RED RASHES OF CHILDHOOD

RED RASHES OF CHILDHOOD[1]

Agent	Associated Syndrome/Disease	Clinical Presentation
Rubella virus	German measles	Rash begins at head and moves dwon, postauricular lymphoadenopathy.
Measles virus	Rubeola, measles	A paramyxovirus, beginning at head and moving dwon; rash is preceded by cough, coryza, conjuntivitis, and blue-white spots on oral mucosa (Koplik).
Mumps virus	Mumps	A paramyxovirus, no rash but can present with parotitis, meningitis, orchitis or oophoritis( in young adults).
VZV	chickenpox	Rash begins on trunk, spread to face and extremities with lessions of different age.
HHV-6	Roseola	A macular rash over body appears after several days of high fever, usually affect infants.
Parvovirus B19	Erythema infectiosum	“Slapped cheek” rash on face later appears over body in reticular, “lace-like” patter (can cause hydrops fetalis in pregnant women).
Streptococcus pyogenes	Scarlet fever	Erythematous, sandpaper-like rash with fever and sorethroat.
Coxsackievirus type A	Hand-foot-mouth disease	Vesicular rash on palms and soles, ulcers in oral mucosa

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[1] (Le, Bhushan, Tolles, & Hofmann, 2011)

ACUTE REAL FAILURE (ARF).[1]

Acute renal failure is defined as an abrupt decline in renal function with increased creatinine and blood urea nitrogen levels (BUN) over a period of several days. There are three main categories of ARF:

1)    Pre-renal azotemia :decreased renal perfusion causes a decreased glomerular filtration rate. In response, the kidney acts to retain salt and water in an attempt to increase blood pressure and perfusion.

2)    Intrinsic renal failure: generally due to acute tubular necrosis, which leads to obstruction of renal tubules with necrotic debris and subsequent fluid backflow with decreased GFR. In this setting the damages renal tubules are unable to retain salt and water.

3)    Post-renal azotemia: caused by outflow obstruction and can only occurs when such obstruction is bilateral. In this setting there is also backflow to fluid with decreased GFR.

Variable	Prerenal	Renal	Postrenal
Urine osmolality	>500	<350	<350
Urine Na	<10	>20	>40
FE Na	<1%	>2%	>4%
BUN/Cr Ratio	>20	<15	>15

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[1] (Le, Bhushan, Tolles, & Hofmann, 2011)

HYDATIDIFORM MOLE[1]:

A hydatidiform mole is a noninvasive tumor caused by aberrant fertilization , leading to cystic swelling of chorionic villi and proliferation of the trophoblast. It result in a mass that can look like a “cluster of grapes”. Hydatidiform Mole can be complete or partial. The genotype of a complete moles is usually 46,XX, completely consisting of paternal DNA. It result when two sperm fertilize an empty egg. There is no associated fetus despite the eleveted levels of β-human chorionic gonadotropin.

The genotype 46,XX, maternal would not cause a hydatidiform mole. Mole are derived from empty ova that are then fertilized by sperm. 46,XX maternal and paternal describe a genotype of a normal fetus, receiving one set of chromosomes from each parent.

69, XXX; 69 XXY or 69 XYY, maternal and paternal describe another posible DNA make up of a partial mole. A partial mole contains more than two set of chromosomes thet usually consist of two paternal and one maternal, or consist of  both paternal and maternal set, resulting in triploidy or tetraploidy. Partial moles may present with a similar grape like mass and are associated with fetal parts.

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[1] (Le, Bhushan, Tolles, & Hofmann, 2011)