Seminar: Viral rash diseases in children

Clinical classes: Physical examination, differential diagnosis, and management of viral infections presenting with skin manifestations.

Time: 4 hours (8:00 AM – 12:00 PM)

Goal

To recognize common viral exanthems in children, understand their etiology and clinical course, and develop the ability to distinguish viral rashes from bacterial infections, allergic reactions, and other potentially serious pediatric conditions.

Before the class

Students should revise:

• Basic morphology of skin lesions.
• Principles of viral pathogenesis and immune responses.
• Basic virology of herpesviruses, enteroviruses, parvovirus B19, rubella and measles virus.
• Principles of active and passive immunization.
• Clinical examination of the skin and mucous membranes.

Topics

1. Varicella (chickenpox)

1.1. Etiology and transmission of varicella-zoster virus (VZV).

1.2. Clinical presentation and characteristic evolution of skin lesions.

1.3. Complications, including bacterial superinfection, pneumonia, and neurological complications.

1.4. Indications for antiviral treatment.

1.5. Prevention, vaccination, and post-exposure prophylaxis.

1.6 Shingles: clinical presentation, treatment.

2. Erythema infectiosum (fifth disease)

2.1. Parvovirus B19 infection.

2.2. Characteristic clinical presentation.

2.3. Complications in patients with hematological disorders, immunodeficiency, and during pregnancy.

3. Roseola infantum (sixth disease)

3.1. HHV-6 and HHV-7 infections.

3.2. Clinical features and typical fever-rash sequence.

3.3. Febrile seizures and other complications.

4. Measles

4.1. Clinical course and characteristic manifestations.

4.2. Koplik spots and the evolution of the rash.

4.3. Complications, including pneumonia and encephalitis.

4.4. Laboratory confirmation.

4.5. Isolation precautions and prevention through vaccination.

5. Hand, foot and mouth disease (HFMD)

5.1. Etiology: enteroviruses, including Coxsackieviruses and EV-A71.

5.2. Typical and atypical clinical manifestations.

5.3. Potential neurological complications.

5.4. Symptomatic treatment and prevention.

6. Herpes simplex virus infections

6.1. Primary herpetic gingivostomatitis.

6.2. Recurrent mucocutaneous HSV infections.

6.3. Eczema herpeticum.

6.4. Indications for antiviral treatment.

7. Rubella

7.1 Clinical course and characteristic manifestations. How is it different from measles?

7.2 Laboratory confirmation

7.3 Prevention through vaccination

7.4 Congenital rubella syndrome

8. Differential diagnosis of pediatric exanthems

8.1. Maculopapular, vesicular, petechial, and purpuric lesions.

8.2. Viral versus bacterial exanthems.

8.3. Drug-related skin eruptions.

8.4. Noninfectious inflammatory diseases presenting with fever and rash (Kawasaki disease, PIMS/MIS-C, HLH, serum-like sickness, erythema multiforme, SJS, TEN).

9. Clinical quiz: recognition and differential diagnosis of viral exanthems

Identification of common viral exanthems based on clinical photographs and brief case presentations, with particular emphasis on characteristic skin lesions, associated symptoms, and differential diagnosis.

Topics' details

Students should be able to explain or discuss:

• The characteristic appearance and distribution of skin lesions in common viral infections.
• The temporal relationship between fever and rash in different viral exanthems.
• Differences between vesicular, maculopapular, petechial, and purpuric rashes.
• How to differentiate chickenpox from HFMD and other vesicular eruptions.
• Clinical features distinguishing erythema infectiosum from roseola infantum.
• Recognition of measles and its major complications.
• How to differentiate measles from rubella.
• Clinical presentations and complications of enterovirus infections.
• Recognition of potentially severe HSV infections.
• Indications for antiviral therapy and supportive treatment.
• When laboratory confirmation of a viral infection is necessary.
• Infectious periods and appropriate isolation precautions.
• The role of vaccination and post-exposure prophylaxis.
• Warning signs suggesting invasive bacterial infection or other serious diseases in children with fever and rash.

Clinical skills

During clinical classes, students should practice:

• Describing skin lesions using appropriate medical terminology.
• Performing a focused examination of a child presenting with fever and rash.
• Identifying characteristic viral exanthems from clinical images and case presentations.
• Formulating a differential diagnosis based on the morphology and distribution of lesions.
• Selecting appropriate diagnostic tests and management strategies.