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At least 19 recordsLinked to original sources
PubMed1989

[The critical 3-day fever-exanthema in young children (exanthema subitum, Zahorsky roseola infantum)--what is new?].

As to the present knowledge the critical rose rash of infants (exanthema subitum, roseola infantum) means to be an exanthematous infectious disease that, occurring preferably in elder babes and younger infants (1st--3rd year of life), is caused by the newly detected herpesvirus (now the sixth one) pathogenic for man. The natural contamination in our latitude is intense (60-75%), and the probably lifelong immunity in the majority of cases is acquired in infancy. Though experts in the clinical subject do stress all the time the exanthema subitum to be the most frequent exanthematous disease in early infancy and infancy, infection chains tested to exanthema, respectively epidemics are observed decidedly seldom. Consequently, most of all infections use to develop clinically inperceptibly or even with other symptoms (and without an exanthema); the exanthema up to now obligatory for establishing the diagnosis uses to appear only in the minority of all cases and in the great majority of them the seroconversion is clinically silent. The prognosis of the exanthema subitum is in force to be good; the disease is the special field of activity for ambulatorily acting physicians (paediatrist, general practitioner). To begin with, the status diagnostically unclear and high-febrile for several days, the central-nervous excitability occurring in many cases, and in some children the appearing of dramatic febrile convulsions, as well as gastroenteric symptoms perpetually give rise to differential diagnostic considerations and sometimes even to a (false) antibiotic therapy. In case of an affection by herpesviruses principally a latency (persistence) of the virus lasting for years (possibly even lasting for life) in human beings is to be taken into account; this condition is also current for HHV 6. On occurring of an immune debility a release and a discharge of herpesviruses--not only by children suffering from an exanthema subitum (!)--are possible so that human beings of each age may come into question to be the source of infection. Double infections of human immune cells (for instance HHV 6 and HIV 1 simultaneously) already have been found. The necessary studies in order to clarify essential clinical and virological problems are world-widely in full activity, and new cognitions (further symptoms of diseases associated with HHV 6, possibly affections in prenatal infections and so on) are soon to be taken into account.

Child, Preschool↗
PubMed1991

[The blood picture in exanthema subitum (Zahorsky)/ critical 3-day fever-exanthema in young children].

Exanthema subitum was described in 1910 by John Zahorsky/USA; in 1986 and 1988 the human herpesvirus 6 (HHV 6) was discovered as the causative agent of the disease and serologic tests were established for diagnostics (specific IgM and IgG antibodies). Up to this time the diagnosis was based on the typical clinical course: the prodromal febrile stage (3 days) followed by the onset of a (more or less characteristic) rash closely connected with the normalisation of the body temperature. Usually a typical white blood cell count was described for diagnostics on the first day of exanthema: leukocytopenia with eosino- and granulocytopenia associated with consequent lymphocytosis. We analysed the hematologic data for children with a serologically documented HHV6 infection including exanthema (group 1: n = 9), without exanthema (group 2: n = 11) or with a serologically unexplained febrile rash (group 3: n = 13). In children with exanthematous HHV6 infection (exanthema subitum) granulocytopenia and a decreased thrombocyte count (mean values) is the rule. But the total white blood cell count and the mean values for eosinophils did not differ between the groups studied.

Agranulocytosis↗
PubMedDate not supplied

Dimorphic exanthema manifested as reticular maculopapular exanthema and erythema multiforme major associated with pyrazolon derivatives.

The non-steroidal anti-inflammatory drugs, especially various pyrazole or pyrazolon derivatives, were one of the classes of drugs commonly implicated in erythema multiforme or Stevens-Johnson syndrome/toxic epidermal necrolysis. Reticular exanthem was a rare morphological pattern of maculopapular drug eruptions. Here we report a case of dimorphic exanthema presenting with partly reticular maculopapular exanthema and erythema multiforme-like lesions, associated with pyrazolon derivatives. Patch testing showed negative reaction to the suspected drugs. The possible mechanism underlying the association of dimorphic exanthema with NSAIDs is discussed.

Aged↗
PubMed1991

[Seroprevalence of antibodies to human herpesvirus 6 (exanthema subitum; critical 3-day fever-exanthema in young children) in the population of Northern Germany].

We tested 989 sera of all age groups (patients and blood donors) from north eastern Germany (West Pomerania and Mecklenburg) and found 820 cases (82.9%) of specific human herpes virus type 6 (HHV 6) antibodies (IgG) gy indirect immunofluorescent assay. The seroprevalence rose to 83.6% when the 7 HHV 6-IgM positive results (0.7%) were included; moreover a further 23 sera (2.3%) showed specific HHV 6 antibodies of both classes (IgM and IgG). The antibody prevalence was constantly high at 90% from the age of 8 months up to the 71-80 years group, and it only decreased in the age group over 80. 93.2% of the newborn infants showed HHV 6-IgG antibodies (of maternal origin) in the cord blood; this prevalence is identical with that for females of reproductive age (92.7% in the 3rd decade, 93.7% in the 4th decade). No sex differences in seroprevalence were observed. The main immunization occurs in the first year of life but infection with HHV 6 at a later age is also well documented. We found the lowest seroprevalence in the 3rd and 4th postnatal months (when maternal immunity had disappeared); later the seroprevalence of specific antibodies rose very rapidly and by the 8th month the rate was the same as for the adult group. The theoretical possibility of prenatal infection due to HHV 6 exists, but the real risk of a first infection during pregnancy is very low, because only 7-8% are susceptible in this group.

Adolescent↗
PubMed1989

[New knowledge of Zahorsky exanthema subitum (critical 3-day fever-exanthema, roseola infantum].

A survey is given on the history, characteristic symptoms and recent data of the etiology of exanthem subitum (Zahorsky's disease, sixth disease, roseola infantum). Some cases are presented and modern diagnostic techniques for atypical cases are discussed. The disease is caused by an infection with the human herpesvirus-6 (HHV 6; syn.:, "human B-lymphotropic virus", HBLV). Most babies and small children have an asymptomatic infection usually leading to lifelong immunity. The typical "exanthem subitum" develops only in a minority of the infected and susceptible persons. We suggest that the novel human herpesvirus-6 also has the potential of lifelong persistence in humans and can then be shedd at any age in case of acquired immunodeficiencies. World-wide research in this field is carried out by several working groups and new data will be available in a few years.

Antibodies, Viral↗
PubMed1993

Exanthema subitum and human herpesvirus 6 infection: clinical observations in fifty-seven cases.

Exanthema subitum had been speculated to be a viral disease although its pathogen is unknown. Human herpesvirus 6 (HHV-6), first isolated in 1986, was proved by Yamanishi et al. to be the causal agent of exanthema subitum. To evaluate the role of HHV-6 as the causal agent in clinically diagnosed exanthema subitum, we tested for HHV-6 antibody in 57 infants with clinical exanthema subitum and exanthema subitum-like rash without fever. Of the 53 patients with clinical exanthema subitum 43 showed seroconversion or a significant rise in antibody titer to HHV-6, 7 were seropositive without significant rise and 3 remained seronegative. The clinical manifestations of these 43 infants with serologically confirmed HHV-6 infection were consistent with the classical characteristics of exanthema subitum. The 4 patients with atypical exanthema subitum showed significant rises in antibody titer. Our results therefore show that the majority of cases with typical clinical manifestations of exanthema subitum had HHV-6 infection. Most cases with HHV-6 infection had the typical clinical course of exanthema subitum, and a few cases might show an afebrile exanthema subitum-like rash.

Antibodies, Viral↗
PubMed1986

[Exanthema during frequent use of antibiotics and antibacterial drugs (penicillin, especially aminopenicillin, cephalosporin and cotrimoxazole) as well as allopurinol. Results of The Berne Comprehensive Hospital Drug Monitoring Program].

Of 19,653 patients hospitalized in the medical divisions of two teaching hospitals, 3980 were treated with an aminopenicillin, 808 with other penicillins, 427 with a cephalosporin, 2619 with cotrimoxazole and 846 with allopurinol. The first part of the study deals only with the incidence of exanthemas definitely or probably due to a specific drug on the basis of clinical considerations. The exanthema incidence is 8.0% for aminopenicillins, 4.7% for other penicillins, 1.9% for cephalosporins and 2.8% for cotrimoxazole. The second part of the study employs a cross-tabulation to determine the incidence of exanthemas definitely and probably drug-induced, and the temporal relationship of these reactions to aminopenicillin and allopurinol exposure. The observed risks of developing an exanthema are as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, neither of the two drugs 1.5%. The increased incidence of exanthemas observed by the Boston Collaborative Drug Surveillance Program (BCDSP) in patients concomitantly treated with aminopenicillin and allopurinol was not confirmed by our results. Our hypothesis is that the time of exposure to aminopenicillins might have been shorter for patients of the BCDSP who were not treated in connection with neoplastic disease and did not receive allopurinol. The incidence of aminopenicillin induced exanthemas increases severalfold with the duration of exposure time during the first 2-3 weeks. In the CHDMB, on the other hand, exposure time does not differ between the patients treated with aminopenicillin alone or in combination with allopurinol.

Allopurinol↗
PubMed2003

[Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology].

OBJECTIVE: To estimate the incidence of maculo-papular viral exanthemas and to describe the epidemiological and clinical patterns. DESIGN: Observational descriptive study with a sample design. PARTICIPANTS AND SETTING: 154 practitioners from the Castilla y León Sentinel Network with a surveilled population of 23 237 people-year under 15 years old, notified in 2002 the cases of diseases by means of a standard form with the variables and inclusion and exclusion criteria. MAIN MEASUREMENTS: It was included the maculo-papular exanthemas associated to a presumable systemic virus disease in patients under 15 years old. It was excluded the infectious mononucleose, the chickenpox, and other non viral infections or exanthemas. RESULTS: 368 cases were notified which represent a incidence rate of 158.37 cases per 10 000 (95% CI, 142.31-174.42). The incidence was maximum under four years old, more than 350 per 10 000, decreasing significantly in children over this age. Erythema infectiousum presented the highest rate, followed by exanthema subitum. The exanthemas caused by measles or rubella were insignificants. CONCLUSIONS: Childhood exanthematous diseases of presumable viral etiology have an important incidence in primary care, although the majorities are banal and self-limited diseases. Clinical characteristics supported the suspicion diagnosis, which was consistent with the observed epidemiological description and expected presentations of each disease. Although serological analysis could diminish the uncertainly on notification and control of diseases submited to especial programs of vaccination and eradication, they would not improve substantially the diagnosis and treatment of these patients.

Adolescent↗
PubMed1990

Histopathology of acute human immunodeficiency virus exanthema.

Acute exanthema occurs in patients who are human immunodeficiency virus (HIV) positive before they become seropositive. The patients have influenza like symptoms and a macular skin rash on the upper trunk. Histopathological investigation of skin punch biopsy specimens from four patients with acute HIV exanthema showed a normal epidermis and a sparse dermal, mainly perivascular, lymphocytic/histiocytic infiltrate around vessels of the superficial plexus. Histopathological changes of the exanthema of acute HIV infection are non-specific and resemble those of other acute viral exanthema, but when both the histopathological features and the clinical picture are suggestive, the clinician should take into consideration the possibility of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Macular exanthema due to fumaric acid esters.

OBJECTIVE: To report a case of an unusual skin reaction to fumaric acid esters (FAE). CASE SUMMARY: A 68-year-old white woman who was treated with FAE for 4 days for lichen planus developed generalized pruritic exanthema. This was suspected to be an allergic drug reaction to FAE, and the treatment was discontinued. After 48-72 hours, the exanthema resolved completely. An objective causality assessment revealed that the adverse drug event was probable. As skin testing for diagnostic purposes is not feasible with FAE, the drug-related origin of the exanthema was confirmed by oral rechallenge with FAE. DISCUSSION: The effectiveness of FAE in the systemic treatment of psoriasis vulgaris has been proven by controlled clinical trials. The compound has been shown to be tolerable and safe even during prolonged treatment. The most frequent adverse effects are gastrointestinal symptoms and flushing, which typically occur 4-6 hours after administration of the drug. Allergic reactions to FAE have not yet been reported. Since the patient was rechallenged with the suspected drug, we could confirm the allergic origin of the exanthema. CONCLUSIONS: The occurrence of allergic skin reaction should be considered in patients receiving treatment with FAE.

Aged↗
PubMed1983

Studies on experimental exanthema in rabbits by means of recurrent systemic sensitization.

To explore the relationship between the tonsils and pustulosis palmaris et plantaris, the author performed several experiments. Since, in the pustulosis palmaris et plantaris abscess, many pleomorphic leukocytes are seen histologically, in order to provoke this condition, sensitized lymphocytes isolated from sensitized rabbits were transferred intravenously. To localize the site of immunological reaction on the skin, extracts were used from cutaneous abscesses elicited by intracutaneous injection of BCE, CA, and PPD, emulsified with FCA. The results were as follows: (1) exanthema was demonstrated in 4 out of 28 rabbits; (2) the antigens that caused exanthema were BCE and CA; (3) the sites on which exanthema appeared were the footpads of both fore- and hindlimbs, in one rabbit only, and in the others, the footpads of hindlimbs; (4) as the predominant cause of the exanthema, the relationship between immune complex and sensitized lymphocytes was suspected.

Abscess↗
PubMed2002

Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity.

BACKGROUND: Teenagers and young adults frequently develop maculopapular exanthema following amoxicillin intake within infectious mononucleosis. The underlying pathomechanisms are still largely unknown. OBJECTIVES: To investigate whether amoxicillin-induced exanthema in florid infectious mononucleosis is a disease-associated phenomenon or results from specific sensitization to the drug. METHODS: Four patients with amoxicillin-induced exanthema within infectious mononucleosis were analysed in vivo by prick, intradermal and patch tests and in vitro by means of the lymphocyte transformation test (LTT) employing amoxicillin, ampicillin, benzylpenicillin and phenoxymethylpenicillin. RESULTS: Drug-specific sensitization to amoxicillin in the LTT was observed in three patients, two of whom showed a side-chain-specific sensitization to amoxicillin and ampicillin. The in vitro results were confirmed in vivo by skin tests. CONCLUSIONS: These data suggest that real sensitization to amoxicillin and ampicillin may occur within infectious mononucleosis and may be detected in vivo and in vitro by means of skin tests and the LTT.

Adult↗