C h a p t e r 4 6
Disorders of Skin Integrity and Function
1179
Skin Manifestations of Common
Infectious Diseases
Infectious childhood diseases that produce rashes
include roseola infantum, rubella, rubeola, and vari-
cella. Because these diseases are seen less frequently than
in the past because of successful immunization programs
and the use of antibiotics, they may be misdiagnosed or
their diagnosis may be delayed.
Roseola Infantum.
Roseola infantum (exanthem subi-
tum or sixth disease) is a contagious disease caused by
human herpes virus type 6 (HHV-6).
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Because HHV-6
is the etiologic agent, the condition is often referred to
as
sixth disease
. Primary HHV-6 infection occurs early
in life. More than 95% of roseola cases occur in chil-
dren younger than 3 years of age, with a peak at 6 to
15 months of age.
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Transplacental antibodies likely
protect most infants until 6 months of age. Roseola
produces a characteristic maculopapular rash covering
the trunk and spreading to the appendages. The rash
is preceded by an abrupt onset of high fever (
≤
105°F),
inflamed tympanic membranes, and coldlike symptoms
usually lasting 3 to 4 days. These symptoms improve at
approximately the same time the rash appears. Because
infants with roseola exhibit a unique constellation of
symptoms over a short time, the infection may be con-
fused with other childhood illnesses. Blood antibody
titers may be taken to determine the actual diagnosis.
In most cases, there are no long-term effects from this
disease. Infants who spike high temperatures should be
seen by their health care providers.
Rubella.
Rubella (i.e., 3-day measles or German mea-
sles) is a childhood disease caused by the rubella virus. It
is characterized by a diffuse, punctate, macular rash that
begins on the trunk and spreads to the arms and legs
(Fig. 46-26). Mild febrile states occur (usually <100°F).
Postauricular, suboccipital, and cervical lymph node
adenopathy is common. Coldlike symptoms usually
accompany the disease in the form of cough, congestion,
and coryza (i.e., nasal discharge).
Rubella usually has no long-lasting sequelae; how-
ever, the transmission of the disease to pregnant women
early in their gestation periods may result in congeni-
tal rubella syndrome. Among the clinical signs of con-
genital rubella syndrome are cataracts, microcephaly,
mental retardation, deafness, patent ductus arteriosus,
glaucoma, purpura, and bone defects. Most states have
laws requiring immunization to prevent transmission of
rubella. Immunization is accomplished by live-virus injec-
tion. Rubella vaccination has close to a 100% immunity
response in treated children. Many states require a sec-
ond preschool or later dose of rubella vaccine to increase
immunity. Cases and outbreaks of rubella occur in the
United States, especially among foreign-born unvacci-
nated adults.
Rubeola.
Rubeola (measles, 7-day measles) is an acute,
highly communicable viral disease caused by a morbil-
livirus.
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The characteristic rash is macular and blotchy;
sometimes the macules become confluent (Fig. 46-27).
The rubeola rash usually begins on the face and spreads
to the appendages. There are several accompanying
symptoms: a fever of 100°F or greater,
Koplik spots
(i.e., small, irregular red spots with a bluish-white speck
FIGURE 46-26.
Rash of rubella on a child’s back. Distribution
is similar to measles (rubeola), but not as intense. (From the
Centers for Disease Control and Prevention Public Health
Image Library. No. 712.)
FIGURE 46-27.
Child with measles (rubeola) showing the
characteristic conjunctivitis, coryza, and red, blotchy rash
that appear around day 3 of illness, first on the face and then
becoming more generalized. (From the Centers for Disease
Control and Prevention Public Health Image Library. No. 1150.)
