PANCE Blueprint Infectious Disease (6%)

Erythema infectiosum (Slapped Cheek/ReelDx + Lecture)

600 REEL-DX-ENHANCED

Fifth disease ReelDx

Patient will present as → a 4-year-old who is brought to the office by his mother. The child has had a low-grade fever, headache, and sore throat for the past week. Four days ago, he suddenly developed a bright red rash on his cheeks, which during the past 2 days has spread to the trunk, arms, and legs. On physical examination, the child has erythema of the cheeks and a maculopapular rash with central clearing on the trunk spreading to the extremities. There are no other significant findings.

Erythema infectiosum is a common viral exanthem observed in pediatric patients caused by parvovirus B-19.

  • Slapped cheek rash on the face with circumoral pallor 2-4 days of lacy reticular rash on extremities.
  • Often preceded by no prodrome sequence, with low-grade fever at most.
  • Sickle cell patients are at high-risk of developing aplastic crises with this disease.

Diagnosis is based primarily on clinical observations, history, and physical exam

  • Serology: associated with enlarged nuclei with peripherally displaced chromatin
  • PARVO B19-specific IgM antibodies and PCR
In the first stage, a bright red rash appears on the cheeks and forehead with circumoral pallor.

In the first stage, a bright red rash appears on the cheeks and forehead with circumoral pallor.

Observation alone

  • Treatment is symptomatic
  • The rash may last a few days to several weeks. It is frequently pruritic
  • There is no specific antiviral used and no vaccine is available
osmosis Osmosis

(Erythema infectiosum lecture begins at 1:15)

IM_NUR_EythemaIfectiosumFifthsDisease_v1.2_ Erythema infectiosum or Fifth's Disease is a mild viral infection that is characterized by the slapped face appearance. It typically occurs in school-age children; however, adults can contract the disease. Pain and swelling in the joints (polyarthropathy syndrome) is a common finding in adult women with the disease. It is transmitted by respiratory secretions, blood, and blood products. The period of communicability is uncertain and the incubation period is 4 to 14 days and may be as long as 21 days. Isolation is not necessary.

View Fifth's Disease Picmonic

 

Question 1
Which of the following is responsible for the skin lesion shown in the video above?
A
Staphylococcus
Hint:
See B for explanation
B
Parvovirus-B19
C
Herpes simplex virus
Hint:
See B for explanation
D
Cytomegalovirus
Hint:
See B for explanation
Question 1 Explanation: 
The skin lesion is the classic ‘slapped-cheek’ appearance of erythema infectiosum caused by Parvovirus-B19
Question 2
Parvovirus-B19 is unlikely to cause aplastic crisis in which of the following conditions
A
Sickle cell anemia
Hint:
See B for explanation
B
Megaloblastic anemia
C
Thalassemia
Hint:
See B for explanation
D
G6PD deficiency
Hint:
See B for explanation
Question 2 Explanation: 
Parvovirus-B19 causes aplastic crisis in patients with chronic hemolytic anemia. Megaloblastic anemia is not associated with chronic hemolysis. All other options are associated with chronic hemolysis.
Question 3
One of the following cross-matches is correct?
A
Lyme disease ------------- Erythema marginatum
Hint:
Lyme disease ------------- Erythema migrans
B
Rheumatic fever ------------- Erythema nodosum
Hint:
Rheumatic fever ------------- Erythema marginatum
C
Parvovirus-B19 --------------- Erythema infectiosum
D
Infectious mononucleosis ------------ Erythema migrans
Hint:
Infectious mononucleosis ------------ Erythema nodosum
Question 3 Explanation: 
A: Lyme disease ------------- Erythema migrans B: Rheumatic fever ------------- Erythema marginatum C: Infectious mononucleosis ------------ Erythema nodosum
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Epstein-Barr virus infections (ReelDx + Lecture) (Prev Lesson)
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