Viral exanthems: An update on laboratory testing of the adult patient

Korman, Abraham M.; Alikhan, Ali; Kaffenberger, Benjamin H.

doi:10.1016/j.jaad.2016.08.034

Cited by 34 publications

(24 citation statements)

References 84 publications

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“…In order to accurately define the cause for the rash, it is important to collect as much information as possible about the episode, chronology and characteristics of the injuries. 4 For this purpose, a comprehensive anamnesis, physical examination and, in this case, due to the high suspicion of COVID-19, a confirmatory RT-PCR test are necessary for the diagnosis.…”

mentioning

confidence: 99%

Cutaneous manifestation of COVID‐19 in images: a case report

Moreno

Villa

Moreno³

et al. 2020

Acad Dermatol Venereol

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mentioning

confidence: 99%

Cutaneous manifestation of COVID‐19 in images: a case report

Moreno

Villa

Moreno³

et al. 2020

Acad Dermatol Venereol

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“…Moreover, certain clinical characteristics of the exanthematous lesions strongly point towards the viral etiology. This happens because the rash associated with the Zika virus infection is generally morbilliform, separates the palms and the plants, and begins on the face and extends cephalocaudally 38 .…”

Section: Discussionmentioning

confidence: 99%

Emergence of chikungunya and Zika in a municipality endemic to dengue, Santa Luzia, MG, Brazil, 2015-2017

Vega

Bezerra

Said

et al. 2019

Rev. Soc. Bras. Med. Trop.

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Introduction: The recent circulation of arboviruses transmitted by vectors, such as dengue, chikungunya, and Zika, is concerning due to the high morbidity rates, clinical complications, and increased demand on health services. The objective of this study was to analyze the clinical and epidemiological aspects of an epidemic caused by arboviruses in the municipality of Santa Luzia, Minas Gerais, Brazil. Methods: Longitudinal study of patients with acute febrile disease and suspected arbovirus infection reported to Brazilian Notifiable Disease Information System (Sistema de Informação de Agravos de Notificação) from the epidemiological week 44 of 2015 to epidemiological week 52 of 2016. Patients with confirmed chikungunya were followed-up for 18 months and those with Zika for 15 months. Additionally, we analyzed and described the temporal distribution of confirmed cases of these arboviruses in this municipality. Results: Overall 3,531 arboviruses cases, including 3,481 (98.7%) cases of dengue, 38 (1.0%) cases of chikungunya, and 12 (0.3%) cases of Zika were confirmed. The highest incidence of arbovirus infection occurred in the first quarter of 2016 (epidemiological week 7 to 14). The most frequent symptoms were for dengue, which included fever, headache, retro-orbital pain, and exanthema. Chikungunya infection was associated with fever, myalgia, arthralgia, and rash while Zika infection with pruritus and rash. Conclusions: Given the similarities in the initial clinical profiles of these arboviruses, it is important to perform a detailed clinical analysis, laboratory diagnosis, and patient follow-up.

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“…The virus also causes vascular leakage through infection of endothelial cells, leading to the appearance of minor haemorrhagic lesions [50]. Although petechial rash is one of the clinical manifestations of dengue virus infection, morbilliform rash is also often described during classical dengue fever [51]. Altogether, these findings, including ours, strongly suggest that the appearance of rash, especially during measles, is closely linked to the viral tropism, the availability and location of susceptible target cells and the subsequent immune responses to clear the infection.…”

Section: Discussionmentioning

confidence: 99%

Measles skin rash: infection of lymphoid and myeloid cells in the dermis precedes viral dissemination to keratinocytes in the epidermis

Laksono

Fortugno

Nijmeijer

et al. 2019

Preprint

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2 precedes viral dissemination to keratinocytes in the epidermis 3 4 The pathogenesis of measles skin rash 5 6 2 24 Abstract 25 Measles is characterised by fever and a maculopapular skin rash, which is associated with 26 immune clearance of measles virus (MV)-infected cells. Histopathological analyses of skin 27 biopsies from humans and non-human primates (NHPs) with measles rash have identified 28 MV-infected keratinocytes and mononuclear cells in the epidermis, around hair follicles and 29 near sebaceous glands. Here, we address the pathogenesis of measles skin rash by combining 30 data from experimentally infected NHPs, ex vivo infection of human skin sheets and in vitro 31 infection of primary human keratinocytes. Longitudinal analysis of the skin of experimentally32 MV-infected NHPs demonstrated that infection in the skin precedes onset of rash by several 33 days. MV infection was initiated in lymphoid and myeloid cells in the dermis before 34 dissemination to the epidermal keratinocytes. These data were in good concordance with ex 35 vivo MV infections of human skin sheets, in which dermal cells were more targeted than the 36 epidermal ones. To address viral dissemination to the epidermis and to determine whether 37 the dissemination is receptor-dependent, we performed experimental infections of primary 38 keratinocytes collected from healthy or nectin-4-deficient donors. These experiments 39 demonstrated that MV infection of keratinocytes is nectin-4-dependent, and nectin-4 40 expression was higher in differentiated than in proliferating keratinocytes. Based on these 41 data, we hypothesise that measles skin rash is initiated by migrating MV-infected 42 lymphocytes that infect dermal skin-resident CD150 + immune cells. The infection is 43 subsequently disseminated from the dermal papillae to nectin-4 + keratinocytes in the basal 44 epidermis. Lateral spread of MV infection is observed in the superficial epidermis, most likely 45 due to the higher level of nectin-4 expression on differentiated keratinocytes. Finally, MV-46 infected cells are cleared by infiltrating immune cells, causing hyperaemia and oedema, which 47 give the appearance of morbilliform skin rash.3 48 49 Author Summary 50 Several viral infections are associated with skin rash, including parvovirus B19, human 51 herpesvirus type 6, dengue virus and rubella virus. However, the archetype virus infection 52 that leads to skin rash is measles. Although all of these viral exanthemata often appear similar, 53 their pathogenesis is different. In the case of measles, the appearance of skin rash is a sign 54 that the immune system is clearing MV-infected cells from the skin. How the virus reaches 55 the skin and is locally disseminated remains unknown. Here we combine observations and 56 expertise from pathologists, dermatologists, virologists and immunologists to delineate the 57 pathogenesis of measles skin rash. We show that MV infection of dermal myeloid and 58 lymphoid cells precedes viral dissemination to the epidermal keratinocytes. We specula...

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Viral exanthems: An update on laboratory testing of the adult patient

Cited by 34 publications

References 84 publications

Cutaneous manifestation of COVID‐19 in images: a case report

Cutaneous manifestation of COVID‐19 in images: a case report

Emergence of chikungunya and Zika in a municipality endemic to dengue, Santa Luzia, MG, Brazil, 2015-2017

Measles skin rash: infection of lymphoid and myeloid cells in the dermis precedes viral dissemination to keratinocytes in the epidermis

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