Generalized Petechial Rashes in Children During a Parvovirus B19 Outbreak
Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. PEDIATRICS
(Impact Factor: 5.47).
03/2010; 125(4):e787-92. DOI: 10.1542/peds.2009-1488
Human parvovirus B19 infection is associated not only with erythema infectiosum (fifth disease) but also, rarely, with purpuric or petechial rashes. Most reports of these atypical rashes describe sporadic cases with skin lesions that have distinctively focal distributions. During a community outbreak of fifth disease, we investigated a cluster of illnesses in children with generalized petechial rashes to determine whether parvovirus was the causative agent and, if so, to describe more fully the clinical spectrum of petechial rashes that are associated with this virus.
Systematic evaluation was conducted by general pediatricians of children with petechial rashes for evidence of acute parvovirus infection.
During the outbreak, acute parvovirus infection was confirmed in 13 (76%) of 17 children who were evaluated for petechial rash. Confirmed case patients typically had mild constitutional symptoms, and most (11 [85%] of 13) had fever. Petechiae were typically dense and widely distributed; sometimes accentuated in the distal extremities, axillae, or groin; and usually absent from the head/neck. Most case patients had leukopenia, and several had thrombocytopenia. Parvovirus immunoglobulin M was detected in 8 (73%) of 11 acute-phase serum specimens, and immunoglobulin G was detectable only in convalescent specimens. Parvovirus DNA was detected in all 7 tested serum specimens, including 2 acute-phase specimens that were immunoglobulin M-negative. All case patients had brief, uncomplicated illnesses, but 6 were briefly hospitalized and 1 underwent a bone marrow examination. Two case patients developed erythema infectiosum during convalescence.
During an outbreak of fifth disease, parvovirus proved to be a common cause of petechial rash in children, and this rash was typically more generalized than described in case reports. Associated clinical features, hematologic abnormalities, and serologic test results are consistent with a viremia-associated illness that is distinct from and occasionally followed by erythema infectiosum.
Available from: Masato Takeuchi
- "Since then, there have been a growing number of publications supporting the relationship between PPGSS and acute parvovirus infection [2,3]. For example, 13 cases with parvovirus-associated purpura were reported during a community outbreak . Initial case reports and case series documented that the eruptions were limited to the hands and feet. "
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ABSTRACT: Parvovirus B19 can cause petechial rashes in the acute phase of illness as well as erythema infectiosum (fifth disease) during convalescence. This petechial rash is often called "gloves and socks" syndrome because of the typical distribution of the eruption. However, involvement of other sites (e.g., intertriginous area) and generalized involvement have been recently recognized. We report here a patient with parvovirus-associated petechiae and cephalhematoma.
The patient was a previously healthy 10-year-old boy. There was a family history of fatal bleeding; his sister died of intracranial bleeding with an uncertain cause at the age of 5 months. The patient was admitted to our hospital because of sudden onset of cephalhematoma associated with fever. He reported that he had no recent head trauma but that he massaged his scalp on the day before admission. On admission, his temperature was 38.8[degree sign]C; otherwise, he was in a stable condition. Besides cephalhematoma, petechial rashes were present on his trunk and limbs. The initial laboratory tests were essentially normal, including platelet count and coagulation tests. Expanded laboratory tests were repeated to explore the etiology of his skin hemorrhage, all of which indicated that hematological disorders were unlikely. His symptoms subsided spontaneously over the next few days and he was discharged uneventfully. Anti-parvovirus IgM titer was elevated during hospitalization and typical erythema infectiosum was seen approximately 1 week after discharge. During 6 months follow-up, he remained stable without recurrence of a hemorrhagic episode. Finally, we concluded that his cephalhematoma was responsible for acute parvoviral infection.
This is believed to be the first report describing a possible association between parvovirus B19 infection and cephalhematoma. Parvovirus B19 infection should be considered in the differential diagnosis of children who present with unexplained hemorrhage such as cephalhematoma or petechiae.
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ABSTRACT: This paper reports on a method of image segmentation using a
threshold value determined via fuzzy logic. Image segmentation is the
core to pattern recognition or is used as the initial process in many
machine vision applications. Images are fuzzy due to the imprecision of
gray values and vagueness in various image definitions. The fuzzy-based
segmentation reported in this paper is an automated threshold
calculation. The threshold value computed by utilizing the histogram of
the image and the measure of fuzziness constitute the initial step in
the proposed segmentation procedure. The threshold value is then
inputted into the "split and merge" method of segmentation. The results
of the segmentation procedure are presented in this paper and they show
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ABSTRACT: An exanthem is any eruptive skin rash that may be associated with fever or other systemic symptoms. Causes include infectious pathogens, medication reactions and, occasionally, a combination of both. In children, exanthems are most often related to infection and, of these, viral infections are the most common. Some exanthems have very specific morphologies that help identify and characterize the eruption. In this article, we describe common and uncommon viral exanthems, based on their morphology, and review current advancements in understanding and treatment of these exanthems.
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