Saturday, August 5, 2017

Image based MCQ on pediatric infections

Hey Awesomites

Yesterday we posted an MCQ on a pediatric infection with characteristic appearance of rash on face, involving both cheeks.

A seven year old child was brought to a pediatric clinic on one morning after Christmas, by her mother. The child had mild cold, fever, headache for last few days. That morning she was found to have highly colored red cheeks. This characteristic appearance on the face is seen in:
A. Sixth disease
B. German measles
C. Erythema infectiosum
D. Scarlet fever
E. Lupus Erythematosus

Slapped cheek appearance
Image courtesy - Medscape
Here is the answer -
C. Erythema infectiosum
Erythema infectiosum, also known as the fifth disease occurs primarily in school going children of 5-15 years of age. It is caused by a virus called Parvovirus B19. Since this virus has a tropism for erythroid lineage of cells at the pronormoblast stage, the viral load is much more extreme in patients with aplastic crisis and sickle cell anemia.

Mild prodromal ( warning ) symptoms such as cold, fever, sore throat, headache. coryza, pruritus may occur 1 week after exposure to PV-B19 and last for 2-3 days. Then after 7-10 days, the infection progresses through the following stages:

Phase 1: The exanthem begins with a classic "slapped-  cheek appearance" on face (2-4 days)
Phase 2: Lacelike pattern of erythematous maculopapular rash on the torso, spreading on to arms, buttocks and thighs ( 1-2 days after phase 1 ).
Phase 3: Rash fades 5-10 days later and recurs after weeks or months on certain stimuli which typically involve rising body temperature.

Thats all
Thanks for your active participation.

- Jaskunwar Singh


  1. I was wondering, why not scarlet fever?

    1. In scarlet fever, the rash appears just 1-2 days after the prodromes (sore throat, fever etc). Face is not involved usually, pink-red blotches appear and skin becomes rough and sandpaper - like which peels off after a few days.


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