. At least one third of these patients have LP skin disease. LP is intriguing to immunologists because of its clinical and histopathologic resemblance to chronic graft-versus-host reaction, systemic drug reactions, and allergic contact stomatitis to metals used in dental restorations. More recently, OLP, particularly the severe, recalcitrant, erosive type, has been associated with chronic hepatitis C infections and internal neoplasms such as thymoma and lymphoma. Lichen planus pemphigoides is a disease with coexisting features of both LP and bullous pemphigoid (BP). Most patients have an autoantibody directed against the 180 kDa minor BP hemidesmosomal antigen, but some patients also react to a unique 200 kDa antigen. Cicatricial pemphigoid (CP) is similar, in that the primary lesion is a subepithelial blister, but the oral and ocular mucous membranes are predominantly affected, with a tendency toward scarring. In CP, the autoantigens are heterogeneous; in about half of the cases, the 180 or 230 kDa BP antigens (or both) are identified in the lamina lucida. Some patients react to an antigen in the lower lamina lucida overlying the lamina densa, which corresponds to epiligrin, and more specifically, the 165 kDa α subunit of laminin 5. Pemphigus vulgaris (PV) and paraneoplastic pemphigus (PNP) are true autoimmune diseases, because the circulating antibodies are believed to be pathogenic. The prognosis for PV has improved dramatically since the corticosteroid era, but ~10% of patients still die of disease or complications of therapy. The PV antigen is a 130 kDa cadherin in the desmosome of epithelial cells. Interference with its function or assembly causes cells to separate and form acantholytic cells and intraepithelial blisters. PNP is usually associated with lymphoproliferative malignancies and demonstrates an array of autoantibodies directed against antigens of the adhering junctions: desmoplakins, PV antigen and other desmosomal proteins, and the major BP antigen. The mortality of PNP is >90% because of the combination of neoplasia and severe mucocutaneous disease. The treatment for all of the foregoing diseases includes corticosteroids in one of the forms, topical or systemic, with or without steroid-sparing agents, mainly dapsone, azathioprine, cyclophosphamide, and cyclosporine. The remainder of the essay is devoted to a brief discussion of selected developmental diseases that are rare but of extreme importance because of pathognomonic oral or cutaneous manifestations and sometimes “preventable” consequences, for example, dyskeratosis congenita (oral cancer); Papillon-LeFèvre syndrome (loss of teeth); nevoid basal cell carcinoma syndrome (skin cancer); and Cowden's syndrome (breast cancer). Finally, a list of common infectious diseases occurring in both the normal and HIV-infected population is considered, followed by the unique associations of Kaposi's sarcoma and non-Hodgkin's lymphoma in patients with AIDS that may be the consequence of a new human herpes virus and Epstein-Barr virus, respectively.

View all citing articles on Scopus

View full text

Viral exanthems

Abstract

J. Pediatr.

Pediatrics

Obstet. Gynecol.

N. Engl. J. Med.

Newer viral exanthems

Cutaneous manifestations of systemic infections

Virus diseases associated with cutaneous eruptions

Prog. Med. Virol.

Virus diseases associated with cutaneous eruptions

Prog. Med. Virol.

Plagues and Peoples

Plagues and Peoples

A respiratory virus study in Great Britain: Review and evaluation

Prog. Med. Virol.

Exanthem and enanthem associated with mumps virus infection

Arch. Environ. Health

Measles

Rubella

Varicella-zoster infections