RSV infections and exanthema

Schneider H, et al. Clinical characteristics of children with viral single- and co-infections and a petechial rash. Pediatr Infect Dis J. 2013 May;32(5):e186-91.

Human respiratory syncytial virus (RSV), Epstein–Barr virus (EBV), cytomegalovirus (CMV), adenovirus, enterovirus (EV) and parvovirus B19 are reported to be associated with a petechial rash. The proportion of viral infections in children with petechiae and fever is understated. [2,7–11] Additionally, currently available studies on children with a petechial rash (with the most recent being performed in 2001) noted an association between evolvement of petechiae in children and upper respiratory tract infections (URTIs) commonly caused by so called respiratory viruses as influenza types (Inf) A, B and H1N1, parainfluenza type 1, 2 and 3, RSV, rhinovirus (RV), EV and adenovirus. [3,12–14]

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Coffin SE, Gest KL, Shimamura A. Respiratory syncytial virus as a cause of fever and petechiae in infants. Clin Pediatr (Phila). 1993 Jun;32(6):355-6.

“While the precise frequency is difficult to determine, we estimate the incidence of fever and petechiae to be 1.4% among patients hospitalized with proven RSV infection (based on a total of 148 children admitted to our hospital with RSV infection during the 1991-1992 winter season). Among patients presenting for evaluation with fever and petechiae, Baker et al. identified RSV infection in 6.3%. These investigators suggested that the quantity and distribution of petechiae may help to distinguish patients with life threatening illnesses from those with more benign infections. They further observed that children with invasive bacterial disease were significantly more likely than patients with nonbacteremic disease to have generalized petechiae. Only 5 of 45 patients (11%) with noninvasive disease were found.”

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Hogan PA, Morelli JG, Weston WL, Viral exanthems. Curr Prob Dermatol. 1992; 4(2): 37-94.

“The exanthem of RSV infection accompanies the fever and acute symptoms and lasts 3 to 5 days. It is described as blotchy red macules and is generalized. A flushing of the face is described. (396, 397) Although one report found the eruption in two of 15 patients infected with RSV, it is an uncommon finding in RSV. (396, 397) There is no enanthem specific to RSV, although some patients have a red throat.”

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Berkovich S, Sidney Kibrick S. Exanthem associated with respiratory syncytial virus infection. J Peds. 1964; 65 (3): 368-370.

“Three of the children (siblings) studied during July, 1960, were also infected with respiratory syncytial virus. Their clinical diagnoses included bronchiolitis, lobar pneu- monia, and acute upper respiratory disease, but without an associated exanthem. Tests for antigenic differences between these strains and the agent recovered from this case were not made. Such variants, however, are now known to exist. ~ It may be, therefore, that the presence or absence of rash during respiratory syncytial virus infection may reflect antigenic differences between the infecting virus strains. The occurrence of exanthem in this patient might also be attributed to a difference in host response. It is possible, for example, that an occasional individual may become hypersensitive to the virus and react by development of a rash.”

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More PubMed results on viral exanthems.

Created 10/03/13; updated 07/30/15. 

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