Every day, local pediatricians in their practice encounter various skin rashes in children. One of the pathologies that is accompanied by the appearance of a skin rash is exanthema.
What it is?
An acute reaction of a child's body in response to various infections with the appearance of a rubella-like rash on the skin is called exanthema. The prevalence of this childhood disease throughout the world is quite high. Infectious exanthema can occur in both boys and girls. Doctors register quite a lot of cases of the disease in newborns and infants.
Most often in pediatric practice, sudden exanthema occurs. Its incidence peaks between 2 and 10 months of age.
The first adverse signs occur even in the youngest patients. A specific skin rash usually appears after a very high fever.
Such an acute reaction of the child’s body is due to a strong immune response to the penetration of an infectious pathogen into it.
Older children and adolescents suffer from this disease much less frequently. In adults, infectious exanthemas practically do not occur. Such a high incidence in children is associated with the special functioning of their immune system. The immunity of some babies reacts to various infections quite violently and vividly, which is accompanied by the appearance of specific symptoms of the disease on the skin.
Many years ago doctors used the term "six day illness" That's what they called sudden exanthema. The essence of this definition is that the clinical symptoms of the disease completely disappear in the sick child on the sixth day. This name is not currently used. In some countries, doctors use different terminology. They call sudden exanthema infantile roseola, pseudorubella, 3-day fever, roseola infantum.
There is also another, quite common form of the disease called Boston exanthema. This is an acute pathological condition that occurs in babies as a result of ECHO infection. During the course of the disease, the child develops a macular-like rash, high fever, and severe symptoms of intoxication syndrome. Scientists have already identified the causative agents of the disease. These include some subspecies of ECHO viruses (4,9,5,12,18,16) and less commonly Coxsackie viruses (A-16, A-9, B-3).
With Boston exanthema, pathogens enter the baby's body through airborne droplets or through the nutritional route (along with food). Cases of Boston exanthema in newborns have been described. In this case, the infection occurred in utero.
Scientists say that the lymphogenous spread of viruses also takes an active part in the development of Boston exanthema.
Causes
Scientists identified the causative agent of sudden exanthema at the end of the 20th century. It turned out to be herpes virus type 6. This microorganism was first discovered in the blood of examined people who suffered from lymphoproliferative diseases. The herpes virus has its main effect on specific cells of the immune system - T-lymphocytes. This contributes to the fact that significant disturbances in the functioning of the immune system occur.
Currently, scientists have received new results from scientific experiments, which indicate that the herpes virus type 6 has several subtypes: A and B. They differ from each other in their molecular structure and virulent properties. It has been scientifically proven that sudden viral exanthema in babies is caused by the herpes virus type B. Viruses of subtype A can also have a similar effect, but there are currently no confirmed cases of the disease. After viruses enter the body, processes of a violent immune response are launched, which in some cases proceeds quite violently.
The inflammatory process leads to severe swelling of collagen fibers, dilation of blood vessels, pronounced cellular proliferation, and also contributes to the development of characteristic rashes on the skin.
Scientists have identified several reasons that can cause signs of infectious exanthems in a child. These include:
What happens in the body?
Most often, babies become infected from each other through airborne droplets. There is another variant of infection - contact-household infection. Doctors note some seasonality in the development of this disease in children. The peak incidence of infectious exanthems usually occurs in spring and autumn. This feature is largely due to decreased immunity during seasonal colds.
Microbes that enter a child's body contribute to the activation of the immune response. It should be noted that after suffering a type 6 herpes infection, many children have strong immunity. According to statistics, Most often, infants of the first year of life and children under three years of age are affected. American scientists conducted scientific studies in which they showed that the majority of apparently healthy people examined have antibodies to herpes virus type 6 in their blood. Such a high prevalence indicates the importance of studying the process of formation of infectious exanthems at different ages.
Sources of infection are not only sick babies. They can also become adults who are carriers of the herpes virus type 6.
Doctors believe that infection with this herpetic infection occurs only if the disease is in an acute stage, and a person releases viruses into the environment along with biological secretions. Large concentrations of microbes are usually found in blood and saliva.
When viruses enter a child’s body and affect T-lymphocytes, a whole cascade of inflammatory immune reactions is triggered. First, the child develops Ig M. These protective protein particles help the child’s body recognize viruses and activate the immune response. It is important to note that in newborn babies who are breastfed, the Ig M level is significantly higher than that of children receiving artificially adapted formulas as food.
After 2-3 weeks from the onset of the disease, the baby develops other protective antibodies - Ig G. An increase in their concentration in the blood indicates that the child’s body has “remembered” the infection and now “knows it by sight.” Ig G can remain for many years, and in some cases even a lifetime.
The peak increase in their concentration in the blood is usually the third week from the onset of the disease. These specific antibodies are quite easy to detect. For this purpose, special serological laboratory tests are performed. To carry out such an analysis, venous blood is first taken from the baby. The accuracy of the laboratory test result is usually at least 90-95%.
For a long time, scientists were concerned about the question of whether repeated reinfection (infection) with the virus is possible. In order to find the answer, they conducted quite a lot of scientific research. Experts have discovered that herpes virus type 6 can infect and persist in monocytes and macrophages of a wide variety of body tissues for quite a long time.
There are even studies confirming that microbes can manifest themselves on bone marrow cells. Any decrease in immunity can lead to reactivation of the inflammatory process.
Symptoms
The appearance of a skin rash in babies is preceded by an incubation period. For sudden exanthema it is usually 7-10 days. At this time, as a rule, the baby does not show any signs of illness. After the end of the incubation period, the child's temperature rises significantly. Its values can reach 38-39 degrees. The severity of the increase in temperature can vary and depends mainly on the initial condition of the child.
Very young children usually suffer from the disease quite seriously. Their body temperature rises to febrile levels. Against the background of severe febrility, the child, as a rule, develops fever and severe chills. Children become easily excitable, whiny, and have difficulty communicating even with close relatives. The baby's appetite also suffers. During the acute period of illness, children usually refuse to eat, but may beg for “sweets.”
The baby develops a pronounced increase in peripheral lymph nodes. Most often, the cervical lymph nodes are involved in the process; they become dense to the touch and adhere to the skin. Palpation of enlarged lymph nodes may cause pain in the child. The baby develops severe nasal congestion and runny nose. It is usually slimy and watery. The eyelids swell, the baby's facial expression takes on a somewhat gloomy and painful appearance.
When examining the pharynx, you can notice moderate hyperemia (redness) and looseness of the posterior wall. In some cases, specific areas of maculopapular rash appear on the upper palate and uvula. Such lesions are also called Nagayama's spots. After some time, the conjunctiva of the eyes becomes injected. The eyes look painful, in some cases they may even water.
Usually, 1-2 days after the onset of high fever, a characteristic sign appears in the child - roseola rash. As a rule, it does not have a specific localization and can occur in almost all areas of the body. During a skin rash, the child's temperature continues to rise. In some cases it rises to 39.5-41 degrees.
However, a distinctive feature of febrility during infectious exanthema is that the baby practically does not feel it.
During the entire period of high body temperature, the child’s well-being does not suffer much. Many babies remain active despite persistent fever. Usually the temperature returns to normal by 4 or 6 days from the onset of the disease. Infectious sudden exanthema is a very mysterious disease. Even the absence of treatment leads to the child’s condition returning to normal on its own.
The rash usually spreads throughout the body when the temperature drops. Skin rashes begin to spread from the back to the neck, arms and legs. The eruptive elements can be different: maculopapular, roseolous or macular. A separate skin element is represented by a small red or pink spot, the size of which is usually does not exceed 3 mm. When you press on such elements, they begin to turn pale. As a rule, the eruptive elements in infectious exanthemas do not itch and do not bring any discomfort to the child. It should also be noted that the skin rashes practically do not merge with each other and are located at some distance from each other.
In some babies, the rash also appears on the face. Typically, the rash remains on the skin for 1-3 days, after which it disappears on its own. As a rule, there are no traces or residual effects on the skin. In some cases, only slight redness may remain, which also goes away on its own without any special treatment.
It should be noted that infectious exanthema in children under three years of age is much milder than in older children. Doctors note the most severe course of this pathological condition in adolescents.
Their body temperature rises greatly and their health deteriorates significantly. Paradoxically, infants tolerate high fever with infectious exanthema much easier than schoolchildren.
What does exanthema look like in a baby?
Infants under one year of age often develop specific symptoms of this disease. The appearance of a skin rash causes real confusion for parents. A child's high body temperature makes them think about a viral infection. This leads to frightened parents urgently calling a doctor to their home. The doctor usually diagnoses a viral infection and prescribes appropriate treatment, which does not save the baby from developing rashes on the skin.
Infectious exanthema is a specific manifestation of an altered reaction of the immune system in response to exposure to a pathogen. If the baby has individual hypersensitivity, skin rashes will occur even with the use of special antiviral drugs. Many parents ask a reasonable question: is it worth treating? It’s definitely worth helping a child’s body fight infection.
Infectious exanthema in a newborn child does not have pronounced clinical features. 1-2 days after the high temperature, the baby also develops skin rashes. The skin of infants is quite tender and loose. This leads to the rash spreading throughout the body quite quickly. After a day, skin rashes can be found on almost all parts of the body, including the face.
The child’s well-being during periods of high temperature suffers slightly. Some babies may refuse breastfeeding, however, most babies continue to actively eat. One of the manifestations of infection in infants is often the appearance of diarrhea. Usually this symptom is transient and completely disappears when the temperature normalizes.
The course of the disease in a child under three years of age is most favorable. Recovery usually occurs 5-6 days from the moment the first adverse symptoms appear.
Many children have strong immunity for the rest of their lives after suffering from an illness. Only in a small number of cases do repeated cases of reinfection occur.
Doctors believe that the trigger point for an exacerbation in such a situation is a decrease in immunity.
Treatment
Infectious exanthema is one of the few childhood diseases that have the most favorable prognosis. Usually it proceeds quite easily and does not cause any long-term consequences or complications of the disease in the child. Doctors note a severe course of the disease only in children with pronounced manifestations of immunodeficiency states. In this case, to eliminate unfavorable symptoms, such children are given a mandatory course of immunostimulating therapy. This specific treatment is prescribed by a pediatric immunologist.
For children suffering from infectious exanthema, doctors offer a number of recommendations to help improve the child’s well-being and speed up his recovery. They recommend that the entire acute period of the disease, especially from the moment the rash appears on the skin, the child must spend time at home. If the body temperature is high, the baby is prescribed bed rest. Active walks outside at this time should be postponed until recovery.
During severe fever, do not wrap the child too tightly. This only contributes to severe overheating of the baby and disrupts the process of protective natural thermoregulation. Fever with infectious exanthema is therapeutic in nature. It helps the child's body fight viruses. Choose comfortable warm clothes for your child that will protect the baby from hypothermia.
Doctors' opinions on hygiene procedures are divided. Some experts believe that bathing a baby with infectious exanthema is possible and even helps the child begin to feel much better. Other pediatric doctors recommend postponing bathing for several days until body temperature normalizes. The choice of tactics remains with the attending physician who is observing the baby. However, daily toileting of a child can be done without any restrictions.
Prescription of special antiviral drugs for the treatment of infectious exanthema in children is not required. This condition will go away on its own in a few days.
It is only important to note that, despite the favorable prognosis for the course of the disease, the baby’s condition should be carefully monitored. If you feel worse, you should definitely consult your doctor.
Prevention
Unfortunately, scientists have not developed specific prevention of infectious exanthema at present. As nonspecific preventive measures, doctors recommend observing all the rules of personal hygiene and avoiding any contact with feverish and sick people. During mass outbreaks of infectious diseases in children's educational institutions, quarantine must be introduced. Such measures will significantly reduce the possibility of infection with viral infections and will help prevent the appearance of signs of infectious exanthema on the baby’s skin.
Any rash that appears on the skin is called exanthema. That is, any spots, blisters, bubbles of different shapes and quantities - this is an exanthema. It can occur in people of any age.
Exanthema in children is a skin rash that appears due to various diseases. It can be infectious or non-infectious. It is not uncommon for children to have viral exanthema, that is, the rash will be a manifestation of a viral infection. Less commonly, rashes are caused by bacteria, allergic reactions, and blood and vascular diseases. Sudden exanthema is the most common viral exanthema.
The causative agents of viral exanthems are transmitted with particles of saliva through the air, household items, handshakes, and also through contaminated water.
If the rash appears on the mucous membranes - in the mouth, eyes, mucous membranes of the genital organs, then it is called enanthema. Very often exanthema and enanthema are combined with each other.
Why does exanthema appear?
The mechanism for the appearance of exanthema, naturally, depends on the cause that causes it. But there are also general reactions of the body.
When a certain virus or allergen enters the body, the immune system is activated. Her cells are trying to neutralize the foreign agent. As a result of complex interactions, a rash appears. A virus or allergen can act directly on the skin, affecting its elements.
With a bacterial infection, the toxins produced by the bacterial cell also play a large role in the development of exanthema. They affect the cells of the immune system, skin, and blood vessels.
With blood diseases, viral and bacterial infections, blood cells will be destroyed in the small vessels of the skin, causing them to become blocked. The walls of the capillaries become brittle and brittle and are easily damaged. As a result, rashes will appear on the skin.
What diseases are characterized by exanthema?
At the beginning of the twentieth century, it was customary for the medical community to designate childhood exanthemas by numbers. Scarlet fever and measles were considered the “first” and “second” diseases. Rubella was called the “third” disease. Infectious mononucleosis, or the “fourth” disease, was identified somewhat later. The “fifth” disease is erythema infectiosum caused by parvovirus B 19. The “sixth” disease, or roseola, completes the list.
The list of viruses that can cause a reaction in the form of exanthema goes on. These include herpes viruses, ECHO viruses and many others. It can be triggered even by harmless rhinoviruses - the most common pathogens of ARVI.
Of the bacterial diseases that occur with exanthema, the most significant is meningococcal infection, which can even take the life of a baby. The well-known scarlet fever can be cured on its own, but it is dangerous due to complications on the kidneys and joints.
Among non-infectious exanthems, allergic skin reactions, in particular to medications, are common. Vasculitis, or inflammation of blood vessels, occurs in response to an allergic reaction, the action of infectious agents or cells of the own immune system. The disease is accompanied by a characteristic exanthema.
Clinical picture
The changes that parents see on the skin of their baby will depend on the causative agent of the infection, if the cause of the exanthema is it. In addition to the rashes, symptoms characteristic of a viral or bacterial infection will be added.
Exanthema due to allergies or vascular diseases also has its own specific features. Diseases have their own symptoms that are different from infections.
Scarlet fever is a bacterial infectious disease that is caused by group A beta-hemolytic streptococcus. These bacteria initially affect the mucous membranes of the pharynx. The child gets a sore throat or... Later, they release a toxin that travels through the blood vessels into the capillaries of the skin, causing exanthema.
Treatment of exanthems
Viral exanthemas go away on their own; it only takes time for the rash to completely disappear. You can treat only the accompanying symptoms: reduce high fever, drink a lot, ease nasal breathing and sore throat.
Bacterial exanthemas require antibiotic treatment. For meningococcal infection, it should be prescribed immediately after the baby has been examined by a doctor. Treatment of meningococcal infection should be carried out only in a hospital setting; the child may have to stay in intensive care for some time.
With timely treatment, the chances of survival are 80–90%. Vaccinations against meningococcal infection have been developed. Unfortunately, vaccination is not included in the national vaccination schedule, but the vaccine is available in pharmacies.
In scarlet fever, an antibiotic is needed to prevent serious complications on the kidneys, joints, and heart.
Allergic exanthemas are treated by prescribing a special diet and antihistamines. Topical creams and ointments can be used to reduce itching. It is imperative to identify the cause of the allergic reaction.
For vascular diseases, it is important to prescribe drugs that normalize blood clotting, as well as drugs that act on the immune system. This will avoid serious complications in the internal organs.
Conclusion
Most often, the cause of exanthema is a variety of viral infections, which the body can easily cope with on its own. It is important for parents to know their symptoms and not panic when rashes appear. You should also not associate any rash with an allergy.
This leads to unnecessary medications and expensive tests being prescribed. But if, with the appearance of exanthema, the child’s condition has sharply worsened, you should immediately consult a doctor to avoid the most negative consequences.
Keywords: children, viral diseases, exanthema, enanthema
Key words: children, viral infections, rash, enanthema
In everyday practice, pediatricians often have to deal with various changes in the skin of patients. According to statistics, various skin lesions are the cause of almost 30% of all visits to the pediatrician. Sometimes these are only dermatological problems, sometimes the rashes are manifestations of an allergic or somatic pathology, but recently the percentage of dermatological manifestations of infectious diseases has increased significantly. In other words, infectious exanthema syndrome is firmly established in our practice and requires a certain awareness, since sometimes it is one of the main diagnostic signs that allows us to make a timely diagnosis and avoid serious consequences.
Exanthems are one of the most striking and significant symptoms in diagnostic and differential diagnostic terms. They occur in many infectious diseases, which are even called exanthematous (measles, rubella, scarlet fever, typhoid and typhus, chicken pox, herpetic infections). With them, the rash is an obligatory component of the clinical picture of the disease; the diagnostic process unfolds around it, and the differential diagnosis is based on it. There is also a group of infections in which a rash occurs, but it is not permanent and ephemeral. This kind of exanthema is possible with many viral infections (entero- and adenovirus, CMV, EBV, etc.). In these cases, the diagnostic value of exanthems is low.
Exanthema almost always coexists with enanthema, with the latter usually appearing several hours or 1-2 days before exanthema. For example, the detection of roseola or petechiae on the palate of a patient with symptoms of acute respiratory viral infection will allow the doctor to suspect a herpetic infection, typhus or leptospirosis, and Filatov-Koplik spots are the only truly pathognomonic symptom of measles. This once again proves the extreme importance of a thorough examination of not only the skin, but also the mucous membranes.
There is currently no unified classification of infectious exanthems. It is most convenient to divide them into generalized and localized. Exanthemas are called classic because diseases belonging to this group always occur with exanthema syndrome. Atypical diseases are often accompanied by rashes, but not always (Fig. 1, 2).
The article will focus on generalized viral atypical exanthemas.
Erythema infectiosum
Erythema infectiosum (syn.: Chamer's erythema, fifth disease, burning cheek disease) is an acute childhood infection caused by parvovirus B19 with characteristic clinical symptoms: red swollen plaques on the cheeks ("slapped" cheeks) and a lacy red rash on the trunk and limbs ( photo 1). The incubation period is about 2 weeks (4-14 days), the prodromal period is often absent, but in 1/3 of cases it can begin 2 days before the appearance of the rash and is manifested by low-grade fever, malaise, headache, and sometimes catarrhal symptoms, nausea and vomiting.
Rice. 1. Classification of exanthems
Photo 1. Symptom of “slapped” cheeks with erythema infectiosum 
The height of the period begins with the appearance of the rash. On the 1st day, it appears on the face in the form of small red spots that quickly merge, forming a bright erythema on the cheeks, which gives the patient the appearance of having been slapped (a symptom of “spanked cheeks”). After 1-4 days, the rash on the face resolves, and at the same time, round spots from pink to bright red and papules appear on the skin of the neck, torso and extensor surfaces of the limbs. Rarely, the palms and soles are affected. Some central clearing is characteristic, giving the rash a peculiar mesh-like, lace-like appearance (a symptom of a lace rash). In most cases, the rash is accompanied by itchy skin. It is important to remember that after the appearance of the rash, the virus is not detected in the secretions of the nasopharynx and blood, so patients are contagious only in the period before the appearance of the rash.
Rice. 2. Generalized exanthemas 
Exanthema with parvovirus infection gradually disappears within 5-9 days, but when exposed to provoking factors such as sun exposure, hot baths, cold, exercise and stress, it can persist for weeks or even months. The rash disappears without a trace.
In some patients, joint damage may occur against the background of the rash or after its disappearance. Characterized by symmetrical damage, predominantly to the knee, ankle, interphalangeal, and metacarpophalangeal joints. The pain syndrome depends on the severity of the disease and can be weak or strong, making it difficult to move independently; the joints are swollen, painful, and hot to the touch. The course of polyarthritis is benign.
A blood test during the rash period reveals mild anemia, low reticulocyte content, and in some cases - neutropenia, thrombocytopenia, and increased ESR. For a more accurate diagnosis, it is possible to use PCR (serum, cerebrospinal fluid, bone marrow punctate, skin biopsy, etc.) to determine parvovirus DNA. The ELISA method is also used to determine the level of specific antibodies in the blood serum: IgM in the patient’s blood serum is detected simultaneously with the onset of symptoms of the disease (on the 12-14th day after infection), their level reaches a maximum on the 30th day, then decreases within 2-3 months. After 5-7 days from the moment of clinical manifestations of parvovirus infection, IgG appears, which persist for several years.
There is no specific etiotropic therapy for parvovirus infection. Depending on the clinical form, syndromic therapy is carried out.
Sudden exanthema
Sudden exanthema (syn.: roseola infantile, sixth disease) is an acute childhood infection caused by herpes virus type 6, less commonly type 7, and is accompanied by maculopapular exanthema that occurs after a decrease in body temperature. Herpes virus type 6 was first isolated and identified in 1986 from patients with lymphoproliferative diseases, and in 1988 it was proven that this type of virus is the etiological agent of sudden exanthema. Infection caused by human herpes virus type 6 is a pressing problem in modern pediatrics, due to its widespread prevalence: almost all children become infected before the age of 3 years and remain immune for life. With this disease, seasonality is clearly expressed - most often sudden exanthema is recorded in spring and autumn.
The incubation period is about 14 days. The disease begins acutely with an increase in body temperature. Febrile fever lasts 3-5, and sometimes 7 days, accompanied by intoxication, enlargement of the cervical and occipital lymph nodes, injection of the pharynx and eardrums. Often there is hyperemia and swelling of the conjunctiva of the eyelids, giving the child a “sleepy” appearance and resolving on the first day of exanthema.
After a decrease in body temperature, less often a day before or a day after, exanthema appears. The rash first appears on the torso and then spreads to the neck, upper and lower extremities, and rarely to the face. They are represented by round spots and papules up to 2-5 mm in diameter, pink in color, surrounded by a white corolla, turning pale when pressed. The rash elements rarely merge and are not accompanied by itching. The duration of the rashes is from several hours to 3-5 days, after which they disappear without a trace. The peculiarity of the disease is that, despite the illness, the child’s well-being does not suffer much; appetite and activity may remain. A clinical blood test reveals leukopenia and neutropenia, lymphocytosis, atypical mononuclear cells and thrombocytopenia may be detected. The course of sudden exanthema is benign, prone to self-resolution.
The diagnosis of roseola in most cases does not cause difficulties and is established, as a rule, on the basis of a typical clinical picture. Serology can be used to confirm the diagnosis, but many children with primary infection do not develop the IgM levels required for detection. In addition, most people over 2 years of age have antibodies to the herpes virus type 6 and paired sera are needed for verification: detection of a fourfold increase in the IgG titer to the herpes virus type 6 or the transition of a negative result to a positive result confirms the diagnosis. It is also possible to use PCR, which can be used to detect the virus in tissues (blood, saliva).
The disease is prone to self-resolution and in the vast majority of cases does not require specific treatment.
Infectious mononucleosis
Infectious mononucleosis is an acute infectious disease caused by viruses of the herpes group, most often EBV, and is characterized by fever, sore throat, enlarged lymph nodes, liver and spleen, lymphocytosis, and the appearance of atypical mononuclear cells in the peripheral blood.
EBV is ubiquitous among the human population, affecting 80-100% of the world's population. Most children are infected by age 3, and the entire population by adulthood. The maximum incidence is observed in 4-6 years and adolescence. Seasonality is pronounced - with a spring peak and a slight rise in October. Increases in incidence every 6-7 years are typical.
The incubation period ranges from 2 weeks to 2 months. The main symptom complex includes the following leading symptoms:
In most cases, the disease begins acutely, with a rise in body temperature to high numbers. Usually the entire symptom complex unfolds by the end of the first week. The earliest clinical manifestations are: increased body temperature; swelling of the cervical lymph nodes; overlays on the tonsils; difficulty in nasal breathing. By the end of the first week from the onset of the disease, in most patients an enlarged liver and spleen are already palpable, and atypical mononuclear cells appear in the blood.
In addition to the main symptom complex, with infectious mononucleosis there are often various changes in the skin and mucous membranes that appear at the height of the disease and are not associated with taking medications. An almost constant symptom is puffiness of the face and swelling of the eyelids, which is associated with lymphostasis that occurs when the nasopharynx and lymph nodes are affected. Enanthema and petechiae also often appear on the oral mucosa. At the height of the disease, various skin rashes are often observed. The rash can be punctate (scarlet-like), maculopapular (measles-like), urticarial, hemorrhagic. The rash appears on the 3-14th day of the disease, can last up to 10 days and resolves without a trace. A distinctive feature is its greater intensity in acral areas, where it usually merges and lasts longer. The exanthema does not itch and goes away without a trace.
One cannot fail to mention another very characteristic manifestation of infectious mononucleosis - the appearance of a rash after the prescription of penicillin antibiotics. The rash usually appears on the 3-4th day from the start of taking antibiotics, is located mainly on the torso, and is represented by a maculopapular confluent exanthema (measles-like in nature). Some elements of the rash may be more intensely colored in the center. The rash resolves on its own without peeling or pigmentation. An important point is that this exanthema is not a manifestation of an allergic reaction to the drug: patients both before and after EBV infection can tolerate penicillin antibacterial drugs well. This reaction has not been fully studied and is currently considered to be an interaction between the virus and the drug. The distinctive features of this rash are the following:
Infectious mononucleosis in most cases proceeds smoothly, without complications. The disease ends in 2-4 weeks. In some cases, after this period, residual manifestations of the disease remain.
Etiotropic therapy for infectious mononucleosis has not been fully developed. For moderate and severe forms, recombinant interferon preparations (viferon), interferon inducers (cycloferon), immunomodulators with an antiviral effect (isoprinosine) can be used. Pathogenetic and symptomatic therapy is mainly used.
Enteroviral exanthema
Enterovirus infection is a group of diseases caused by viruses of the enterovirus genus, characterized by an intoxication syndrome and polymorphism of clinical manifestations. There are two main types of skin lesions due to enteroviral infections - enteroviral exanthema and hand-foot-mouth disease (photo 2).
Photo 2. Hand, foot and mouth disease 
Enteroviral exanthema can be caused by various types of enteroviruses, and depending on the etiology, the symptoms vary. There are three types of enteroviral exanthems:
Measles exanthema occurs mainly in young children. The disease begins acutely, with a rise in body temperature, headache, and muscle pain. Almost immediately, hyperemia of the oropharynx and scleral injection appear; often at the beginning of the disease there is vomiting, abdominal pain, and loose stools are possible. On the 2-3rd day from the beginning of the febrile period, a profuse, widespread exanthema immediately appears on an unchanged skin background. The rash is always located on the face and torso, less often on the arms and legs, can be spotty, maculopapular, less often petechial, the size of the elements is up to 3 mm. The rash lasts 1-2 days and disappears without a trace. Around the same time, body temperature decreases.
Roseoloform exanthema (Boston disease) also begins acutely, with an increase in temperature to febrile levels. Fever is accompanied by intoxication, sore throat and sore throat, although upon examination of the oropharynx there are no significant changes, except for increased vascular patterns. In uncomplicated cases, the fever lasts 1-3 days and drops sharply to normal. Simultaneously with the normalization of temperature, exanthema appears. It looks like round pinkish-red spots ranging in size from 0.5 to 1.5 cm and can be located throughout the body, but is most abundant on the face and chest. On the extremities, especially in exposed areas, the rash may be absent. The rash lasts 1-5 days and disappears without a trace.
Generalized exanthema herpetiformis occurs in the presence of immunodeficiency and is characterized by the presence of a small vesicular rash. The difference from herpetic infection is the absence of grouping of vesicles and clouding of their contents.
One of the local variants of enteroviral exanthema is a disease that occurs with damage to the skin of the hands and feet, and the mucous membrane of the oral cavity - the so-called disease of the hands, feet and mouth (syn.: foot-and-mouth syndrome, viral pemphigus of the extremities and oral cavity). The most common causative agents of this disease are Coxsackie viruses A5, A10, A11, A16, B3 and enterovirus type 71.
The disease occurs everywhere, affecting mainly children under 10 years of age, but there are cases of the disease among adults, especially young men. As with other enteroviral diseases, it occurs more often in summer and autumn.
The incubation period is short, from 1 to 6 days, the prodromal period is insignificant or absent altogether. The disease begins with a slight increase in body temperature and moderate intoxication. Abdominal pain and symptoms of respiratory tract damage are possible. Almost immediately, enanthema appears on the tongue, buccal mucosa, hard palate and inner surface of the lips in the form of a few painful red spots, which quickly turn into vesicles with an erythematous rim. The vesicles quickly open with the formation of yellow or gray erosions. The oropharynx is not affected, which distinguishes the disease from herpangina. Soon after the development of enanthema, 2/3 of patients develop similar rashes on the skin of the palms, soles, lateral surfaces of the hands and feet, and less commonly, the buttocks, genitals and face. Just like mouth rashes, they begin as red spots that turn into oval, elliptical or triangular vesicles with a halo of hyperemia. Rashes can be single or multiple.
The disease is mild and resolves on its own without complications within 7-10 days. However, it must be remembered that the virus is released up to 6 weeks after recovery.
Diagnosis of enteroviral exanthems is complex and involves the assessment of clinical symptoms of the disease together with epidemiological history data and mandatory laboratory confirmation (isolation of enterovirus from biological materials, increase in antibody titer).
Treatment is mostly symptomatic. The use of recombinant interferons (viferon, reaferon), interferonogens (cycloferon, neovir), immunoglobulins with high antibody titers may be required only in the treatment of patients with severe forms of enteroviral encephalitis.
Thus, the problem of infectious diseases accompanied by exanthemas remains relevant to this day. The high prevalence of this pathology among the population requires increased attention from doctors of any specialty.
– an acute infectious disease of young children caused by herpes virus types 6 and 7, occurring with a temperature reaction and skin rashes. With sudden exanthema, febrile temperature appears successively, then a papular rash on the skin of the torso, face and limbs. Specific methods for diagnosing sudden exanthema are PCR detection of HHV-6 and ELISA for IgM and IgG titers. Treatment of sudden exanthema is mainly symptomatic (antipyretics); antiviral drugs may be prescribed.
General information
Sudden exanthema (pseudo-rubella, roseola, three-day fever, sixth disease) is a childhood viral infection characterized by high fever and a spotty rash on the skin. Sudden exanthema affects about 30% of young children (from 6 months to 3 years). In most cases, sudden exanthema develops in a child between 9 months and 1 year of age; less often up to 5 months. It is assumed that the disease is transmitted by airborne droplets and contact. The peak of the spread of infection occurs in autumn and winter; girls and boys get sick equally. Sudden exanthema is experienced by children once, after which those who have recovered develop stable immunity.
Causes of sudden exanthema
The etiological agents causing sudden exanthema are human herpes viruses types 6 and 7 (HHV-6 and HHV-7). Among these two types, HHV6 is more pathogenic and is considered the main causative agent of sudden exanthema; HHV7 acts as a second pathogen (cofactor).
HHV-6 and HHV-7 belong to the family Herpesviridae, genus Roseolovirus. Viruses have the greatest tropism for T-lymphocytes, monocytes, macrophages, astrocytes, arborescent cells, epithelial tissue, etc. Once in the body, pathogens stimulate the production of cytokines (interleukin-1b and tumor necrosis factor-α), react with cellular and circulating immune complexes , causing the appearance of sudden exanthema.
In adolescents and adults, HHV-6 is associated with asymptomatic urinary infection. In addition, reactivation of a virus that latently persists in the central nervous system can cause the development of meningoencephalitis and myelitis. HHV-6 is reported to be the culprit in benign (lymphadenopathy) and malignant (lymphoma) lymphoproliferative diseases. Some authors associate chronic fatigue syndrome with HHV-7.
Symptoms of sudden exanthema
The incubation period for sudden exanthema ranges from 5 to 15 days. The disease begins with a sudden increase in body temperature to high values (39-40.5°C). The period of fever lasts for 3 days, accompanied by severe intoxication syndrome (weakness, apathy, lack of appetite, nausea).
It is characteristic that with sudden exanthema, despite such a high temperature, in most cases there are no catarrhal symptoms (runny nose, cough). Relatively rarely, younger children experience diarrhea, nasal congestion, enlarged cervical lymph nodes, swelling of the eyelids, hyperemia of the pharynx, and a small rash on the soft palate and uvula. In infants, pulsation of the fontanelle is sometimes observed.
Body temperature decreases slightly in the morning; While taking antipyretics, children feel satisfactory. Since sudden exanthema coincides with teething, parents often explain the increased temperature precisely by this fact. Sometimes, with a sharp increase in temperature to 40°C and above, febrile convulsions develop: with sudden exanthema, they occur in 5-35% of children aged 18 months to 3 years. Febrile seizures are usually not dangerous and go away on their own; they are not associated with damage to the nervous system.
A critical decrease in temperature with sudden exanthema occurs on the 4th day. Normalizing the temperature creates a false impression that the child has completely recovered, but almost simultaneously, a pinpoint or small-spotted pink rash appears all over the body. The rash first appears on the back and abdomen, then quickly spreads to the chest, face and limbs. Elements of the rash with sudden exanthema are roseolous, macular or maculopapular in nature; pink color, diameter up to 1-5 mm; when pressed they turn pale, do not tend to merge and do not itch. The rash that accompanies sudden exanthema is not contagious. During the period of rashes, the child’s general well-being does not suffer. Skin manifestations disappear without a trace after 2-4 days. In some cases, sudden exanthema may occur without a rash, only with a febrile period.
Complications from sudden exanthema develop quite rarely and, mainly, in children with reduced immunity. Cases of the development of acute myocarditis, meningoencephalitis, cranial polyneuritis, reactive hepatitis, intussusception, and post-infectious asthenia have been described. It has been noted that after suffering a sudden exanthema, children may experience accelerated growth of adenoids and frequent colds.
Diagnosis of sudden exanthema
Despite its high prevalence, the diagnosis of sudden exanthema is extremely rarely made in a timely manner. This is facilitated by the transience of the disease: while a diagnostic search is underway, the symptoms of infection, as a rule, disappear on their own. However, children with a high fever or rash should definitely be examined by a pediatrician and a pediatric infectious disease specialist.
In the physical examination, the leading role belongs to the study of the elements of the rash. Sudden exanthema is characterized by the presence of small pink spots that disappear with diascopy, as well as papules with a diameter of 1-5 mm. In side lighting, it is noticeable that the elements of the rash rise slightly above the surface of the skin.
A general blood test reveals leukopenia, relative lymphocytosis, eosinopenia, granulocytopenia (sometimes agranulocytosis). The PCR method is used to detect the virus. To determine the active virus in the blood, a culture method is used. In children who have recovered from sudden exanthema, IgG and IgM to HHV-6 and HHV-7 are detected in the blood using ELISA.
In case of complications of sudden exanthema, consultation is necessary
Viral exanthema in children is one of the most common causes of skin rashes in infants and older children. Its main symptoms are the appearance of a red or pink rash on the child’s body.
Treatment is mainly aimed at reducing the severity of symptoms of the underlying disease. Exanthema can appear either at the very beginning of the disease or frighten parents after a seemingly complete recovery.
A number of viruses can cause exanthema in children: respiratory viruses (including adenovirus, rhinovirus), parvovirus, herpes viruses, enteroviruses, rubella viruses, chickenpox, Epstein-Barr virus, cytomegalovirus and others. Some of these viruses cause very characteristic rashes (measles, chickenpox).
Exanthems, which are caused by most other viruses, differ little from each other and their causative agent is identified mainly by symptoms (enlarged lymph nodes, red eyes, other symptoms).
Symptoms
Translated from Greek, the term “exanthema” means “I bloom.” That is, the rash often appears simultaneously and suddenly, covering almost the entire body of the child. One of the characteristic signs is discoloration, the disappearance of rashes when pressed.
You can take a transparent glass or plastic vessel (glass, shot glass) and gently press it to the baby's skin. You will be able to see if the rash goes away with pressure. When the pressure on the skin disappears, the rash appears again.
The rashes are usually not painful or itchy (chickenpox is an exception). If the patient experiences severe itching, it could also be urticaria of allergic origin or insect bites.
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In most cases, exanthema in children is not a symptom of any dangerous disease. However, any rash in children should be seen by a doctor. There are several signs that should force parents to urgently consult a pediatrician:
- the rash does not disappear with pressure;
- the rash is very itchy;
- the child’s general condition is significantly impaired - high fever, diarrhea, vomiting, and other signs of a serious illness are observed.
And, of course, a baby with a rash (until he is examined by a doctor) should not have contact with other children. Pregnant women should also avoid contact with a sick baby until it is ruled out.
Kinds
The appearance of the rash, its location and the sequence of appearance on different parts of the body depends on the causative agent of the infection and can help in making a diagnosis and deciding how to treat. The rash can spread throughout the body or “settle” only on certain parts of it – the cheeks, back, stomach, buttocks.
- Measles exanthema in children it appears as single pinkish or reddish spots, sometimes merging with each other. If you lightly run your fingers over them, you can feel small bumps and papules rising above the skin.
- The rash may look like lace ( in case of infection with parvovirus B19). Initially, small lesions appear on the face, subsequently merging into one. After a few days, children's elbow and knee bends are affected.
- For chickenpox, herpes simplex and herpes zoster(these diseases are caused by viruses from the herpetic group) exanthema has the appearance of individual small bubbles against the background of reddened skin. Chickenpox is characterized by rashes throughout the body, and shingles follows the direction of the nerve trunks.
- On the ears, nose, fingers and toes, and buttocks of children, where body temperature is reduced, rashes may appear, the cause of which is cytomegalovirus, Epstein-Barr virus, even hepatitis B.
Roseola
A very characteristic and widespread viral exanthema in children is roseola, caused by. This exanthema begins with an increase in temperature in the absence of a runny nose, cough, pain or intestinal disorders.
After three days, the temperature drops and the child gives the impression of complete health and well-being.
However, after some time (usually 10-12 hours), the baby’s body is covered with a small pink rash, which disappears without a trace after a few days.
First in the stomach, and then spread throughout the body. Moreover, the individual elements of the rash do not merge with each other. Many children from six months to two years old suffer from roseola, but local pediatricians rarely diagnose this infection.
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Treatment
Viral exanthema in children does not require special treatment. The rashes disappear on their own when the body copes with the infection. Do not cover the rash with brilliant green or other similar means until a doctor sees it.
If a baby has measles or rubella, treatment usually involves bed rest, antipyretics and antihistamines. Chickenpox is usually easily tolerated by children and there is usually no need to resort to strict bed rest.
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Often during this disease, rashes are lubricated with brilliant green or a solution of manganese, although, according to many pediatricians, this does not make much sense. Treatment of herpetic infections involves the administration of Acyclovir in ointments.
If your baby's rash-covered skin is very dry, you can moisturize it with a hypoallergenic baby cream.
The patient's room should have moist, cool air. If your baby is hot and sweats, the skin condition will only worsen.
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