| Table 2-3 Childhood Infections |
| | Disease | | Exanthem | | Etiology/Course |
| | Acute Hemorrhagic
Edema of Infancy
(Finkelstein Disease) | | Large circinate painful purpuric plaques involving face, ears, distal extremities → evolve into edematous targetoid lesions | | Etiology: likely infectious (viral or bacterial)
Age: 6 months–3 years; self-limited
Leukocytoclastic vasculitis seen on histology
May be hypersensitivity reaction to infection (medication/vaccination less likely) |
| | Erythema Infectiosum
(‘Slapped Cheek’ or
Fifth Disease) | | Bright red macular erythema over cheeks → lacy eruption mainly on the extremities | | Etiology: parvovirus B19 (ssDNA) also causes hydrops fetalis; peaks in spring and winter
Age: school-age children; self-limited
Mild prodrome, 10% with arthralgias |
| | Gianotti–Crosti
Syndrome | | Abrupt onset of skin-colored to pink-red edematous papules to cheeks, buttocks, extremities | | Etiology: likely infectious (HBV, EBV)
Age: 6 months–2 years; self-limited
May have low-grade fever and lymphadenopathy |
| | Hand-Foot-Mouth
Disease | | Elliptical grayish vesicles, pustules, and erosions on hands, feet, and buttocks
Oral: vesicles/erosions red base | | Etiology:coxsackievirus A16 (enterovirus 71 less often)
Age: children <10 years (± adults); self-limited
Fever, sore mouth, anorexia, abdominal pain; enteroviral infection may also cause myocarditis, pneumonia, meningoencephalitis |
| | Henoch–Schönlein
Purpura (HSP) | | Purpuric macules and papules favoring lower extremities and buttocks | | Etiology: possibly infectious (viral, strep)
Age: peaks at 4–7 years (± adults); self-limited Presents 1–2 week after upper respiratory infection
Arthralgias, GI bleeding, abdominal pain, nephritis with hematuria → IgA vasculitis |
| | Herpangina | | Exanthem: often absent
Oral: painful gray vesicles on
tonsillar, palate, buccal mucosa | | Etiology: various enteroviruses (often coxsackie group A/B and echovirus)
Age: 3–10 years old; self-limited |
| | Kawasaki Disease
(Mucocutaneous Lymph
Node Syndrome) | | Polymorphous eruption (morbilliform, erythema multiforme-like or bullous); ± edema and erythema of distal extremities; can be generalized or localized (groin, LE)
Oral: red swollen or dry fissured lips; strawberry tongue; pharyngeal erythema | | Etiology: unknown but likely infectious
Age: children <5 years of age
Arthritis, abdominal pain, GI symptoms
Complications: cardiac aneurysm (in ¼ of untreated patients), myocarditis, pericarditis Oral: red swollen or dry fissured lips; strawberry tongue; pharyngeal erythema
Need 5 of 6 criteria for diagnosis: rash • fever >5 days • conjunctivitis • palmoplantar erythema, edema, or desquamation • swollen lips or red tongue • cervical lymphadenopathy |
| | Measles (Rubeola or
First Disease) | | Erythematous macules/papules over forehead, hairline, and behind the ears → spreads downward
Oral: Koplik spots (gray papules on buccal mucosa) | | Etiology: measles virus (paramyxovirus)
Age: unvaccinated children
Prodrome: fever, cough, nasal congestion, rhinorrhea, conjunctivitis; rash appears after Koplik spots
Complications:encephalitis, otitis media, pneumonia, myocarditis, ± subacute sclerosing panencephalitis |
| | Infectious
Mononucleosis | | Polymorphous: morbilliform (common), urticarial, petechial, or erythema multiforme-like lesions
Of note, morbilliform eruption may occur after treatment with ampicillin | | Etiology: infectious (EBV)
Age: children, young adults (15–25 years); self-limited
Fever, pharyngitis, fatigue, myalgias, headaches, hepatosplenomegaly, lymphadenopathy
Complications: splenic rupture, airway obstruction, hepatitis |
| | Papular Purpuric
Gloves and Socks
Syndrome | | Erythema, edema, petechiae, and purpura on palms/soles (± extension to dorsal aspect), + burning and pruritus | | Etiology: parvovirus B19
Age: children and young adults; self-limited
Mild prodromal symptoms, occurs mainly in young adults; peaks in spring |
| | Roseola
(Exanthem Subitum
or Sixth Disease) | | Circular to elliptical “rose red” macules or papules involving trunk, occasionally surrounded by white halo | | Etiology: human herpesvirus 6 (HHV6)
Age: 6 months–3 years
Sudden-onset high fever; rash begins as fever subsides
Complications in healthy patient: mainly seizures |
| | Rubella
(German Measles or
Third Disease) | | Erythematous macules and papules on face → spreads acrally, accompanied by tender lymphadenopathy (occipital, postauricular, cervical) | | Etiology: togavirus (ssRNA)
Age: unvaccinated children/adults; self-limited
Usually mild prodrome
Complications: arthralgia/arthritis, hepatitis, myocarditis, pneumonia |
| | Scarlet Fever
(Second Disease) | | Erythema of axilla, neck, chest → evolve to pink papules with erythematous background (sandpaper-like) → hand and foot desquamation (7–10 days later); Pastia’s lines (linear petechial streaks in body folds)
Oral: “red strawberry” tongue | | Etiology: group A β-hemolytic streptococci (erythrogenic toxin A, B, C)
Age: children (1–10 years old)
Extracutaneous: sore throat, headaches, chills, fever, nausea, abdominal pain, anorexia
Treatment: PCN 10–14 days (erythromcyin in PCN- allergic pts) |
| | Unilateral
Laterothoracic
Exanthem | | Morbilliform or eczematous eruption in axilla and lateral trunk with unilateral dominance (± bilateral involvement) | | Etiology: likely viral
Age: children (6 months–10 years); self-limited |
| | Varicella (Chickenpox) | | Pruritic, erythematous macules/papules of scalp, face → spreads to trunk and extremities, evolves into vesicles with narrow red halo (“dew drops on rose petal”), central crust or necrosis seen within lesions | | Etiology : varicella zoster virus (VZV)
Age : children and adults; self-limited in healthy children
Complications in children: secondary bacterial infection
Adults with more severe presentation (pneumonia, 10–30% mortality if untreated)
All stages of development seen simultaneously |
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